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Volume 10, Number 6—June 2004

Historical Review

Emerging Issues in Infective Endocarditis

Beverley C. Millar* and John E. Moore*Comments to Author 
Author affiliations: *Belfast City Hospital, Belfast, Northern Ireland, United Kingdom

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Table 2

Recent suggested modifications to the Duke criteria for the diagnosis of infective endocarditis (IE)a

Microbiologic Biochemical Clinical
Blood culture
   Bacteremia due to Staphylococcus aureus should be considered a major criterion regardless of whether the infection is nosocomially acquired or whether a removable source of infection is present
Serology
   Positive for Coxiella burnetii (major criterion)
   Positive for Bartonella spp.
   Positive for Chlamydia spp.
Molecular
   Evidence for the presence of bacterial or fungal DNA in blood or valve material (major criterion) Elevated level of CRP >100 mg/L
Elevated ESR defined as more than one and a half times higher than normal, i.e.
   >30 mm/h for patients <60 years of age
   >50 mm/h for patients >60 years of age Possible endocarditis now defined as one major and one minor criterion or three minor criteria
Omission of criterion “ echocardiogram consistent with IE but not meeting major criterion”
Newly diagnosed clubbing
Evidence of splinter hemorrhages
Petechiae
Microscopic hematuria (disregarded for patients with positive urine cultures, menstruating women, patients with end-stage renal disease and patients with urinary catheters)
Presence of central nonfeeding venous lines or peripheral venous lines (minor)
Purpura

aSources (7,8); CRP, C-reactive protein; ESR, erythrocyte sedimentation rate.

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