Duke criteria for infective endocarditis require 2 major, 1 major + 3 minor, or 5 minor criteria for 'definite' clinical diagnosis. Which pathological finding is a major criterion even without positive blood cultures?

• A Fever >38°C
• B Splinter haemorrhages
• C Predisposing heart condition
• D Positive echocardiography showing intracardiac oscillating mass (vegetation) on a valve ✓

Explanation

The modified Duke criteria include two major criteria: (1) positive blood cultures (sustained bacteraemia with typical organisms OR two positive cultures with less typical organisms) and (2) evidence of endocardial involvement — including positive echocardiography showing vegetation, abscess, or new partial dehiscence of prosthetic valve, OR new valvular regurgitation. An oscillating intracardiac mass on echo is a major criterion. Fever, splinter haemorrhages, and predisposing condition are minor criteria.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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