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Harrison's Principles of Internal Medicine - 19th Edition (April 17, 2015)



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Duke Criteria for Infective Endocarditis (IE) Print E-mail
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Written by G. Firman MD   
Thursday, 26 February 2009 10:33


The diagnosis of infective endocarditis is generally based on clinical, microbiologic, and echocardiographic findings. The Duke criteria have sensitivity and specificity of more than 80% and are the reference criteria for diagnosis.




Major criteria:

A. Positive blood culture for Infective Endocarditis

1- Typical microorganism consistent with IE from 2 separate blood cultures, as noted below:

  • viridans streptococci, Streptococcus bovis, or HACEK* group, or

  • community-acquired Staphylococcus aureus or enterococci, in the absence of a primary focus


2- Microorganisms consistent with IE from persistently positive blood cultures defined as:

  • 2 positive cultures of blood samples drawn >12 hours apart, or

  • all of 3 or a majority of 4 separate cultures of blood (with first and last sample drawn 1 hour apart)

B. Evidence of endocardial involvement

1- Positive echocardiogram for IE defined as :

· oscillating intracardiac mass on valve or supporting structures, in the path of regurgitant jets, or on implanted material in the absence of an alternative anatomic explanation, or

· abscess, or

· new partial dehiscence of prosthetic valve


2- New valvular regurgitation (worsening or changing of preexisting murmur not sufficient)


Minor criteria:

  • Predisposition: predisposing heart condition or intravenous drug use
  • Fever: temperature > 38.0° C (100.4° F)
  • Vascular phenomena: major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, and Janeway lesions
  • Immunologic phenomena: glomerulonephritis, Osler's nodes, Roth spots, and rheumatoid factor
  • Microbiological evidence: positive blood culture but does not meet a major criterion as noted above¹ or serological evidence of active infection with organism consistent with IE
  • Echocardiographic findings: consistent with IE but do not meet a major criterion as noted above


Clinical criteria for infective endocarditis requires:

• Two major criteria, or

• One major and three minor criteria, or

• Five minor criteria

*HACEK group: Haemophilus sp, Actinobacilius actinomycetemcomitans, Cardiobacterium hominis, Eikenella rodens y Kingella sp



References :

  1. Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med. 1994 Mar;96(3):200-9. [Medline]
  2. Hoen B, Duval X. Clinical practice. Infective endocarditis. N Engl J Med. 2013 Apr 11;368(15):1425-33. [Medline]
Created: July 14, 2005

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