Clinicopathologic findings and outcome in dogs with infective endocarditis: 71 cases (1992–2005)

Jane E. Sykes Department of Medicine and Epidemiology, University of California, Davis, CA 95616.

Search for other papers by Jane E. Sykes in
Current site
Google Scholar
PubMed
Close
 BVSc, PhD, DACVIM
,
Mark D. Kittleson Department of Medicine and Epidemiology, University of California, Davis, CA 95616.

Search for other papers by Mark D. Kittleson in
Current site
Google Scholar
PubMed
Close
 DVM, PhD, DACVIM
,
Bruno B. Chomel Department of Population Health and Reproduction, University of California, Davis, CA 95616.

Search for other papers by Bruno B. Chomel in
Current site
Google Scholar
PubMed
Close
 DVM, PhD
,
Kristin A. MacDonald Department of Medicine and Epidemiology, University of California, Davis, CA 95616.

Search for other papers by Kristin A. MacDonald in
Current site
Google Scholar
PubMed
Close
 DVM, PhD, DACVIM
, and
Patricia A. Pesavento Department of Pathology, Microbiology, and Immunology, University of California, Davis, CA 95616.

Search for other papers by Patricia A. Pesavento in
Current site
Google Scholar
PubMed
Close
 DVM, PhD, DACVP

Abstract

Objectives—To evaluate clinical, laboratory, and necropsy findings in dogs with infective endocarditis (IE).

Design—Retrospective case series.

Animals—71 dogs with possible or definite IE.

Procedures—Medical records were reviewed for signalment, clinical features, and results of clinicopathologic testing and diagnostic imaging. Yearly incidence and the effect of variables on survival were determined by use of survival curve analysis.

Results—The overall incidence of IE was 0.05%. Most affected dogs were of large breeds, and > 75% were older than 5 years. The aortic valve was affected in 36 of the 71 (51%) dogs, and the mitral valve was affected in 59%. Lameness caused by immune-mediated polyarthritis, septic arthritis, or peripheral arterial thromboembolism was observed in 53% of the dogs. Neurologic complications were diagnosed in 17 of 71 (24%) dogs. Thromboembolic disease was suspected in 31 of 71 (44%) of dogs. The mortality rate associated with IE was 56%, and median survival time was 54 days. Factors negatively associated with survival included thrombocytopenia, high serum creatinine concentration, renal complications, and thromboembolic complications.

Conclusions and Clinical Relevance—A diagnosis of IE should be suspected in dogs with fever, systolic or diastolic murmur, and locomotor problems. Dogs with thrombocytopenia, high serum creatinine concentration, thromboembolism, or renal complications may have a shorter survival time.

Abstract

Objectives—To evaluate clinical, laboratory, and necropsy findings in dogs with infective endocarditis (IE).

Design—Retrospective case series.

Animals—71 dogs with possible or definite IE.

Procedures—Medical records were reviewed for signalment, clinical features, and results of clinicopathologic testing and diagnostic imaging. Yearly incidence and the effect of variables on survival were determined by use of survival curve analysis.

Results—The overall incidence of IE was 0.05%. Most affected dogs were of large breeds, and > 75% were older than 5 years. The aortic valve was affected in 36 of the 71 (51%) dogs, and the mitral valve was affected in 59%. Lameness caused by immune-mediated polyarthritis, septic arthritis, or peripheral arterial thromboembolism was observed in 53% of the dogs. Neurologic complications were diagnosed in 17 of 71 (24%) dogs. Thromboembolic disease was suspected in 31 of 71 (44%) of dogs. The mortality rate associated with IE was 56%, and median survival time was 54 days. Factors negatively associated with survival included thrombocytopenia, high serum creatinine concentration, renal complications, and thromboembolic complications.

Conclusions and Clinical Relevance—A diagnosis of IE should be suspected in dogs with fever, systolic or diastolic murmur, and locomotor problems. Dogs with thrombocytopenia, high serum creatinine concentration, thromboembolism, or renal complications may have a shorter survival time.

Contributor Notes

The authors thank Dr. Helen L. Thomas for assistance with diagnostic imaging findings and Dr. Philip H. Kass for statistical assistance.

Address correspondence to Dr. Sykes.
  • 1

    Bayer AS, Scheld WM. Endocarditis and intravascular infections. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas and Bennett's principles and practice of infectious diseases. 5th ed. Philadelphia: Churchill Livingstone, 2000;857902.

    • Search Google Scholar
    • Export Citation
  • 2

    Anderson CA, Dubielzig RR. Vegetative endocarditis in dogs. J Am Anim Hosp Assoc 1984;20:149152.

  • 3

    Calvert CA. Valvular bacterial endocarditis in the dog. J Am Vet Med Assoc 1982;180:10801084.

  • 4

    Elwood CM, Cobb MA, Stepien RL. Clinical and echocardiographic findings in 10 dogs with vegetative bacterial endocarditis. J Small Anim Pract 1993;34:420427.

