Endocarditis In Dogs Research Articles

Infective endocarditis in dogs and cats

Infective endocarditis is an uncommon cardiac disease, caused by microbial invasion of the endocardium or heart valves. It presents many challenges with respect to diagnosis and effective treatment. This article reviews the pathogenesis, clinical presentation, methods of diagnosis and treatment of bacterial endocarditis in dogs and cats.

Outcome and prognostic factors in infective endocarditis in dogs: 113 cases (2005-2020).

BackgroundFactors associated with outcome in dogs diagnosed with infective endocarditis (IE) are not well characterized.ObjectivesEvaluate outcome and prognostic factors in dogs with IE.AnimalsOne hundred and thirteen dogs with IE.MethodsMedical records for dogs that fulfilled the modified Duke criteria between 2005 and 2020 were retrospectively reviewed. Signalment, preexisting conditions, clinicopathologic findings, treatment regimen, and outcomes were recorded. Univariate logistic regression was performed to identify categorical factors associated with mortality, and then multivariate analysis was performed.ResultsDogs were categorized as survivors (n = 47), non‐survivors (n = 57), or lost to follow‐up (n = 9). Survival to discharge and at 1 month was documented in 79 (70%) of 113 and 56 (54%) of 104 dogs, respectively, with median survival time (MST) of 72 days. Risk factors associated with mortality included development of congestive heart failure (odds ratio [OR], 11.8; 95% confidence interval [CI], 1.4‐97.8), thromboembolic events (OR, 5.7; 95% CI, 2.3‐14.4), and acute kidney injury (OR, 6.2; 95% CI, 2.0‐18.8). Administration of antithrombotic medications was associated with survival (OR, 0.35; 95% CI, 0.13‐0.97). Dogs that were not treated with antithrombotics had MST of 92 days, whereas dogs treated with antithrombotics did not reach MST during the study period. The heart valves involved and etiologic agent identified did not correlate with outcome.Conclusion and Clinical ImportanceDogs with IE that had thromboembolic events, acute kidney injury, or congestive heart failure had higher risk of mortality. Administration of antithrombotics was associated with prolonged survival time.

Evaluation of serum cardiac troponin-I concentrations for diagnosis of infective endocarditis in dogs.

BackgroundInfective endocarditis (IE) in dogs is associated with severe disease and a high case fatality rate but often presents with nonspecific clinical signs.Hypothesis/ObjectivesSerum concentration of cardiac troponin‐I (cTnI) is elevated in dogs with IE and can differentiate dogs with IE from dogs with other diseases with similar clinical features. Concentration of serum cTnI is negatively correlated with survival time in dogs with IE.AnimalsSeventy‐two client‐owned dogs; 29 with IE, 27 with stage‐B myxomatous mitral valve disease (MMVD), and 16 with immune‐mediated disease (IMD).MethodsRetrospective clinical cohort study. Concentration of serum cTnI was measured in all dogs at time of diagnosis. Clinical findings and echocardiographic interpretation were also recorded. Statistical analyses included Kruskal‐Wallis test, pairwise Mann‐Whitney U tests, receiver operator characteristic, and Cox proportional hazards.ResultsSerum concentration of cTnI was significantly higher in the IE group (0.69 ng/mL [0.03‐80.8]) than in the MMVD (0.05 ng/mL [0.02‐0.11], P < .001) and IMD groups (0.05 ng/mL [0.03‐0.57], P < .001). Increased cTnI was a moderately accurate predictor of IE (area under the curve 0.857 (95% confidence interval [CI] 0.745‐0.968, P < .001). A cTnI cutoff of 0.625 ng/mL had 100% specificity (95% CI 90%‐100%) and 52% sensitivity (95% CI 33%‐70%) in this study sample. There was no association between cTnI concentration and survival time in dogs with IE (hazard ratio 1.013, 95% CI 0.993‐1.034, P = .2).Conclusions and Clinical ImportanceCardiac troponin‐I concentrations are higher in dogs with IE compared to dogs with preclinical MMVD or IMD. In dogs with a compatible clinical presentation, serum cTnI concentrations >0.625 ng/mL are supportive of IE.

