View source for ESC 2015 modified criteria for the diagnosis of infective endocarditis

== Background ==

* Used to diagnose [[infective endocarditis]]
* Recommended when the [[modified Duke criteria]] are possible or rejected, but with high clinical suspicion
** Repeat the echo
** Look for imaging evidence of embolic phenomena, such as MRI brain, whole body CT, or PET/CT
** Consider specialized imaging like cardiac CT, PET/CT, or white cell SPECT/CT
* Compared to [[modified Duke criteria]], the ESC criteria add the following:
** Paravalvular lesions detected by cardiac CT
** Abnormal activity around a prosthetic valve detected by <sup>18</sup>F-FDG PET/CT or radiolabelled leukocyte SPECT/CT
** Detection of embolic phenomena by imaging

== Criteria ==

=== Major Criteria ===

* Blood cultures positive for IE
** Typical microorganisms consistent with IE from 2 separate blood cultures
*** [[Viridans group streptococci]], [[Streptococcus gallolyticus]] ([[Streptococcus bovis]]), [[HACEK group]], [[Staphylococcus aureus]]; or
*** Community-acquired [[enterococci]], in the absence of a primary focus; or
** Microorganisms consistent with IE from persistently positive blood cultures
*** ≥2 positive blood cultures of blood samples drawn more than 12 hours apart; or
*** All of 3 or a majority of ≥4 separate cultures of blood with first and last samples drawn at least 1 hour apart; or
** Single positive blood culture for [[Coxiella burnetii]] or phase I IgG antibody titre greater than 1:800
* Imaging positive for IE
** Echocardiogram positive for IE
*** Vegetation
*** Abscess, pseudoaneurysm, or intracardiac fistula
*** Valvular perforation or aneurysm
*** New partial dehiscence of prosthetic valve
** Abnormal activity around the site of prosthetic valve implantation detected by <sup>18</sup>F-FDG PET/CT (only if the prosthesis was implanted for greater than 3 months) or radiolabelled leukocytes SPECT/CT
** Definite paravalvular lesions by cardiac CT

=== Minor Criteria ===

* Predisposition, such as predisposing heart condition or injection drug use
* Fever with temperature >38ºC
* Vascular phenomena, including those detected by imaging only: major arterial emboli, septic pulmonary infarcts, infection/mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, and Janeway lesions
* Immunological phenomena: glomerulonephritis, Osler nodes, Roth spots, positive rheumatoid factor
* Microbiologic evidence: positive blood culture that does not meet a major criteria, or serological evidence of active infection with an organism consistent with IE