VALUE OF DUKE CRITERIA FOR THE DIAGNOSIS OF INFECTIVE ENDOCARDITIS IN CHILDREN

Chen SB, Sun K, Huang MR, et al

Dept of Pediaric Cardiology, Xinhau Hospital, Shanghai Children’s Medical Center, Shanghai, China

Objective: To explore the value of Duke criteria for the diagnosis of pediatric infective endocarditis.

Methods: 50 patients with pediatric infective endocarditis who all underwent echocardiography, 13 of them surgically proven, were classified using Duke criteria.

Results: Same microorganism was detected in two or more than two separate blood cultures in 15 patients (30%), one positive blood culture in 10 patients (20%). Vegetation was detected by echocardiography in 39 patients (78%), 26 of them with oscillating vegetations, one patient complicated with valve perforation, one patient with new partial dehiscence of VSD's patch. Of 50 patients, 21 patients were classified as definite IE by Duke criteria, 12 patients met two major criteria, 9 patients had one major and more than three minor criteria. IE was rejected in one patient. In 13 surgically proven IE patients, 15 patients (38.5%) was correctly classified as definite IE, 8 patients were misclassified as possible IE. 6 patients met one major and two minor criteria, 2 patients were associated with one major and one minor criteria. Negative blood culture occurred in 10 surgically proven patients, nonscillating vegetation in 2 patients.

Conclusion: The results of this study showed that the detection of vegetation using echocardiography had important significance in the diagnosis of IE, vegetation should not be defined as oscillating intracardiac mass in pediatric patient. In patient with prior antibiotic therapy and typical echocardiographic findings, definite IE could be considered in the presence of one major and two minor criteria. Therefore, the sensitivity of the diagnosis of IE will be further improved.

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