Duke criteria

If endocarditis is suspected , between

• the definitive (secured),
• the probable (likely present) and
• the excluded infectious endocarditis

distinguished. The Duke criteria (named after Duke University , Durham, North Carolina) help diagnose infectious endocarditis in patients safely and in good time. They were formulated in 1994 by David T. Durack's working group and were modified by Li in 2015 (with increased sensitivity but lower specificity ).

pathology

The diagnosis of infectious endocarditis is confirmed if the following pathological features are met:

Detection of microorganisms by means of

• Blood culture (two independently positive for typical endocarditis pathogens) or
• Histology in a vegetation or
• in an embolus or
• in an abscess of the heart or
• a pathological lesion, vegetation, or abscess of the heart with histological features of active endocarditis.

clinic

For all other patients, Duke's clinical criteria for diagnosing infectious endocarditis apply . The reliable (definitive) diagnosis of infectious endocarditis can be difficult in vivo, for example not possible through echocardiography alone. It must be either

• two main criteria or
• one main criterion and three secondary criteria or
• five secondary criteria must be met.

Duke - main criteria

Positive blood cultures

• Microorganisms that can typically cause infectious endocarditis from two separate blood cultures
  • Streptococcus viridans , S. bovis , HACEK group or
  • Staphylococcus aureus or
  • Enterococcus in the absence of a primary focus
• persistent positive blood cultures with microorganisms, typically an infectious endocarditis can cause
  • Blood cultures more than 12 hours apart or
  • three or the majority of at least four different blood cultures, the first and last being taken at least one hour apart.

Morphological evidence of cardiac lining / heart valve involvement

• Positive echocardiography findings ( ultrasound image of the heart by echocardiography : transesophageal echocardiography or transthoracic echocardiography ) for infectious endocarditis means that the following criteria are present:
  • floating mass (oscillating structures) on a flap or
  • the holding device or
  • towards the regurgitation jets
  • or on an iatrogenic material (such as a pacemaker probe)
    • in the absence of an alternative anatomical explanation, or
  • Abscess or
  • new partial dehiscence of an artificial key or
• New valve regurgitation (amplification or alteration of a pre-existing heart murmur is insufficient)

Modification according to Li

• positive Q fever serology
• Staphylococcus aureus bacteremia

Duke minor criteria

predisposition

• predisposing heart disease or
• intravenous drug use

fever

• Fever > 38.0 ° C

Vascular findings

• arterial emboli ,
• septic lung infarction,
• mycotic aneurysms,
• Cerebral hemorrhage ,
• Bleeding of the mucous membranes,
• Janeway lesions

Signs of a systemic immune reaction

• Glomerulonephritis ,
• Löhlein herd nephritis,
• Osler nodules ,
• Roth spots on the fundus of the eye with retinal hemorrhage,
• Rheumatoid factor

Echocardiography

• Indication of infectious endocarditis without being a main criterion (suspected diagnosis)

microbiology

• positive blood cultures , but not according to the main criteria, or
• Serological evidence of active infection with an organism compatible with infectious endocarditis

Exclusion of infectious endocarditis

Infectious endocarditis can be ruled out

• when a clear alternative diagnosis is likely,
• if the clinical picture has ended or the symptoms recede after four days of antibiotic treatment, or
• if no histological (tissue) or bacteriological evidence of infectious endocarditis can be found in surgery or autopsy within the first four days after the start of antibiotic treatment.

Probable infectious endocarditis

Findings that do not correspond to those of so-called definitive endocarditis, but also do not correspond to an exclusion :

• a main criterion and a secondary criterion or
• three secondary criteria

literature

• M. Dietel, N. Suttorp, M. Zeitz: Harrison's internal medicine. 16th edition. McGraw-Hill, ABW Wissenschaftsverlag, Berlin 2005.
• DP Zipes, P. Libby, RO Bonow, E. Braunwald: Braunwald's Heart Disease, a textbook of cardiovascular medicine. 7th edition. Elsevier Saunders, 2005, p. 1638.
• Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , pp. 14-16.

Individual evidence

1. ^ DT Durack, AS Lukes, DK Bright: New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service . In: The American journal of medicine . 96, No. 3, March 1994, ISSN  0002-9343 , pp. 200-209. PMID 8154507 .
2. ↑ Jennifer S. Li, Daniel J. Sexton, Nathan Mick, Richard Nettles, Vance G. Fowler, Thomas Ryan, Thomas Bashore, G. Ralph Corey: Proposed Modifications to the Duke Criteria for the Diagnosis of Infective Endocarditis . In: Clinical Infectious Diseases . 30, No. 4, Jan. 4, 2000, ISSN  1058-4838 , pp. 633-638. doi : 10.1086 / 313753 . PMID 10770721 . Retrieved January 23, 2014.

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !