Von Reyn (Beth Israel) Criteria for Infective Endocarditis

 

Definite: direct evidence of infective endocarditis

(1) based on histology of material removed at surgery or at autopsy

(2) on Gram stain or culture of valvular vegetation or peripheral embolus

 

Probable:

(A) persistently positive blood cultures plus one or both of the following:

(A1) new regurgitant murmur

(A2) vascular phenomenon and predisposing heart disease

(B) negative or intermittently positive blood cultures with all 3 of the following

(B1) fever

(B2) new regurgitant murmur

(B3) vascular phenomenon

 

Possible:

(A) persistently positive blood cultures plus one of the following:

(A1) vascular phenomenon

(A2) predisposing heart disease

(B) negative or intermittently positive blood cultures with all 3 of the following

(B1) fever

(B2) predisposing heart disease

(B3) vascular phenomenon

(C) viridans streptococcus isolated

(C1) at least 2 positive blood cultures

(C2) no extra-cardiac source for positive blood cultures

(C3) fever

 

Rejected:

(1) endocarditis unlikely with an alternative diagnosis generally apparent

(2) endocarditis not excluded, but empiric therapy warranted

(3) culture negative endocarditis diagnosed clinically, but excluded by postmortem

 

Definitions

 

Predisposing heart disease:

(1) congenital heart disease

(2) valvular heart disease, or

(3) cardiac prosthesis other than permanent pacemaker

 

Persistently positive blood cultures :

(1) at least 2 blood cultures obtained

(2) 2 of 2, 3 of 3, or at least 70% of 4 more cultures taken positive

 

Intermittently positive blood cultures:

(1) at least one blood culture positive

(2) does not meet definition of persistently positive

 

Vascular phenomenon: petechiae, splinter hemorrhages, conjunctival hemorrhages, Roth spots, Osler's nodes, Janeway lesions, aseptic meningitis, glomerulonephritis, and emboli (pulmonary, CNS, coronary or peripheral)