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19th June 2024
Diagnosis & Treatment
2 Major or 1 Major and 3 Minor criteria are required, or all 5 minor criteria are required.
| Major criteria |
|---|
| Positive blood cultures for IE (1 of the following): |
| Typical microorganisms consistent with IE from 2 separate blood cultures |
| Persistently positive blood culture |
| For organisms that are typical causes of IE – At least 2 positive blood cultures from blood samples drawn >12 hours apart |
| For organisms that are more commonly skin contaminants – 3 or a majority of ≥4 separate blood cultures (with first and last drawn at least 1 hour apart) |
| Single positive blood culture for Coxiella burnetii or phase I IgG antibody titre >1:800 |
| Evidence of endocardial involvement (1 of the following): |
| Echocardiogram positive for IE: |
| Vegetation (oscillating intracardiac mass on a valve or on supporting structures, in the path of regurgitant jets, or on implanted material, in the absence of an alternative anatomic explanation), OR |
| Abscess, OR |
| New partial dehiscence of prosthetic valve |
| New valvular regurgitation |
| NB – Increase in or change in pre-existing murmur not sufficient |
| Minor criteria |
| Predisposition – Intravenous drug use or presence of a predisposing heart condition (prosthetic heart valve or a valve lesion associated with significant regurgitation or turbulence of blood flow) |
| Fever – Temperature ≥38.0°C (100.4°F) |
| Vascular phenomena – Major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial haemorrhage, conjunctival haemorrhages, or Janeway lesions |
| Immunologic phenomena – Glomerulonephritis, Osler nodes, Roth spots, or rheumatoid factor |
| Microbiological evidence – Positive blood cultures that do not meet major criteria OR serologic evidence of active infection with organism consistent with IE |
Medical treatment is based on the sensitivity of organisms isolated, with broad spectrum antibiotics used in the initial blind therapy when infective endocarditis is suspected. Surgery also plays a significant role in the management of IE, this will be teased out in the following questions.
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