10 mm.o Increased risk of embolisation,o Microabscesses in Brain and Meninges.Mycotic aneurysms, microabscesses in brain, glomerulonephritis can occur.Cardiac failure, perivalvular abscess, pericarditis, conduction blocks.The Duke Criteria for the Clinical Diagnosis of Infective EndocarditisMajor Criteria1. Positive blood cultureA). Typical microorganism for infective endocarditis from two separate blood cultures.Viridans streptococci, Streptococcus gallolyticus, HACEK group, Staphybcoccus aureus, orCommunity-acquired enterococci in the absence of a primary focus, orB). Persistently positive blood culture, defined as recovery of a microorganism consistent with infective endocarditis from:*. Blood cultures drawn >12 h apart; or*. All of 3 or a majority of >4 separate blood cultures, with first and last drawn at least 1 h apart.C). Single positive blood culture for Coxiella burnedi or phase I IgG antibody titer of >1:800.2. Evidence of Endocardial InvolvementA) Positive echocardiogram*. Oscillating intracardiac mass on valve or supporting structures or in the path of regurgitant jets or in implanted material, in the absence of an alternative anatomic explanation, or*. Abscess, or*. New partial dehiscence of prosthetic valve.B) New valvular regurgitation {increase or change in preexisting murmur not sufficient).Minor Criteria1. Predisposition. Predisposing heart condition or injection drug use.2. Fever >38.0degC (>100.4degF).3. Vascular phenomena. Major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, Janeway lesions.4. Immunologic phenomena: Glomerulonephritis, Osier's nodes, Roth's spots, rheumatoid factor.5. Microbiologic evidence: Positive blood culture but not meeting major criterion as noted previously*" or serologic evidence of active infection with organism consistent with infective endocarditis.Poor Prognostic FactorsOlder ageSevere comorbid conditionsDiabetesDelayed diagnosisProsthetic valvesInvolvement of aortic valveInvasive infections (Staph aureus)Antibiotic-resistant pathogens (P aeruginosa, yeast)Intracardiac complicationsMajor neurologic complications.">