Endocarditis and Duke Criteria

Question 1

How many of the Major and Minor criteria must be met for a diagnosis of infective endocarditis?

Answer 1

- 2 Major 
      OR
- 1 Major + 3 Minor 
      OR
- 5 Minor

Question 2

What are the Major Duke criteria?

Answer 2

+ve blood culture:
=> Typical micro-organism in 2 separate cultures
=> Persistently positive blood cultures

Endocardial Involvement:
=> ECHO showing oscillating intracardiac mass on the valve or in the path of the regurgitated blood flow
=> Abscess
=> Newly inserted valve wound rupture
=> New valvular regurgitation

Question 3

What are the Minor Duke Criteria?

Answer 3

• Predisposing heart condition
• IVDU
• Fever over 38°C
• Vascular problem (e.g. conjunctival haemorrhage, Janeway lesions etc.)
• Immunological problem (e.g. Osler nodes, Roth spots etc.)
• Positive blood cultures not meeting major criteria
• ECHO consistent with endocarditis

Question 4

What are the HACEK organisms which can cause endocarditis?

Answer 4

Haemophilus species
Aggregatibacter species
Cardiobacterium hominis
Eikenella corrodens
Kingella species

Question 5

Conditions causing native valve endocarditis

Answer 5

Rheumatic Fever
Congenital Heart
Mitral Valve Prolapse and assoc. murmur
Degenerative Heart Disease (e.g. calcific aortic stenosis due to a bicuspid valve OR Marfan syndrome)

Question 6

Most Native valve endocarditis is due to what organism?

Answer 6

STreptococcus

• viridans
• gallollyticus
• enterococci

Question 7

What organisms are known to cause prosthetic valve endocarditis?

Answer 7

Staph. aureus 
Corynebacterium
Nonenterococcal streptococci
Fungi (eg, C albicans and Aspergillus species)
Legionella
HACEK group

Question 8

Staph aureus causes most endocarditis in relation to IVDUs, but what Gm -ves can rarely cause their infection?

Answer 8

Pseudomonas Aeruginosa

HACEK group