    • Search Google Scholar
    • Export Citation
  • 5

    MacDonald KA, Chomel BB, Kittleson MD, et al. A prospective study of canine infective endocarditis in northern California (1999–2001): emergence of Bartonella as a prevalent etiologic agent. J Vet Intern Med 2004;18:5664.

    • Search Google Scholar
    • Export Citation
  • 6

    Sisson D, Thomas WP. Endocarditis of the aortic valve in the dog. J Am Vet Med Assoc 1984;184:570577.

  • 7

    Meier H, Shouse CL. Acute vegetative endocarditis in the dog and cat. J Am Vet Med Assoc 1956;129:278289.

  • 8

    Lombard CW, Buergelt CD. Vegetative bacterial endocarditis in dogs; echocardiographic diagnosis and clinical signs. J Small Anim Pract 1983;24:325339.

    • Search Google Scholar
    • Export Citation
  • 9

    Taboada J, Palmer GH. Renal failure associated with bacterial endocarditis in the dog. J Am Anim Hosp Assoc 1989;25:243251.

  • 10

    Sykes JE, Kittleson MD, Pesavento P, et al. Evaluation of the relationship between causative organisms and clinical characteristics of infective endocarditis in dogs: 71 cases (1992–2005). J Am Vet Med Assoc 2006;228:17231734.

    • Search Google Scholar
    • Export Citation
  • 11

    Calvert CA, Greene CE, Hardie EM. Cardiovascular infections in dogs: epizootiology, clinical manifestations, and prognosis. J Am Vet Med Assoc 1985;187:612616.

    • Search Google Scholar
    • Export Citation
  • 12

    Drazner FH. Bacterial endocarditis in the dog. Compend Contin Educ Pract Vet 1979;1:918923.

  • 13

    Eriksen K, Fossum K, Gamlem H, et al. Endocarditis in two dogs caused by Erysipelothrix rhusiopathiae. J Small Anim Pract 1987;28:117123.

    • Search Google Scholar
    • Export Citation
  • 14

    Junius G, Bavegems V, Stalpaert M, et al. Mitral valve endocarditis in a labrador retriever caused by an actinomyces species identified as Actinomyces turicensis. J Vet Intern Med 2004;18:899901.

    • Search Google Scholar
    • Export Citation
  • 15

    Murdoch DB, Baker JR. Bacterial endocarditis in the dog. J Small Anim Pract 1977;18:687699.

  • 16

    Pesavento PA, Chomel BB, Kasten RW, et al. Pathology of bartonella endocarditis in six dogs. Vet Pathol 2005;42:370373.

  • 17

    Tessier-Vetzel D, Carlos C, Dandrieux J, et al. Spontaneous vegetative endocarditis due to Enterococcus faecalis in a rottweiler puppy. Schweiz Arch Tierheilkd 2003;145:432436.

    • Search Google Scholar
    • Export Citation
  • 18

    Wall M, Calvert CA, Greene CE. Infective endocarditis in dogs. Compend Contin Educ Pract Vet 2002;24:614625.

  • 19

    Calvert C, Wall M. Cardiovascular infections. In: Greene CE, ed. Infectious diseases of the dog and cat. St Louis: Saunders Elsevier, 2006;841865.

    • Search Google Scholar
    • Export Citation
  • 20

    Kittleson MD, Kienle RD. Infective endocarditis (and annuloaortic ectasia). In: Small animal cardiovascular medicine. St Louis: CV Mosby Co, 1998;402412.

    • Search Google Scholar
    • Export Citation
  • 21

    Caywood DD, Wilson JW, O'Leary TP. Septic polyarthritis associated with bacterial endocarditis in two dogs. J Am Vet Med Assoc 1977;171:549552.

    • Search Google Scholar
    • Export Citation
  • 22

    Cook LB, Coates JR, Dewey CW, et al. Vascular encephalopathy associated with bacterial endocarditis in four dogs. J Am Anim Hosp Assoc 2005;41:252258.

    • Search Google Scholar
    • Export Citation
  • 23

    Ramirez GA, Espinosa de los Monteros A, Rodriguez F, et al. Left ventricular outflow tract-right atrial communication (Gerbode type defect) associated with bacterial endocarditis in a dog. Vet Pathol 2003;40:579582.

    • Search Google Scholar
    • Export Citation
  • 24

    Smith AN, Finn-Bodner ST, Dillon AR. Left ventricular outflow tract to left atrial fistula associated with endocarditis in a dog. J Am Anim Hosp Assoc 2000;36:133136.

    • Search Google Scholar
    • Export Citation
  • 25

    Chu VH, Cabell CH, Benjamin DK Jr, et al. Early predictors of in-hospital death in infective endocarditis. Circulation 2004;109:17451749.

    • Search Google Scholar
    • Export Citation
  • 26

    Mansur AJ, Grinberg M, Cardoso RH, et al. Determinants of prognosis in 300 episodes of infective endocarditis. Thorac Cardiovasc Surg 1996;44:210.

    • Search Google Scholar
    • Export Citation
  • 27

    Wallace SM, Walton BI, Kharbanda RK, et al. Mortality from infective endocarditis: clinical predictors of outcome. Heart 2002;88:5360.

