Endocarditis diagnostic study of choice: Difference between revisions

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==Overview==
==Overview==
The Duke criteria can be used to establish the diagnosis of [[endocarditis]].
The [[Duke criteria]] can be used to establish the diagnosis of [[endocarditis]].


==Diagnostic Study of Choice==
==Diagnostic Study of Choice==
Line 10: Line 10:
=== Study of choice ===
=== Study of choice ===


* Echocardiogram is the gold standard test for the diagnosis of endocarditis.
*[[Echocardiography|Echocardiogram]] is the gold standard test for the diagnosis of [[endocarditis]].<ref name="Erbel">{{cite journal | author = Erbel R, Rohmann S, Drexler M, Mohr-Kahaly S, Gerharz C, Iversen S, Oelert H, Meyer J | title = Improved diagnostic value of echocardiography in patients with infective endocarditis by transoesophageal approach. A prospective study. | journal = Eur Heart J | volume = 9 | issue = 1 | pages = 43-53 | year = 1988 | id = PMID 3345769}}</ref><ref name="Shively">{{cite journal | author = Shively B, Gurule F, Roldan C, Leggett J, Schiller N | title = Diagnostic value of transesophageal compared with transthoracic echocardiography in infective endocarditis. | journal = J Am Coll Cardiol | volume = 18 | issue = 2 | pages = 391-7 | year = 1991 | id = PMID 1856406}}</ref>


* The following result of echocardiogram is confirmatory of endocarditis:
* The following result of [[Echocardiography|echocardiogram]] is confirmatory of [[endocarditis]]:
** For more information, click [[Endocarditis echocardiography and ultrasound|here]].
** For more information, click [[Endocarditis echocardiography and ultrasound|here]].


* Among the patients who present with clinical signs of endocarditis, transoesophageal echo (TEE) has a higher sensitivity (90%) in comparison to transthoracic echo (TTE).
* Among the patients who present with clinical signs of [[endocarditis]], [[Transesophageal echo cardiography|transesophageal]] echo ([[Transesophageal echocardiography (TEE)|TEE]]) has a higher sensitivity (90%) in comparison to [[Transthoracic echocardiography|transthoracic echo]] ([[TTE]]).


==== Sequence of Diagnostic Studies ====
The various investigations must be performed in the following order:
* History and symptom
* laboratory data
*[[Echocardiography]]
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
|valign=top|
|+
! style="background: #4479BA; width: 200px;" | Endocarditis
! style="background: #4479BA; width: 400px;" | Fever
! style="background: #4479BA; width: 400px;" | Cardiac murmur
! style="background: #4479BA; width: 400px;" | leukocytosis
! style="background: #4479BA; width: 400px;" | CRP
! style="background: #4479BA; width: 400px;" | Blood culture
! style="background: #4479BA; width: 400px;" | Echo
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
:Infective endocarditis
| style="padding: 5px 5px; background: #F5F5F5;" |+
| style="padding: 5px 5px; background: #F5F5F5;" |+
| style="padding: 5px 5px; background: #F5F5F5;" |+
| style="padding: 5px 5px; background: #F5F5F5;" |+
| style="padding: 5px 5px; background: #F5F5F5;" |+
| style="padding: 5px 5px; background: #F5F5F5;" |
* Mobile mass,
* Variable size
* Localised on the auricular surface of the auriculoventricular valves or aortic surface of aortic valve
* Valve abscess and rupture are common
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Nonbacterial thrombotic endocarditis
| style="padding: 5px 5px; background: #F5F5F5;" |−
| style="padding: 5px 5px; background: #F5F5F5;" |−
| style="padding: 5px 5px; background: #F5F5F5;" |−
| style="padding: 5px 5px; background: #F5F5F5;" |−/+
| style="padding: 5px 5px; background: #F5F5F5;" |−
| style="padding: 5px 5px; background: #F5F5F5;" |
* Vegetations are typically small, <1 cm in diameter, broad based and irregular in shape.
* Valve abscess and rupture uncommon
|-
|}<br />
<br />
=== Duke Diagnostic Criteria For Infective Endocarditis ===
=== Duke Diagnostic Criteria For Infective Endocarditis ===


====Definite infective endocarditis====
====Definite infective endocarditis====


* Pathological Criteria<ref name="Durack">{{cite journal | author = Durack D, Lukes A, Bright D | title = New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. | journal = Am J Med | volume = 96 | issue = 3 | pages = 200-9 | year = 1994 | id = PMID 8154507}}</ref>
* Pathological Criteria<ref name="Durack">{{cite journal | author = Durack D, Lukes A, Bright D | title = New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. | journal = Am J Med | volume = 96 | issue = 3 | pages = 200-9 | year = 1994 | id = PMID 8154507}}</ref><ref name="LiSexton2000">{{cite journal|last1=Li|first1=J. S.|last2=Sexton|first2=D. J.|last3=Mick|first3=N.|last4=Nettles|first4=R.|last5=Fowler|first5=V. G.|last6=Ryan|first6=T.|last7=Bashore|first7=T.|last8=Corey|first8=G. R.|title=Proposed Modifications to the Duke Criteria for the Diagnosis of Infective Endocarditis|journal=Clinical Infectious Diseases|volume=30|issue=4|year=2000|pages=633–638|issn=1058-4838|doi=10.1086/313753}}</ref><ref name="pmid8154507">{{cite journal |vauthors=Durack DT, Lukes AS, Bright DK |title=New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service |journal=Am. J. Med. |volume=96 |issue=3 |pages=200–9 |date=March 1994 |pmid=8154507 |doi=10.1016/0002-9343(94)90143-0 |url=}}</ref><ref name="pmid15145855">{{cite journal |vauthors=Prendergast BD |title=Diagnostic criteria and problems in infective endocarditis |journal=Heart |volume=90 |issue=6 |pages=611–3 |date=June 2004 |pmid=15145855 |pmc=1768277 |doi=10.1136/hrt.2003.029850 |url=}}</ref><ref name="pmid10770721">{{cite journal |vauthors=Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG, Ryan T, Bashore T, Corey GR |title=Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis |journal=Clin. Infect. Dis. |volume=30 |issue=4 |pages=633–8 |date=April 2000 |pmid=10770721 |doi=10.1086/313753 |url=}}</ref>
** Microorganisms demonstrated by culture or histological examination of a vegetation, a vegetation that has embolized, or an intracardiac abscess specimen
**[[Microorganisms]] demonstrated by culture or [[histological]] examination of a [[Vegetation (pathology)|vegetation]], a [[Vegetation (pathology)|vegetation]] that has embolized, or an [[intracardiac]] [[abscess]] specimen


: {{or}}
: {{or}}
:* Pathological lesions; vegetation or intracardiac abscess confirmed by histological examination showing active endocarditis
:* Pathological lesions; vegetation or intracardiac abscess confirmed by histological examination showing active [[endocarditis]]
 
* Clinical criteria
* Clinical criteria


:* 2 major clinical criteria
:* 2 major clinical criteria


{{or}}
: {{or}}
:* 1 major and 3 minor clinical criteria
:* 1 major and 3 minor clinical criteria


{{or}}
: {{or}}
:* 5 minor clinical criteria<br />
:* 5 minor clinical criteria<br />


Line 50: Line 97:
{{or}}
{{or}}


* Improving of clinical manifestations with antibiotic therapy ≤4 days
* Improving clinical manifestations with antibiotic therapy ≤4 days


{{or}}
{{or}}


* No pathologic evidence of infective endocarditis is found at surgery or autopsy after antibiotic therapy for 4 days or less
* No pathologic evidence of infective [[endocarditis]]<nowiki/>is found at surgery or [[autopsy]] after [[antibiotic therapy]] for 4 days or less


{{or}}
{{or}}


* Lack of clinical criteria for possible or definite infective endocarditis
* Lack of clinical criteria for possible or definite infective [[endocarditis]]