Infective endocarditis in dogs: Review

Infective endocarditis (IE) is a systemic disease caused by bacterial or, more rarely, fungal colonization of the valvar or mural endocardium. The most affected area is usually the left side of the heart, with involvement of the mitral valve, aortic valve, or both. Among the animals most prone to infection are those of medium to large size and males, in addition to the incidence and prevalence intensified with advancing age. The clinical signs are very unspecific in the majority, which makes it even more difficult to suspect and diagnose the precocity that the disease in question demands, but the development of a murmur or alteration of this is a strong indication of valve endocarditis. The diagnosis is mainly due to positive results of blood culture, with attention to infections by microorganisms of the genus Bartonella, which can hardly be identified through standard microbiological techniques and through the visualization of characteristic vegetative lesions using the echocardiographic method. The indicated therapeutic protocol is the basis for administration of bactericidal antimicrobials, which should not be postponed and always supported in the results of blood culture and antibiogram. The objective of this work is to carry out a literature review on IE in dogs, with emphasis on the main clinical aspects, diagnosis and treatment of the disease.

Polymerase chain reaction detection of Bartonella spp. in dogs from Spain with blood culture-negative infectious endocarditis

ObjectivesThe presence of Bartonella spp. was detected by polymerase chain reaction (PCR) in dogs from Spain with blood culture-negative endocarditis. The aim of this study is to add information about canine infectious endocarditis in Europe. AnimalsThirty dogs with naturally occurring blood culture-negative endocarditis were examined from 2010 to 2017 at three veterinary referral hospitals, located in northwest, northeast, and southeast of Spain. MethodsIt is a retrospective study. Medical records were reviewed to extract relevant data. Frozen or paraffin-embedded cardiac valve tissue and/or ethylenediamine tetraacetic acid blood samples were evaluated by PCR for the presence of Bartonella DNA. Positive results were sequenced to confirm the species. ResultsPolymerase chain reaction was positive for eight out of 30 dogs included (26.6%). Bartonella rochalimae, Bartonella vinsonii subsp. berkhoffii, and Bartonella koehlerae were detected in valve tissue or blood. ConclusionsBartonella could be an important cause of blood culture-negative infectious endocarditis in dogs from Spain. The outcome for those dogs affected with Bartonella spp. was grave. Prompt empirical treatment with amoxicillin-clavulanate plus fluoroquinolones could be of value in cases of blood culture-negative endocarditis.

Molecular survey of neglected bacterial pathogens reveals an abundant diversity of species and genotypes in ticks collected from animal hosts across Romania

BackgroundTicks are transmitting a wide range of bacterial pathogens that cause substantial morbidity and mortality in domestic animals. The full pathogen burden transmitted by tick vectors is incompletely studied in many geographical areas, and extensive studies are required to fully understand the diversity and distribution of pathogens transmitted by ticks.ResultsWe sampled 824 ticks of 11 species collected in 19 counties in Romania. Ticks were collected mainly from dogs, but also from other domestic and wild animals, and were subjected to molecular screening for pathogens. Rickettsia spp. was the most commonly detected pathogen, occurring in 10.6% (87/824) of ticks. Several species were detected: Rickettsia helvetica, R. raoultii, R. massiliae, R. monacensis, R. slovaca and R. aeschlimannii. A single occurrence of the zoonotic bacterium Bartonella vinsonii berkhoffii was detected in a tick collected from a dog. Anaplasma phagocytophilum occurred in four samples, and sequences similar to Anaplasma marginale/ovis were abundant in ticks from ruminants. In addition, molecular screening showed that ticks from dogs were carrying an Ehrlichia species identical to the HF strain as well as the enigmatic zoonotic pathogen “Candidatus Neoehrlichia mikurensis”. An organism similar to E. chaffeensis or E. muris was detected in an Ixodes ricinus collected from a fox.ConclusionsWe describe an abundant diversity of bacterial tick-borne pathogens in ticks collected from animal hosts in Romania, both on the level of species and genotypes/strains within these species. Several findings were novel for Romania, including Bartonella vinsonii subsp. berkhoffii that causes bacteremia and endocarditis in dogs. “Candidatus Neoehrlichia mikurensis” was detected in a tick collected from a dog. Previously, a single case of infection in a dog was diagnosed in Germany. The results warrant further studies on the consequences of tick-borne pathogens in domestic animals in Romania.

