Diagnosis & Treatment | Medibuddy
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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