Which of the follow ing is not a part of Duke’s Criteria for infective endocarditis?
Correct Answer: Splenomegaly
Description: Ans. a. Splenomegaly (Ref: Harrison 19/e p819, Harrison 18/e p1055; Nelson 20/ep2266)Splenomegaly is not a part of Duke's Criteria for infective endocarditis.Criteria for the Clinical Diagnosis of Infective EndocarditisMajor CriteriaMinor Criteria1. Positive blood culture for IE2. Evidence of endocardial involvement1. Predisposition: predisposing heart condition or injection drug use2. Fever > 38.0degC (> 100.4degF)3. Vascular phenomena: major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, Janeway lesions4. Immunologic phenomena: glomerulonephritis, Osier's nodes, Roth's spots, rheumatoid factor5. 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* Typical microorganism for infective endocarditis from two separate blood cultures:Q- Viridans streptococci. Streptococcus gallolyticus, 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 3 or a majority of > 4 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 titer of >1:800* Positive echocardiogram:- Oscillating intracardiac mass on valve or supporting structures or in the path of regurgitant jets or in implanted material - Abscess, or- New partial dehiscence of prosthetic valve, or* New valvular regurgitation (increase or change in preexisting murmur not sufficient)Definite endocarditis is defined by documentation of two major criteria, of one major criterion and three minor criteria, or of five minor criteria.Transesophageal echocardiography is recommended for assessing possible prosthetic valve endocarditis or complicated endocarditis.Excluding single positive cultures for coagulase-negative staphylococci and diphtheroids, which are common culture contaminants, and organisms that do not cause endocarditis frequently, such as gram-negative bacilli.Note: HACEK, Haemophilus spp., Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella spp.
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