Pathological criteria
|
Microorganisms demonstrated by culture or histological examination |
Active endocarditis demonstrated by histological examination |
Major criteria
|
Positive blood cultures | To be added: |
–typical microorganisms consistent with endocarditis from two separate blood cultures | –positive serology for Coxiella burnetti7,8 |
–microorganisms consistent with endocarditis from persistently positive blood cultures | –bacteraemia due to Staphyloccocus aureus8 |
Evidence of endocardial involvement | –positive molecular assay for specific gene targets and universal loci for bacteria and fungi13 |
–echocardiography: oscillating structures, abscess formation, new partial dehiscence of prosthetic valve |
–positive serology for Chlamydia psittaci9 |
–new valvar regurgitation | –positive serology for Bartonella species9 |
Minor criteria
|
–predisposing heart disease | To be omitted: |
–fever >38°C | Suspect echocardiography (no major criterion)8 |
–vascular phenomena | To be added: |
–immunological phenomena | Elevated CRP, elevated ESR, splenomegaly, haematuria, clubbing, splinter haemorrhages, petechiae and purpura6 |
–microbiological evidence (no major criterion) |
–suspect echocardiography (no major criterion) |
| Identified IE organism from metastatic lesions12 |
Categories
|
Definite:
| Pathological criteria positive | |
| or 2 major criteria positive | |
| or 1 major and 2 minor criteria positive | |
| or 5 minor criteria positive | |
Possible:
| All cases which cannot be classified as definite or rejected | 1 major and 1 minor criterion positive8 |
| | 3 minor criteria positive8 |
Rejected:
| Alternative diagnosis | |
| Resolution of the infection with antibiotic treatment for ⩽4 days | |
| No histological evidence | |