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Internal Medicine
For making diagnosing SBE draw 3-5 sets of blood cultures , at 3 different sites ,
over 24 hours.
This detects 92-98% of cases in patients who have not received antibiotics
In the case of Acute infective endocarditis, 3 sets may be drawn over 30 minutes
(with separate venipunctures) to document a continuous bacteremia.
2. Echocardiography
Has become the indirect diagnostic method of choice, especially in patients who
present with a clinical picture of infective endocarditis but who have
nondiagnostic blood cultures.
The diagnosis of infective endocarditis can never be excluded by a negative
3. Other Tests:
Electrocardiography may detect the 10% of patients who develop a conduction
delay during infective endocarditis by documenting an increasing P-R interval.
Rheumatoid factor becomes positive in 50% of patients with subacute disease. It becomes
negative after successful treatment.
Table III -4-2. The Duke Criteria for the Clinical Diagnosis of Infective Endocarditis
Major Criteria
1. Positive blood culture:
for typical microorganism that causes infective
endocarditis from two separate blood cultures.
( Viridans streptococci,
Streptococcus bovis, HACEK group, or Community-acquired Staphylococcus
aureus or enterococci in the absence of a primary focus )
2. Positive echocardiogram:
Definitive vegetation ( oscillating intracardiac mass on valve or supporting
structures )
New partial dehiscence of prosthetic valve
New valvular regurgitation (increase or change in preexisting murmur not