Modified Duke's Criteria for Endocarditis

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Pathological Criteria

• Positive histology or microbiology of pathological material obtained at autopsy or cardiac surgery

• Valve tissue, vegetation, embolic fragments or intracardiac abscess content

Major Criteria

• 2 positive Blood Cultures showing typical organisms consistent with infective endocarditis, such as Streptococcus viridans and the HACEK group


• Persistent bacteraemia from 2 Blood Cultures taken > 12 hours apart or 3 or more positive Blood Cultures where the pathogen is less specific, such as Staphylococcus aureus and Staphylococcus epidermidis


• Positive serology for Coxiella burnetti, Bartonella species, or Chlamydia psittaci


• Positive molecular assays for specific gene targets

• Positive echocardiogram showing oscillating structures, abscess formation, new valvular regurgitation or dehiscence of prosthetic valves.

Minor Criteria

• Predisposing heart disease

• Fever > 38

• Immunological phenomena such as glomerulonephritis, Osler's nodes, Roth spots, or positive Rheumatoid factor

• Microbiological evidence not fitting major criteria

• Elevated C reactive protein (CRP) or erythrocyte sedimentation rate (ESR)

• Vascular phenomena such as major emboli, splenomegaly, clubbing, splinter haemorrhages, petechiae or purpura

Definite Infective Endocarditis

• Pathological criteria positive


• TWO major criteria


• ONE major and TWO minor criteria


• FIVE minor criteria