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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

Main Article

Table 1

Original Duke criteria for the diagnosis and classification of infective endocarditisa

Major criteria Minor criteria Diagnosis
1. Positive blood culture
i) Typical organism in >2 blood cultures in the absence of a primary focus (Staphylococcus aureus, enterococci, viridans streptococci, Strep. bovis, HACEK
ii) Persistently positive blood culture drawn more than 12 h apart or all ¾ drawn at least 1 h apart between first and last
1. Predisposition
Heart condition
Drug abuse
1. Definite
2 Major
1 Major and 3 minor
5 Minor
pathologic/histologic findings
2. Evidence of endocardial involvement
i) Positive echocardiogram (TOE)
Oscillating intracardiac mass on valve, implanted material or supporting structures in path of regurgitant jets
New partial dehiscence of prosthetic valve
ii) New valvular regurgitation
2. Fever
2. Possible
Findings fell short of the definite but not rejected categories

3. Vascular phenomena
Major arterial emboli
Janeway lesions
Septic pulmonary infarcts
3. Rejected
Alternate diagnosis
Resolution of the infection with antibiotic therapy for <4 days
No pathologic evidence after antibiotic therapy

4. Immunologic phenomena
Osler’s nodes
Roth spots
Rheumatoid factor

5. Microbiologic evidence
Positive blood culture not meeting major criteria
Positive serology

6. Endocardiographic evidence
Consistent with infective endocarditis but not meeting the major criteria

aSource: (6); HACEK, Haemophilus aphrophilus, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae) group, Bartonella spp., and Coxiella burnetii; TOE, transesophageal echocardiogram.

Main Article