Incidence of postoperative implant-related bacterial endocarditis in dogs that underwent trans-catheter embolization of a patent ductus arteriosus without intra- and post-procedural prophylactic antibiotics

Intra- and post-procedural prophylactic antibiotics are routinely administered by veterinary cardiologists to dogs that undergo trans-catheter embolization of a patent ductus arteriosus for prevention of implant-related infective endocarditis. The hypothesis of our study was that primary antibiotic prophylaxis is not necessary to prevent bacterial endocarditis. In this retrospective case series 54 client-owned dogs that underwent trans-catheter occlusion of a patent ductus arteriosus in a single tertiary veterinary referral center between 2004 and 2016 were evaluated. Follow-up information was gained by telephone interviews with the owners or the referring veterinarians, or from the digital archives of the authors’ clinic. Inclusion criteria were that at least one metal implant (a coil or an Amplatz duct occluder) had to be delivered in the ductal ampulla, no local or systemic antibiotics were given on the day of the intervention or the week thereafter, at least 3 months of postoperative follow-up information was available, and the author was performing the procedure either as the primary or as the supervising cardiology specialist. None of the 54 dogs developed infective endocarditis in the postoperative 3 months. A study describing a similar population reports 2 of the included 47 dogs having developed infective endocarditis in the postoperative period despite the administration of intra- and post-procedural prophylactic antibiotics. We conclude that intra- and post-procedural antibiotic prophylaxis is not justified in dogs that undergo trans-catheter closure of a patent ductus arteriosus. Proper surgical technique and the use of new sterile catheters and implants are sufficient to prevent infective endocarditis in these dogs.

Aortic Thromboembolism as a Consequence of Bacterial Endocarditis Causing Acute Ischemic Neuromyopathy in a Dog

Background: Aortic thromboembolism (ATE) is a potentially fatal and rare condition in dogs. Ischemic neuromyopathy is main consequence, characterized by paraparesis or paraplegia, loss of femoral pulses, pain and hypothermia in distal part of affected limbs. In felines, affection is primarily associated with heart problems, whereas in dogs, condition is due to diseases which compromise the blood flow, such as, hyperadrenocorticism, immune-mediated hemolytic anemia, disseminated intravascular coagulation, sepsis, and more rarely cardiac problems. The aim of this article is describe a case of acute aortic thromboembolism due to bacterial endocarditis in a dog.Case: A female, 9-year-old dog, weighing 28.5 kg, was referred for examination due to acute paraparesis and pain. Patient showed cyanosis in nail beds and cold extremities in hind limbs, heart murmur degree V / IV, and bilateral absence of femoral arterial pulse. Due to suspicion of ATE, patient was treated with heparin, aspirin and tramadol, however it came to die less than 24 h after initial care. At necropsy, there was pulmonary edema, moderate hyperemia and severe tricuspid mitral valve. A thrombus with 3.0 cm of diameter in left atrium was found. At beginning of aorta there was also a thrombus measuring 5.0 cm x 0.3 cm x 0.3 cm and other thrombus in abdominal aortic trifurcation measuring 3.0 cm x 0.5 cm x 0.5 cm. Kidneys showed diffusely marked coagulative necrosis associated with extensive congestion and hemorrhage in corticomedullar region. Multiples focus of dark red coloration lesions and elevated surfaces ranging from 0.5 to 3.0 cm of diameter were observed in the spleen. Histological examination of heart valves showed presence of moderate amounts of degenerate neutrophils indicating bacterial endocarditis, whereas, same exam of kidneys, interstitial inflammatory infiltrate mostly constituted by a small quantity of degenerated neutrophils and lymphocytes was found. Thus, final diagnosis was ATE, resulting from bacterial endocarditis.Discussion: Aortic thromboembolism is an uncommon disease in dogs, generally affecting patients ranging from medium to big-sized and middle-aged to elderly dogs. Majority of dogs show chronic signs, whilst acute presentation, described herein, is uncommon. Clinical signs, showed by our patient were similar to what occur in felines with same disease, being absence of femoral pulse pathognomonic for both species. Patients can present partial or full obstruction to aortic trifurcation, with signs which range from weakness to paraplegia, as a consequence of ischemic neuromyopathy, as well observed in the present report. On post-mortem examination clinical suspicion of ATE was confirmed, however, unlike majority of reports of this condition in literature, two more thrombus were also identified. Due to acute picture and fast evolution to death, complementary exams, such as, two-dimensional ultrasound or Doppler, which are effective in viewing of presence of occlusion of aortic and decrease of blood flow, were not possible to accomplish. Severity and fatal evolution of this picture also prevented both etiologic diagnosis and treatment to be conducted. In consulted literature, descriptions of ATE due to bacterial endocarditis in dogs weren’t found, but it is believed that in present report, ATE may have occurred due to bacterial endocarditis. Unfortunately, both prognoses of bacterial endocarditis as ATE are poor and association of these two affections is probably associated with fast worsening picture and evolution to death.Keywords: embolism, endocarditis, aortic diseases, paraplegia.

Enterococcal Infective Endocarditis following Periodontal Disease in Dogs.

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.

