Clark Grace K, Spier Alan, Nestor Derek, Rizzo Scott
From the Department of Internal Medicine, BluePearl Veterinary Partners, Louisville, Kentucky (G.K.C., D.N., S.R.); and Department of Cardiology, BluePearl Veterinary Partners, Tampa, Florida (A.S.).
J Am Anim Hosp Assoc. 2018 Sep/Oct;54(5):e54502. doi: 10.5326/JAAHA-MS-6582. Epub 2018 Jul 24.
An 11 yr old female spayed golden retriever weighing 30.3 kg presented for evaluation of progressive lethargy, anorexia, tachypnea, stiff gait, and nonlocalized pain. On physical exam, the patient was febrile and tachycardic, and an arrhythmia with pulse deficits was noted. Clinicopathological abnormalities included thrombocytopenia, leukocytosis, nonregenerative anemia, and mild hypoalbuminemia. The patient progressed overnight to develop a productive cough, and an echocardiogram performed the next morning revealed irregular proliferative lesions of the pulmonic valve with moderate pulmonic regurgitation. Subsequent blood cultures grew two organisms: alpha-hemolytic streptococci spp. and Empedobacter brevis. The dog was treated with appropriate intravenous antibiotics for 2 wk and then switched to oral therapy. The clinicopathologic abnormalities, fever, and clinical signs resolved with oral antibiotic treatment. To the authors' knowledge, this case report represents the first detailed published case of bacterial endocarditis with E brevis bacteremia involving the pulmonic valve. The clinical presentation, diagnosis, treatment, and follow-up are discussed.
一只11岁已绝育的雌性金毛猎犬，体重30.3千克，因进行性嗜睡、厌食、呼吸急促、步态僵硬和非局限性疼痛前来评估。体格检查时，该患者发热、心动过速，且发现伴有脉搏短绌的心律失常。临床病理异常包括血小板减少、白细胞增多、非再生性贫血和轻度低蛋白血症。患者在夜间病情进展，出现咳痰，次日早晨进行的超声心动图显示肺动脉瓣有不规则增殖性病变，并伴有中度肺动脉反流。随后的血培养培养出两种微生物：甲型溶血性链球菌属和短稳杆菌。这只狗接受了为期2周的适当静脉抗生素治疗，然后改为口服治疗。口服抗生素治疗后，临床病理异常、发热和临床症状均得到缓解。据作者所知，本病例报告是首例详细发表的涉及肺动脉瓣的短稳杆菌菌血症引起的细菌性心内膜炎病例。本文讨论了其临床表现、诊断、治疗及随访情况。