<br />
<br />
:
:
:
:
:
:
===Criteria for Rejecting the Diagnosis===
* Firm alternate diagnosis to infective endocarditis
* Resolution of infective endocarditis syndrome in under 4 days on antibiotics
* Does not meet the criteria below
===Criteria for Definitive Endocarditis===
The Duke Clinical Criteria for definitive infective endocarditis require either:
* Two major criteria
: {{or}}
* One major and three minor criteria
: {{or}}
* Five minor criteria


===Major Criteria===
===Major Criteria===
Line 95: Line 122:
====2. Evidence of endocardial involvement====
====2. Evidence of endocardial involvement====
:'''Positive echocardiogram for infective endocarditis defined as:'''
:'''Positive echocardiogram for infective endocarditis defined as:'''
::{{unicode|☑}} Oscillating intracardiac mass on valve or supporting structures, in the path of regurgitant jets, '''or'''  
::{{unicode|☑}} Oscillating [[intracardiac]] mass on valve or supporting structures, in the path of regurgitant jets, '''or'''
::{{unicode|☑}} On implanted material in the absence of an alternative anatomic explanation, '''or'''
::{{unicode|☑}} On implanted material in the absence of an alternative anatomic explanation, '''or'''
::{{unicode|☑}} Abscess, '''or'''
::{{unicode|☑}} Abscess, '''or'''
::{{unicode|☑}} New partial dehiscence of prosthetic valve
::{{unicode|☑}} New partial [[dehiscence]] of [[Prosthetic valves|prosthetic valve]]
:{{or}}
:{{or}}
::{{unicode|☑}} New valvular regurgitation (worsening or changing of preexisting murmur not sufficient)
::{{unicode|☑}} New [[valvular]] [[regurgitation]] (worsening or changing of preexisting murmur not sufficient)


===Minor criteria:===
===Minor criteria:===
:{{unicode|☑}} Predisposition: predisposing heart condition or [[intravenous drug use]]
:{{unicode|☑}} Predisposition: predisposing heart condition or [[intravenous drug use]]
:{{unicode|☑}} [[Fever]]: temperature > 38.0° C (100.4° F)
:{{unicode|☑}} [[Fever]]: temperature > 38.0° C (100.4° F)
:{{unicode|☑}} Vascular phenomena: major [[arterial emboli]], [[septic pulmonary infarct]]s, [[mycotic aneurysm]], [[intracranial hemorrhage]], [[conjunctival hemorrhage]]s, and [[Janeway lesions]]
:{{unicode|☑}} Vascular phenomena: major arterial [[emboli]], septic [[Pulmonary infarction|pulmonary infarcts]], [[mycotic aneurysm]], [[intracranial hemorrhage]], [[conjunctival hemorrhage]]s, and [[Janeway lesions]]
:{{unicode|☑}} Immunologic phenomena: [[glomerulonephritis]], [[Osler's nodes]], [[Roth spot]]s, and [[rheumatoid factor]]
:{{unicode|☑}} [[Immunology|Immunologic]] phenomena: [[glomerulonephritis]], [[Osler's nodes]], [[Roth spot]]s, and [[rheumatoid factor]]
:{{unicode|☑}} Microbiological evidence: positive [[blood culture]] but does not meet a major criterion as noted above (see footnote) or serological evidence of active infection with organism consistent with infectious endocarditis
:{{unicode|☑}} [[Microbiological]] evidence: positive [[blood culture]] but does not meet a major criterion as noted above (see footnote) or serological evidence of active infection with organism consistent with infectious endocarditis
:{{unicode|☑}} Echocardiographic findings: consistent with infectious endocarditis but do not meet a major criterion as noted above
:{{unicode|☑}} [[Echocardiography|Echocardiographic]] findings: consistent with [[infectious endocarditis]] but do not meet a major criterion as noted above
:'''Footnote:''' It should be noted that the criteria exclude single positive cultures for [[coagulase-negative staphylococci]], [[diphtheroids]], and organisms that do not commonly cause endocarditis.
:'''Footnote:''' It should be noted that the criteria exclude single positive cultures for [[coagulase-negative staphylococci]], [[Diphtheroid|diphtheroids]], and organisms that do not commonly cause [[endocarditis]].


