Duke's modified criteria for infective endocarditis (IE) require a definite diagnosis based on which combination of major and minor criteria?

• A 2 major OR 1 major + 2 minor OR 5 minor criteria ✓
• B 1 major + 3 minor OR 3 major criteria
• C 2 major OR 1 major + 1 minor OR 3 minor criteria
• D 3 major + 1 minor criteria only

Explanation

The modified Duke criteria for definitive IE diagnosis: 2 major criteria OR 1 major + 3 minor criteria OR 5 minor criteria. Major criteria: positive blood culture with typical IE organisms (viridans streptococci, S. aureus, etc.) in ≥2 separate cultures, evidence of endocardial involvement (positive echocardiogram: vegetation, abscess, new dehiscence of prosthetic valve, or new valvular regurgitation). Minor criteria include predisposing heart condition, fever >38°C, vascular phenomena, immunological phenomena, and microbiological evidence not meeting major criteria. 18F-FDG PET and cardiac CT were added as new major criteria in 2023 ESC guidelines.

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

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