Invasion of canine erythrocytes by Bartonella vinsonii subsp. berkhoffii

Bartonella vinsonii subsp. berkhoffii is a recognized cause of endocarditis in dogs and human patients and has been associated with cardiac arrhythmias, myocarditis, granulomatous lymphadenitis, polyarthritis, and granulomatous rhinitis in dogs. Little is known regarding the mode of transmission or cellular localization of this bacteria following infection of a canine host. The aim of the current study was to determine whether erythrocytes may serve as a site of infection by B. vinsonii subsp. berkhoffii. In the study, we successfully demonstrate the invasion of canine erythrocytes by a B. vinsonii subsp. berkhoffii genotype III strain using an in vitro model system. Dog erythrocytes were incubated with B. vinsonii subsp. berkhoffii after which tubes were treated with gentamicin at 12, 24, and 48h post-inoculation. After gentamicin elimination of extracellular bacteria, there was a gradual increase in intra-erythrocytic bacteria, as assessed by colony forming units per ml, at each collection time point. The largest recovery of intracellular bacteria occurred at 48h post-infection. These results suggest that canine erythrocytes may serve in the maintenance of bacteremia due to B. vinsonii subsp. berkhoffii within an infected host.

Correction: Association of periodontal disease, oral procedures, and other clinical findings with bacterial endocarditis in dogs

Correction: Association of periodontal disease, oral procedures, and other clinical findings with bacterial endocarditis in dogs

Serological evidence of Bartonella vinsonii lymphadenopathies in a child bitten by a dog

Bartonella species are gram-negative bacilli that belong to the alpha two subgroup of Proteobacteria. Bartonella species are being recognised as increasingly important bacterial pathogens in veterinary and human medicine [1]. These organisms can be transmitted by an arthropod vector or alternatively by animal scratches or bites [1]. Cat scratch disease (CSD) is caused by Bartonella henselae and is certainly the most common Bartonella zoonosis worldwide. Cats are the main reservoir of B. henselae, and the bacterium may be transmitted from cat to cat by the cat flea. The main clinical manifestation of typical CSD in an immunocompetent host remains lymphadenopathy and that appears approximately 2 weeks after inoculation. Bartonella vinsonii subsp. arupensis appeared to be closely related to B. vinsonii subsp. vinsonii, another rodent-associated taxon, and to B. vinsonii subsp. berkhoffii, which was described recently in dogs [1]. These three subspecies have been reported to be agents of bacteraemia and endocarditis in dogs [1]. B. vinsonii subsp. berkhoffii and B. vinsonii subsp. arupensis have been reported to be rare agents of endocarditis in humans [2]. Here we report the first serological evidence of B. vinsonii infection, in a French child with multiple lymphadenopathies following a dog bite.

BartonellaEndocarditis

Bartonellae were first recognized to cause endocarditis in humans in 1993 when cases caused by Bartonella quintana, B. elizabethae, and B. henselae were reported. Since the first isolation of Bartonella vinsonii subspecies berkhoffii from a dog with endocarditis, this organism has emerged as an important pathogen in dogs and an emerging pathogen in people. Subsequently, four types of B. vinsonii subsp. berkhoffii have been described, all of which have been associated with endocarditis in dogs. A limited number of dog endocarditis cases have also been associated with B. clarridgeiae, B. washoensis, B. quintana, and B. rochalimae. The second canine B. clarridgeiae endocarditis case is presented. The clinical and pathological characteristics of Bartonella endocarditis in dogs are similar to disease observed in humans, more often affecting the aortic valve, presenting with highly vegetative lesions with accompanying calcification, and in most instances high antibody titers. Pathological features in dogs include a combination of fibrosis, mineralization, endothelial proliferation, and neovascularization with variable inflammation. Endocarditis has also been described in animal species, which are the natural reservoir of specific Bartonella species, once thought to be solely healthy carriers of these pathogens. A few Bartonella endocarditis cases, including B. henselae, have been reported in cats in the USA and Australia. The second case of B. henselae type Houston I identified in the USA is presented. Furthermore, two cases of B. bovis endocarditis were recently described in adult cows from France. Finally, on-going investigation of valvular endocarditis in free-ranging Alaskan sea otters suggests the involvement of Bartonella species.