===Pre-Test Probability of Endocarditis and When to Perform an Echocardiogram===
===Pre-Test Probability of Endocarditis and When to Perform an Echocardiogram===
In so far as the [http://www.medcalc.com/endocarditis.html Duke Criteria] rely heavily upon the results of [[echocardiography]], it is important to know when to order an [[echocardiogram]].  Studies have evaluated the pre-test probability of endocarditis based upon signs and symptoms to predict occult endocarditis among patients with intravenous drug abuse<ref name="Weisse">{{cite journal | author = Weisse A, Heller D, Schimenti R, Montgomery R, Kapila R | title = The febrile parenteral drug user: a prospective study in 121 patients. | journal = Am J Med | volume = 94 | issue = 3 | pages = 274-80 | year = 1993 | id = PMID 8452151}}</ref><ref name="Samet">{{cite journal | author = Samet J, Shevitz A, Fowle J, Singer D | title = Hospitalization decision in febrile intravenous drug users. | journal = Am J Med | volume = 89 | issue = 1 | pages = 53-7 | year = 1990 | id = PMID 2368794}}</ref><ref name="Marantz">{{cite journal | author = Marantz P, Linzer M, Feiner C, Feinstein S, Kozin A, Friedland G | title = Inability to predict diagnosis in febrile intravenous drug abusers. | journal = Ann Intern Med | volume = 106 | issue = 6 | pages = 823-8 | year = 1987 | id = PMID 3579068}}</ref> and among non drug abusing patients <ref name="Leibovici">{{cite journal | author = Leibovici L, Cohen O, Wysenbeek A | title = Occult bacterial infection in adults with unexplained fever. Validation of a diagnostic index. | journal = Arch Intern Med | volume = 150 | issue = 6 | pages = 1270-2 | year = 1990 | id = PMID 2353860}}</ref><ref name="Mellors">{{cite journal | author = Mellors J, Horwitz R, Harvey M, Horwitz S | title = A simple index to identify occult bacterial infection in adults with acute unexplained fever. | journal = Arch Intern Med | volume = 147 | issue = 4 | pages = 666-71 | year = 1987 | id = PMID 3827454}}</ref>. ''Unfortunately, this research is over 20 years old and it is possible that changes in the epidemiology of [[endocarditis]] and bacteria such as [[staphylococcus]] make the following estimates incorrectly low.''


'''Among patients who do not use illicit drugs and have a [[fever]] in the emergency room''', there is a less than 5% chance of occult endocarditis. Mellors <ref name="Mellors">.</ref> in 1987 found no cases of endocarditis nor of [[staphylococcal]] bacteremia among 135 febrile patients ''in the emergency room''. The upper [http://medinformatics.uthscsa.edu/calculator/calc.shtml confidence interval] for 0% of 135 is 5%, so for statistical reasons alone, there is up to a 5% chance of endocarditis among these patients. In contrast, Leibovici <ref name="Leibovici">.</ref> found that among 113 non-selected adults ''admitted to the hospital'' because of fever there were two cases (1.8% with 95%CI: 0% to 7%) of [[endocarditis]].
* In so far as the [http://www.medcalc.com/endocarditis.html Duke Criteria] rely heavily upon the results of [[echocardiography]], it is important to know when to order an [[echocardiogram]].<ref name="Samet">{{cite journal | author = Samet J, Shevitz A, Fowle J, Singer D | title = Hospitalization decision in febrile intravenous drug users. | journal = Am J Med | volume = 89 | issue = 1 | pages = 53-7 | year = 1990 | id = PMID 2368794}}</ref><ref name="Weisse">{{cite journal | author = Weisse A, Heller D, Schimenti R, Montgomery R, Kapila R | title = The febrile parenteral drug user: a prospective study in 121 patients. | journal = Am J Med | volume = 94 | issue = 3 | pages = 274-80 | year = 1993 | id = PMID 8452151}}</ref><ref name="Marantz">{{cite journal | author = Marantz P, Linzer M, Feiner C, Feinstein S, Kozin A, Friedland G | title = Inability to predict diagnosis in febrile intravenous drug abusers. | journal = Ann Intern Med | volume = 106 | issue = 6 | pages = 823-8 | year = 1987 | id = PMID 3579068}}</ref><ref name="Leibovici">{{cite journal | author = Leibovici L, Cohen O, Wysenbeek A | title = Occult bacterial infection in adults with unexplained fever. Validation of a diagnostic index. | journal = Arch Intern Med | volume = 150 | issue = 6 | pages = 1270-2 | year = 1990 | id = PMID 2353860}}</ref><ref name="Mellors">{{cite journal | author = Mellors J, Horwitz R, Harvey M, Horwitz S | title = A simple index to identify occult bacterial infection in adults with acute unexplained fever. | journal = Arch Intern Med | volume = 147 | issue = 4 | pages = 666-71 | year = 1987 | id = PMID 3827454}}</ref>
* Studies have evaluated the pre-test probability of [[endocarditis]] based upon signs and symptoms to predict occult [[endocarditis]] among patients with [[Intravenous drug abuse endocarditis|intravenous drug abuse]] and among non drug abusing patients.
* Unfortunately, this research is over 20 years old and it is possible that changes in the epidemiology of [[endocarditis]] and bacteria such as [[staphylococcus]] make the following estimates incorrectly low.
 
