Diagnosis of Definite Endocarditis - Modified Duke criteria

Question 1

What is Modified Duke (MD) criteria used for?

Answer 1

Diagnosis of possible or definite endocarditis

Question 2

How many criteria (major + minor) are there in MD criteria?

Answer 2

2 major criteria

7 minor criteria

Question 3

3 combinations of major/minor criteria for diagnosis of definite endocarditis?

Answer 3

2 major criteria
1 major + 3 minor criteria
5 minor criteria

Question 4

2 combinations of major/minor criteria for diagnosis of possible endocarditis?

Answer 4

1 major + 1 minor criteria

3 minor criteria

Question 5

Major criteria for MD score?

Answer 5

Blood cultures
1 - typical organism from 2 cultures
2 - positive cultures >12 hours apart
3 - ≥3 positive cultures taken over more than 1 hour

Endocardial involvement
1 - vegetations on echocardiogram
2 - new valvular regurgitation

Question 6

Minor criteria for MD score?

Answer 6

• Predisposing cardiac/valvular abnormality
• IV drug use
• Fever ≥38
• Vasculitis phenomenon
• Embolic phenomenon
• Blood cultures positive but not matching major criteria
• Echocardiographic findings suggestive but not matching major criteria

Question 7

Example of cardiac/valvular abnormality predisposing patient to endocarditis?

Answer 7

Metal prosthetic valve

Question 8

Examples of vasculitis phenomena predisposing patients to endocarditis?

Answer 8

Petechiae
Splinter haemorrhages
Osler nodes

Question 9

Example of embolic phenomenon predisposing patients to endocarditis?

Answer 9

Cerebral abscesses

Question 10

Which bacterium accounts for 30-40% of endocarditis?

Answer 10

Strep. viridans

Question 11

What is the Modified Duke criteria useful for, other than making a definite diagnosis?

Answer 11

Guiding prognosis and management

Question 12

Management of endocarditis? (on average)

Answer 12

Long regimen of multiple antibiotics usually over 4-6 weeks