Association of periodontal disease, oral procedures, and other clinical findings with bacterial endocarditis in dogs

To identify risk factors potentially associated with the development of bacterial endocarditis in dogs and determine whether periodontal disease and surgical procedures (oral and nonoral) were associated with bacterial endocarditis. Retrospective case-control study. 76 dogs with (cases) and 80 dogs without (controls) bacterial endocarditis. Medical records were reviewed for information on signalment, physical examination findings, recent medical history, and results of echocardiography, clinicopathologic testing, and necropsy. None of the dogs with endocarditis had a history of undergoing any dental or oral procedure in the 3 months prior to the diagnosis of endocarditis, and no significant difference was found between groups with regard to the prevalence of oral infection. Dogs with endocarditis were significantly more likely to have undergone a nonoral surgical procedure that required general anesthesia in the preceding 3 months or to have developed a new heart murmur or a change in intensity of an existing heart murmur. Preexisting cardiac dis-ease (congenital or acquired) was not found to be a risk factor. Results did not provide any evidence of an association between bacterial endocarditis in dogs and either dental or oral surgical procedures or oral infection. Findings suggested that the routine use of prophylactic antimicrobial administration in dogs undergoing oral procedures needs to be reevaluated.

Canine Bacterial Endocarditis: A Review

Bacterial endocarditis is a disease of primarily middle-aged to older, large-breed dogs that is associated with high morbidity and mortality. It presents many challenges with respect to diagnosis and effective treatment. This paper reviews the pathogenesis, clinical presentation, progression, methods of diagnosis, and treatment of bacterial endocarditis in dogs. Methods for proper diagnosis, including echocardiographic findings and blood culture techniques, and recommendations for effective antimicrobial therapy are also provided.

Evaluation of the relationship between causative organisms and clinical characteristics of infective endocarditis in dogs: 71 cases (1992–2005)

To evaluate microbiologic findings in dogs with infective endocarditis (IE) and determine whether there were differences in clinical features of disease caused by different groups of infective agents. Retrospective case series. 71 dogs with suspected or definite IE. Medical records were reviewed for results of bacterial culture and susceptibility testing, serologic assays for vector-borne disease, and PCR testing on vegetative growths. Cases were grouped by causative organism and relationships among infectious agent group, and various hematologic, biochemical, and clinical variables were determined. Survival analyses were used to determine associations between infecting organisms and outcome. Causative bacteria were identified in 41 of 71 (58%) dogs. Gram-positive cocci were the causative agents in most (21/41; 51%) infections, with Streptococcus canis associated with 24% of infections. Gram-negative organisms were detected in 9 of the 41 (22%) dogs. Infection with Bartonella spp was detected in 6 of 31 (19%) dogs with negative results for microbial growth on blood culture. Aortic valve involvement and congestive heart failure were more frequent in dogs with endocarditis from Bartonella spp infection, and those dogs were more likely to be afebrile. Infection with Bartonella spp was negatively correlated with survival. Mitral valve involvement and polyarthritis were more frequent in dogs with streptococcal endocarditis. Streptococci were the most common cause of IE and were more likely to infect the mitral valve and be associated with polyarthritis. Dogs with IE secondary to Bartonella spp infection were often afebrile, more likely to develop congestive heart failure, rarely had mitral valve involvement, and had shorter survival times.

Vegetative bacterial endocarditis in dogs; echocardiography diagnosis and clinical signs

ABSTRACTOver a two‐year period, three hundred and forty‐five consecutive canine patients of a Cardiology Specialty Clinic were screened for signs of bacterial endocarditis. Ten dogs were identified to have echocardio‐graphical signs suggestive of this disease. Their clinical and haematologic data are presented in tables, and the clinical diagnoses were confirmed by necropsies. The echocardiographic signs of bacterial endocarditis and the usefulness of this new technique are discussed.

Subacute bacterial endocarditis following cardiac surgery.

Mechanical trauma to the valves of the heart has long been known to be the most reliable experimental method of production of bacterial endocarditis.1The first attempt by this method is attributed to Rosenbach (1878),2who in dogs and rabbits succeeded in producing a bacterial endocarditis by injuring the aortic cusps with a nonsterile rod passed through the carotid artery. As the traumatizing agent, Ribbert (1885)3used suspensions of staphylococci and starch granules from potato cultures; Fulci (1908),4bacteria in carbon suspension; Panichi and Guelfi (1909),5bacteria and carcinoma cells; Viti (1912),6a medium composed of sterile flour and bacteria. Regardless of the nature of the traumatizing agent, a bacterial endocarditis ensued in the injured valves upon implantation of the bacteria. Equally successful was an experiment by Kinsella and Hayes (1927),7who induced bacterial endocarditis in dogs by injuring the aortic valves with

Experimental endocarditis in dogs: Blahd, Margery, Frank, Ira, and Saphir, Otto: Arch. Path. 27: 424, 1939

Experimental endocarditis in dogs: Blahd, Margery, Frank, Ira, and Saphir, Otto: Arch. Path. 27: 424, 1939