* Among patients who do not use illicit drugs and have a [[fever]] in the emergency room, there is a less than 5% chance of occult [[endocarditis]].
* Mellors in 1987 found no cases of endocarditis nor of [[staphylococcal]] bacteremia among 135 [[febrile]] patients ''in the'' emergency room.
* The upper [http://medinformatics.uthscsa.edu/calculator/calc.shtml confidence interval] for 0% of 135 is 5%, so for statistical reasons alone, there is up to a 5% chance of [[endocarditis]] among these patients.
* In contrast, Leibovici found that among 113 non-selected adults admitted to the hospital because of fever there were two cases (1.8% with 95%CI: 0% to 7%) of [[endocarditis]].


'''Among patients who do use illicit drugs and have a fever in the emergency room''', there is about a 10% to 15% prevalence of [[endocarditis]]. This estimate is not substantially changed by whether the doctor believes the patient has a trivial explanation for their fever<ref name="Marantz">.</ref>. Weisse<ref name="Weisse">.</ref> found that 13% of 121 patients had endocarditis. Marantz <ref name="Marantz">.</ref> also found a prevalence of endocarditis of 13% among such patients in the emergency room with fever. Samet <ref name="Samet">.</ref> found a 6% incidence among 283 such patients, but after excluding patients with initially apparent major illness to explain the fever (including 11 cases of manifest endocarditis), there was a 7% prevalence of endocarditis.
* Among patients who do use illicit [[drugs]] and have a fever in the emergency room, there is about a 10% to 15% prevalence of [[endocarditis]].
* This estimate is not substantially changed by whether the doctor believes the patient has a trivial explanation for their fever.  
* Weisse found that 13% of 121 patients had [[endocarditis]]. Marantz also found a prevalence of endocarditis of 13% among such patients in the emergency room with a fever.
* Samet found a 6% incidence among 283 such patients, but after excluding patients with initially apparent major illness to explain the fever (including 11 cases of manifest [[endocarditis]]), there was a 7% prevalence of [[endocarditis]].


'''Among patients with staphylococcal bacteremia (SAB)''', one study found a 29% prevalence of [[endocarditis]] in community-acquired SAB versus 5% in nosocomial SAB<ref name="Kaech">{{cite journal | author = Kaech C, Elzi L, Sendi P, Frei R, Laifer G, Bassetti S, Fluckiger U | title = Course and outcome of Staphylococcus aureus bacteraemia: a retrospective analysis of 308 episodes in a Swiss tertiary-care centre. | journal = Clin Microbiol Infect | volume = 12 | issue = 4 | pages = 345-52 | year = 2006 | id = PMID 16524411 | doi=10.1111/j.1469-0691.2005.01359.x}}</ref>. However, only 2% of strains were resistant to [[methicillin]] and so these numbers may be low in areas of higher resistance.
* Among patients with [[staphylococcal]] [[bacteremia]] (SAB), one study found a 29% prevalence of [[endocarditis]] in community-acquired SAB versus 5% in [[nosocomial]] SAB.
* However, only 2% of [[strains]] were resistant to [[methicillin]] and so these numbers may be low in areas of higher resistance.