    • Search Google Scholar
    • Export Citation
  • 28

    Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med 2001;345:13181330.

  • 29

    Mourvillier B, Trouillet JL, Timsit JF, et al. Infective endocarditis in the intensive care unit: clinical spectrum and prognostic factors in 228 consecutive patients. Intensive Care Med 2004;30:20462052.

    • Search Google Scholar
    • Export Citation
  • 30

    Netzer RO, Zollinger E, Seiler C, et al. Infective endocarditis: clinical spectrum, presentation and outcome. An analysis of 212 cases 1980–1995. Heart 2000;84:2530.

    • Search Google Scholar
    • Export Citation
  • 31

    Cabell CH, Jollis JG, Peterson GE, et al. Changing patient characteristics and the effect on mortality in endocarditis. Arch Intern Med 2002;162:9094.

    • Search Google Scholar
    • Export Citation
  • 32

    Hasbun R, Vikram HR, Barakat LA, et al. Complicated leftsided native valve endocarditis in adults: risk classification for mortality. JAMA 2003;289:19331940.

    • Search Google Scholar
    • Export Citation
  • 33

    Siddiq S, Missri J, Silverman DI. Endocarditis in an urban hospital in the 1990s. Arch Intern Med 1996;156:24542458.

  • 34

    Kienle RD, Thomas WP, Pion PD. The natural clinical history of canine congenital subaortic stenosis. J Vet Intern Med 1994;8:423431.

  • 35

    Pelletier LL Jr, Petersdorf RG. Infective endocarditis: a review of 125 cases from the University of Washington Hospitals, 1963–72. Medicine (Baltimore) 1977;56:287313.

    • Search Google Scholar
    • Export Citation
  • 36

    Brodey RS. Hypertrophic osteoarthropathy in the dog: a clinicopathologic survey of 60 cases. J Am Vet Med Assoc 1971;159:12421256.

  • 37

    Vulgamott JC, Clark RG. Arterial hypertension and hypertrophic pulmonary osteopathy associated with aortic valvular endocarditis in a dog. J Am Vet Med Assoc 1980;177:243246.

    • Search Google Scholar
    • Export Citation
  • 38

    Remetz MS, Quagliarello V. Endovascular infections arising from right-sided heart structures. Cardiol Clin 1992;10:137149.

  • 39

    Arnold DM, Smaill F, Warkentin TE, et al. Cardiobacterium hominis endocarditis associated with very severe thrombocytopenia and platelet autoantibodies. Am J Haematol 2004;76:373377.

    • Search Google Scholar
    • Export Citation
  • 40

    Conlon PJ, Jefferies F, Krigman HR, et al. Predictors of prognosis and risk of acute renal failure in bacterial endocarditis. Clin Nephrol 1998;49:96101.

    • Search Google Scholar
    • Export Citation
  • 41

    Buyukasyk NS, Ileri M, Alper A, et al. Increased blood coagulation and platelet activation in patients with infective endocarditis and embolic events. Clin Cardiol 2004;27:154158.

    • Search Google Scholar
    • Export Citation
  • 42

    Di Salvo G, Habib G, Pergola V, et al. Echocardiography predicts embolic events in infective endocarditis. J Am Coll Cardiol 2001;37:10691076.

    • Search Google Scholar
    • Export Citation
  • 43

    Jones JE. Bacterial endocarditis in the pig with special reference to streptococcal endocarditis. J Comp Pathol 1980;90:1128.

  • 44

    Lepeschkin E. On the relation between the site of valvular involvement in endocarditis and the blood pressure resting on the valve. Am J Med Sci 1952;224:318319.

    • Search Google Scholar
    • Export Citation
  • 45

    Power HT, Rebbun WC. Bacterial endocarditis in adult dairy cattle. J Am Vet Med Assoc 1983;182:806808.

  • 46

    Rohmann S, Erbel R, Gorge G, et al. Clinical relevance of vegetation localization by transoesophageal echocardiography in infective endocarditis. Eur Heart J 1992;13:446452.

    • Search Google Scholar
    • Export Citation
  • 47

    Fabri J Jr, Issa VS, Pomerantzeff PM, et al. Time-related distribution, risk factors and prognostic influence of embolism in patients with left-sided infective endocarditis. Int J Cardiol [serial online] 2005;5. Available at: www.sciencedirect.com. Accessed Oct 29, 2005.

    • Search Google Scholar
    • Export Citation
  • 48

    Eknoyan G, Lister BJ, Kim HS, et al. Renal complications of bacterial endocarditis. Am J Nephrol 1985;5:457469.

  • 49

    Majumdar A, Chowdhary S, Ferreira MA, et al. Renal pathological findings in infective endocarditis. Nephrol Dial Transplant 2000;15:17821787.

    • Search Google Scholar
    • Export Citation
  • 50

    Neugarten J, Baldwin DS. Glomerulonephritis in bacterial endocarditis. Am J Med 1984;77:297304.

Advertisement