Endocarditis: Classification

Duke criteria are a diagnostic scheme for clinical diagnosis of infective endocarditis (IE).

To confirm the diagnosis, 2 major criteria, one major criterion and 3 minor criteria, or 5 minor criteria or must be present.

Main criteria Secondary criteria
  • Positive cultural detection of typical pathogens (microorganisms that can typically cause IE).
  • Evidence of endocardial involvement/interventricular involvement by imaging (echocardiography: e.g., floundering vegetations, abscess, new valve regurgitation/valvular leak, etc., or 18F-FDG PET/CT or in leukocyte SPECT/CT pathologic activity is detectable in the area of a valve replacement (implanted at least three months ago))
  • Predisposition
    • Predisposing heart disease
    • I.v. drug use
  • Fever > 38.0 °C
  • Vascular findings (vascular findings; even if exclusively detectable on imaging studies, especially chest CT).
    • Arterial emboli
    • Intracranial hemorrhage (bleeding within the skull; parenchymatous, subarachnoid, sub- and epidural, and supra- and infratentorial hemorrhages)
    • Septic infarcts
    • Infectious aneurysms
  • Signs of a systemic immune response
    • Glomerulonephritis
    • Löhlein’s focal nephritis
    • Osler’s nodule
    • Janeway lesions
  • Atypical echocardiography findings (cardiac ultrasound; e.g., pericardial effusion).
  • Microbiologic evidence of atypical pathogens, including serologic evidence of active infection with an organism compatible with infective endocarditis