==References==
==References==

Latest revision as of 21:46, 3 March 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The Duke criteria can be used to establish the diagnosis of endocarditis.

Diagnostic Study of Choice

Study of choice

Sequence of Diagnostic Studies

The various investigations must be performed in the following order:

Endocarditis Fever Cardiac murmur leukocytosis CRP Blood culture Echo
Infective endocarditis
 + + + + +
  • Mobile mass,
  • Variable size
  • Localised on the auricular surface of the auriculoventricular valves or aortic surface of aortic valve
  • Valve abscess and rupture are common
Nonbacterial thrombotic endocarditis
 − − − −/+ −
  • Vegetations are typically small, <1 cm in diameter, broad based and irregular in shape.
  • Valve abscess and rupture uncommon



Duke Diagnostic Criteria For Infective Endocarditis

Definite infective endocarditis

OR
  • Pathological lesions; vegetation or intracardiac abscess confirmed by histological examination showing active endocarditis
  • Clinical criteria
  • 2 major clinical criteria
OR
  • 1 major and 3 minor clinical criteria
OR
  • 5 minor clinical criteria

Possible infective endocarditis

  • 1 major and 1 minor clinical criteria

OR

  • 3 minor clinical criteria

Rejected infective endocarditis

  • Presence of alternate diagnosis

OR

  • Improving clinical manifestations with antibiotic therapy ≤4 days

OR

OR

  • Lack of clinical criteria for possible or definite infective endocarditis


Major Criteria

1. Positive Blood Culture for Infective Endocarditis

A. Typical microorganism consistent with infective endocarditis from 2 separate blood cultures, as noted below:
Template:Unicode Viridans streptococci, Streptococcus bovis, or
Template:Unicode HACEK group, or
Template:Unicode Community-acquired Staphylococcus aureus or enterococci, in the absence of a primary focus
OR
B. Microorganisms consistent with infective endocarditis from persistently positive blood cultures defined as:
Template:Unicode 2 positive cultures of blood samples drawn >12 hours apart, or
Template:Unicode All of 3 or a majority of 4 separate cultures of blood (with first and last sample drawn 1 hour apart)

2. Evidence of endocardial involvement

Positive echocardiogram for infective endocarditis defined as:
Template:Unicode Oscillating intracardiac mass on valve or supporting structures, in the path of regurgitant jets, or
Template:Unicode On implanted material in the absence of an alternative anatomic explanation, or
Template:Unicode Abscess, or
Template:Unicode New partial dehiscence of prosthetic valve
OR
Template:Unicode New valvular regurgitation (worsening or changing of preexisting murmur not sufficient)

Minor criteria:

Template:Unicode Predisposition: predisposing heart condition or intravenous drug use
Template:Unicode Fever: temperature > 38.0° C (100.4° F)
Template:Unicode Vascular phenomena: major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, and Janeway lesions
Template:Unicode Immunologic phenomena: glomerulonephritis, Osler's nodes, Roth spots, and rheumatoid factor
Template:Unicode Microbiological evidence: positive blood culture but does not meet a major criterion as noted above (see footnote) or serological evidence of active infection with organism consistent with infectious endocarditis
Template:Unicode Echocardiographic findings: consistent with infectious endocarditis but do not meet a major criterion as noted above
Footnote: It should be noted that the criteria exclude single positive cultures for coagulase-negative staphylococci, diphtheroids, and organisms that do not commonly cause endocarditis.

