Table 1.

Terminology used for diagnostic criteria for infective endocarditisa (Modified Duke's Endocarditis Service) 70, 86

Major criteria
 A positive blood culture for infective endocarditis as defined by the recovery of:
  A typical microorganism from two separate blood cultures in the absence of a primary focus (viridans streptoccoccibS. bovis, HACEK group, or community-acquired S. aureus or enterococci)
  A persistently positive blood culture defined as the recovery of a microorganism consistent with endocarditis from either blood cultures drawn more than 12 h apart or all three or a majority of four or more separate blood cultures with the first and last drawn at least 1 h apart.
 Evidence of endocardial involvement:
  Positive echocardiogram for infective endocarditis
   (i) 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
   (ii) Abscess, or
   (iii) New partial dehiscence of prosthetic valve
  New valvular regurgitation (increase or charge in preexisting murmur not sufficient)
 Serology for Q fever by IFA showing phase 1 IgG antibodies at >800
Minor criteria
 Predisposition: predisposing heart condition or intravenous drug use
 Fever: ≥38°C (100.4°F)
 Vascular phenomena: major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, Janeway lesions
 Immunologic phenomena: glomerulonephritis, Osler's nodes, Roth spots, rheumatoid factor
 Microbiologic evidence: positive blood culture but not meeting major criterion as noted above,c or serologic evidence of an active infection with organism consistent with infective endocarditisd
 Echocardiogram: consistent with infective endocarditis but not meeting major criterion as noted above
  • a Modified Duke's Endocarditis Service70, 86.

  • b Including Abiotrophia spp.

  • c Excluding single positive blood cultures for coagulase-negative staphylococci and organisms that do not cause endocarditis.

  • d Serologic test result positive forBrucella spp., Chlamydia spp.,Legionella spp., and Bartonella spp.