**2. Diagnosis**

The modified Duke criteria [2] is used to categorize endocarditis as definite, possible or rejected based on clinical, microbiological, echocardiographic, and pathological findings. Blood cultures and echocardiography are the two key criteria for IE. The modified Duke criteria [2] has an overall sensitivity of ∼80–90%, and specificity >90% for diagnosis of IE when compared to pathological diagnosis; however, it is less reliable for identification of prosthetic valve endocarditis (PVE) with sensitivity ∼70–80% [3–7]. Transesophageal echocardiography has been shown to improve the diagnostic accuracy of the Duke criteria for definite IE when compared with TTE imaging [8].

A high-clinical suspicion for IE should be adopted especially when fever is present in patients with a prosthetic valve or device, new murmur or heart block, underlying valvular disease or congenital heart disease (CHD), embolism, immunosuppression, previous IE, or intravenous drug abuse (IVDA). It is imperative for early blood cultures be collected prior to antibiotic therapy and urgent echocardiography performed.
