Abstract
In humans, one of the major factors associated with infective endocarditis (IE) is the concurrent presence of periodontal disease (PD). However, in veterinary medicine, the relevance of PD in the evolution of dogs’ endocarditis remains poorly understood. In order to try to establish a correlation between mouth-associated Enterococcus spp. and infective endocarditis in dogs, the present study evaluated the presence and diversity of enterococci in the gum and heart of dogs with PD. Samples were collected during necropsy of 32 dogs with PD and visually diagnosed with IE, which died of natural causes or euthanasia. Enterococci were isolated, identified and further characterized by Pulsed-Field Gel Electrophoresis (PFGE); susceptibility to antimicrobial agents and pathogenicity potential was also evaluated. In seven sampled animals, PFGE-patterns, resistance and virulence profiles were found to be identical between mouth and heart enterococci obtained from the same dog, allowing the establishment of an association between enterococcal periodontal disease and endocarditis in dogs. These findings represent a crucial step towards understanding the pathogenesis of PD-driven IE, and constitute a major progress in veterinary medicine.
Highlights
Infective endocarditis (IE) is an important medical condition in dogs, with high morbidity and mortality rates
The present study investigated the possible association between periodontitis and infective endocarditis, by evaluating the presence and genomic relatedness of Enterococcus spp. present in the gum and heart of dogs with periodontal disease (PD)
Identification at species level was performed by multiplex-PCR using species specific primers and conditions previously described [21] and the genomic relatedness between isolates of the microbial collection was further assessed by SmaI-macrorestriction analysis using Pulsed-Field Gel Electrophoresis (PFGE) [22]
Summary
Infective endocarditis (IE) is an important medical condition in dogs, with high morbidity and mortality rates. Considered an uncommon disease, with a prevalence ranging from 0.09 to 6.6% [1], its true incidence is undoubtedly underestimated, as its final in vivo diagnosis is only possible after echocardiography, by detection of characteristic oscillating vegetative lesions in cardiac valves and valvular insufficiency [1], [2]. As well as in humans, IE requires an initial damage of the mitral and aortic valves endothelium, followed by platelet-fibrin deposition and bacterial colonization and adherence [1]. Disease evolution may promote acute congestive heart failure, thromboembolic disease and arrhythmias [1], [3]. IE prognosis depends on the pathogenic profile of associated bacteria, infection severity and affected valves, but it is usually poor. Treatment is only efficient in the PLOS ONE | DOI:10.1371/journal.pone.0146860 January 11, 2016
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