tailieunhanh - Chapter 118. Infective Endocarditis (Part 5)

Diagnosis The Duke Criteria The diagnosis of infective endocarditis is established with certainty only when vegetations obtained at cardiac surgery, at autopsy, or from an artery (an embolus) are examined histologically and microbiologically. Nevertheless, a highly sensitive and specific diagnostic schema—known as the Duke criteria—has been developed on the basis of clinical, laboratory, and echocardiographic findings (Table 118-3). Documentation of two major criteria, of one major and three minor criteria, or of five minor criteria allows a clinical diagnosis of definite endocarditis. The diagnosis of endocarditis is rejected if an alternative diagnosis is established, if symptoms resolve and do not recur. | Chapter 118. Infective Endocarditis Part 5 Diagnosis The Duke Criteria The diagnosis of infective endocarditis is established with certainty only when vegetations obtained at cardiac surgery at autopsy or from an artery an embolus are examined histologically and microbiologically. Nevertheless a highly sensitive and specific diagnostic schema known as the Duke criteria has been developed on the basis of clinical laboratory and echocardiographic findings Table 118-3 . Documentation of two major criteria of one major and three minor criteria or of five minor criteria allows a clinical diagnosis of definite endocarditis. The diagnosis of endocarditis is rejected if an alternative diagnosis is established if symptoms resolve and do not recur with 4 days of antibiotic therapy or if surgery or autopsy after 4 days of antimicrobial therapy yields no histologic evidence of endocarditis. Illnesses not classified as definite endocarditis or rejected are considered cases of possible infective endocarditis when either one major and one minor criterion or three minor criteria are identified. Requiring the identification of clinical features of endocarditis for classification as possible infective endocarditis increases the specificity of the schema without significantly reducing its sensitivity. Table 118-3 The Duke Criteria for the Clinical Diagnosis of Infective Endocarditis Major Criteria 1. Positive blood culture Typical microorganism for infective endocarditis from two separate blood cultures Viridans streptococci Streptococcus bovis HACEK group Staphylococcus aureus or Community-acquired enterococci in the absence of a primary focus or Persistently positive blood culture defined as recovery of a microorganism consistent with infective endocarditis from Blood cultures drawn 12 h apart or All of three or a majority of four or more separate blood cultures with first and last drawn at least 1 h apart Single positive blood culture for Coxiella burnetii or phase I IgG antibody

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