The Duke criteria for infective endocarditis include which of the following as a MAJOR criterion?

• A Fever >38°C
• B New valvular regurgitation confirmed by echocardiography ✓
• C Positive blood cultures with viridans streptococcus from two separate draws
• D Splinter haemorrhages

Explanation

The modified Duke criteria classify endocarditis as definite (2 major, or 1 major + 3 minor, or 5 minor criteria). Major criteria include: (1) positive blood cultures (typical organisms in ≥2 separate cultures, or persistently positive cultures, or single positive culture for Coxiella burnetii); and (2) positive echocardiographic findings — oscillating intracardiac mass (vegetation), abscess, prosthetic valve dehiscence, or NEW valvular regurgitation. Fever is a minor criterion. Splinter haemorrhages are a minor criterion (vascular phenomenon). Viridans streptococcus is a typical organism but fever alone is minor.

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

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