Pre-Test Probability of Endocarditis and When to Perform an Echocardiogram

  • Among patients who do not use illicit drugs and have a fever in the emergency room, there is a less than 5% chance of occult endocarditis.
  • Mellors in 1987 found no cases of endocarditis nor of staphylococcal bacteremia among 135 febrile patients in the emergency room.
  • The upper confidence interval for 0% of 135 is 5%, so for statistical reasons alone, there is up to a 5% chance of endocarditis among these patients.
  • In contrast, Leibovici found that among 113 non-selected adults admitted to the hospital because of fever there were two cases (1.8% with 95%CI: 0% to 7%) of endocarditis.
  • Among patients who do use illicit drugs and have a fever in the emergency room, there is about a 10% to 15% prevalence of endocarditis.
  • This estimate is not substantially changed by whether the doctor believes the patient has a trivial explanation for their fever.
  • Weisse found that 13% of 121 patients had endocarditis. Marantz also found a prevalence of endocarditis of 13% among such patients in the emergency room with a fever.
  • Samet found a 6% incidence among 283 such patients, but after excluding patients with initially apparent major illness to explain the fever (including 11 cases of manifest endocarditis), there was a 7% prevalence of endocarditis.

References

  1. ↑ Erbel R, Rohmann S, Drexler M, Mohr-Kahaly S, Gerharz C, Iversen S, Oelert H, Meyer J (1988). "Improved diagnostic value of echocardiography in patients with infective endocarditis by transoesophageal approach. A prospective study". Eur Heart J. 9 (1): 43–53. PMID 3345769.
  2. ↑ Shively B, Gurule F, Roldan C, Leggett J, Schiller N (1991). "Diagnostic value of transesophageal compared with transthoracic echocardiography in infective endocarditis". J Am Coll Cardiol. 18 (2): 391–7. PMID 1856406.
  3. ↑ Durack D, Lukes A, Bright D (1994). "New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service". Am J Med. 96 (3): 200–9. PMID 8154507.
  4. ↑ Li, J. S.; Sexton, D. J.; Mick, N.; Nettles, R.; Fowler, V. G.; Ryan, T.; Bashore, T.; Corey, G. R. (2000). "Proposed Modifications to the Duke Criteria for the Diagnosis of Infective Endocarditis". Clinical Infectious Diseases. 30 (4): 633–638. doi:10.1086/313753. ISSN 1058-4838.
  5. ↑ Durack DT, Lukes AS, Bright DK (March 1994). "New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service". Am. J. Med. 96 (3): 200–9. doi:10.1016/0002-9343(94)90143-0. PMID 8154507.
  6. ↑ Prendergast BD (June 2004). "Diagnostic criteria and problems in infective endocarditis". Heart. 90 (6): 611–3. doi:10.1136/hrt.2003.029850. PMC 1768277. PMID 15145855.
  7. ↑ Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG, Ryan T, Bashore T, Corey GR (April 2000). "Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis". Clin. Infect. Dis. 30 (4): 633–8. doi:10.1086/313753. PMID 10770721.
  8. ↑ Samet J, Shevitz A, Fowle J, Singer D (1990). "Hospitalization decision in febrile intravenous drug users". Am J Med. 89 (1): 53–7. PMID 2368794.
  9. ↑ Weisse A, Heller D, Schimenti R, Montgomery R, Kapila R (1993). "The febrile parenteral drug user: a prospective study in 121 patients". Am J Med. 94 (3): 274–80. PMID 8452151.
  10. ↑ Marantz P, Linzer M, Feiner C, Feinstein S, Kozin A, Friedland G (1987). "Inability to predict diagnosis in febrile intravenous drug abusers". Ann Intern Med. 106 (6): 823–8. PMID 3579068.
  11. ↑ Leibovici L, Cohen O, Wysenbeek A (1990). "Occult bacterial infection in adults with unexplained fever. Validation of a diagnostic index". Arch Intern Med. 150 (6): 1270–2. PMID 2353860.
  12. ↑ Mellors J, Horwitz R, Harvey M, Horwitz S (1987). "A simple index to identify occult bacterial infection in adults with acute unexplained fever". Arch Intern Med. 147 (4): 666–71. PMID 3827454.

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