小動物疾病系統

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犬傳染性心內膜炎
作者
潘翊諗、賴政宏、鄭豐邦
中文病名 犬傳染性心內膜炎
英文病名 Canine infectious endocarditis
疾病描述

 病因:

心內膜炎為心臟內側組織表面受感染和發炎,特別指心臟瓣膜處。

造成心內膜炎的原因以細菌性最多,也有黴菌性及立克次體感染引起。細菌可能來自於全身任何處,例如口腔(牙周病)、骨骼、前列腺、子宮、腎臟、腸道或皮膚,包括膿瘍及傷口等皆可能使心臟瓣膜受感染而發炎。

臨床症狀:

多數病犬呈現左心鬱血性心衰竭,臨床可見患犬咳嗽、呼吸困難、運動不耐及昏睡。

診斷方法

 根據病史、臨床症狀外,在聽診時可發現許多犬隻具有心雜音。

藉由影像學x-ray及超音波了解病程進行狀況。

另外可用心電圖監控患犬心雜音或心律不整之問題。

治療方法

 急性期的心內膜感染可以抗生素治療,但無法扭轉瓣膜結構上的傷害。
當瓣膜閉鎖不全,甚至發展成鬱血性心衰竭時,治療方向則朝向不可逆性心臟傷害進行。

預防控制方法

 日常口腔照護和定期帶給獸醫師洗牙及拋光為預防感染性心內膜炎最佳的方式。
主要仍以觀察到臨床症狀才能發現。
患犬若出現症狀經診斷後,應長期以心臟超音波追蹤。較嚴重且具心衰竭危險之動物,建議畜主避免讓動物激烈運動。

相關圖片 <p>&nbsp;<span style="font-family: 標楷體;">圖一</span><span style="font-family: 'Times New Roman', serif;"> </span><span style="font-family: 標楷體;">本圖為犬隻心臟內膜受細菌感染後於主動脈瓣出現菜花樣增生,細菌栓子脫落後經循環到達腦部造成栓塞。可見大腦右半球有兩處有栓塞性出血性腦炎。</span></p>
<p class="MsoNormal"><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;
mso-fareast-font-family:標楷體"><o:p></o:p></span></p>
Close<p>&nbsp;<span style="font-family: 標楷體;">圖一</span><span style="font-family: 'Times New Roman', serif;"> </span><span style="font-family: 標楷體;">本圖為犬隻心臟內膜受細菌感染後於主動脈瓣出現菜花樣增生,細菌栓子脫落後經循環到達腦部造成栓塞。可見大腦右半球有兩處有栓塞性出血性腦炎。</span></p>
<p class="MsoNormal"><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;
mso-fareast-font-family:標楷體"><o:p></o:p></span></p>

<p>&nbsp;<span style="font-family: 標楷體;">圖一</span><span style="font-family: 'Times New Roman', serif;"> </span><span style="font-family: 標楷體;">本圖為犬隻心臟內膜受細菌感染後於主動脈瓣出現菜花樣增生,細菌栓子脫落後經循環到達腦部造成栓塞。可見大腦右半球有兩處有栓塞性出血性腦炎。</span></p> <p class="MsoNormal"><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;; mso-fareast-font-family:標楷體"><o:p></o:p></span></p>


<p>&nbsp;<span lang="EN-US" style="font-family: 'Times New Roman', serif;">(</span><span lang="EN-US" style="font-family: 'Times New Roman', serif;">King, 1983</span><span lang="EN-US" style="font-family: 'Times New Roman', serif;">)</span></p>
<p class="MsoNormal"><span style="mso-bidi-font-size:12.0pt;font-family:標楷體;
mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;">圖二</span><span style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;
mso-fareast-font-family:標楷體"> </span><span style="mso-bidi-font-size:12.0pt;
font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:
&quot;Times New Roman&quot;">本圖為嚴重心內膜炎之拳師犬,病灶位於主動脈瓣。</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;
mso-fareast-font-family:標楷體"><o:p></o:p></span></p>
Close<p>&nbsp;<span lang="EN-US" style="font-family: 'Times New Roman', serif;">(</span><span lang="EN-US" style="font-family: 'Times New Roman', serif;">King, 1983</span><span lang="EN-US" style="font-family: 'Times New Roman', serif;">)</span></p>
<p class="MsoNormal"><span style="mso-bidi-font-size:12.0pt;font-family:標楷體;
mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;">圖二</span><span style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;
mso-fareast-font-family:標楷體"> </span><span style="mso-bidi-font-size:12.0pt;
font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:
&quot;Times New Roman&quot;">本圖為嚴重心內膜炎之拳師犬,病灶位於主動脈瓣。</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;
mso-fareast-font-family:標楷體"><o:p></o:p></span></p>

<p>&nbsp;<span lang="EN-US" style="font-family: 'Times New Roman', serif;">(</span><span lang="EN-US" style="font-family: 'Times New Roman', serif;">King, 1983</span><span lang="EN-US" style="font-family: 'Times New Roman', serif;">)</span></p> <p class="MsoNormal"><span style="mso-bidi-font-size:12.0pt;font-family:標楷體; mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;">圖二</span><span style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;; mso-fareast-font-family:標楷體"> </span><span style="mso-bidi-font-size:12.0pt; font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family: &quot;Times New Roman&quot;">本圖為嚴重心內膜炎之拳師犬,病灶位於主動脈瓣。</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;; mso-fareast-font-family:標楷體"><o:p></o:p></span></p>


<p>&nbsp;<span style="font-family: 'Times New Roman', serif; text-indent: 60pt;">(Courtesy of V. Luis Fuentes)</span></p>
<p class="MsoNormal"><span style="mso-bidi-font-size:12.0pt;font-family:標楷體;
mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;">圖三</span><span style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;
mso-fareast-font-family:標楷體"> </span><span style="mso-bidi-font-size:12.0pt;
font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:
&quot;Times New Roman&quot;">此圖為組織病理學鏡檢主動脈瓣,可見炎症細胞浸潤於組織間。</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;
mso-fareast-font-family:標楷體"><o:p></o:p></span></p>
Close<p>&nbsp;<span style="font-family: 'Times New Roman', serif; text-indent: 60pt;">(Courtesy of V. Luis Fuentes)</span></p>
<p class="MsoNormal"><span style="mso-bidi-font-size:12.0pt;font-family:標楷體;
mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;">圖三</span><span style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;
mso-fareast-font-family:標楷體"> </span><span style="mso-bidi-font-size:12.0pt;
font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:
&quot;Times New Roman&quot;">此圖為組織病理學鏡檢主動脈瓣,可見炎症細胞浸潤於組織間。</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;
mso-fareast-font-family:標楷體"><o:p></o:p></span></p>

<p>&nbsp;<span style="font-family: 'Times New Roman', serif; text-indent: 60pt;">(Courtesy of V. Luis Fuentes)</span></p> <p class="MsoNormal"><span style="mso-bidi-font-size:12.0pt;font-family:標楷體; mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;">圖三</span><span style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;; mso-fareast-font-family:標楷體"> </span><span style="mso-bidi-font-size:12.0pt; font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family: &quot;Times New Roman&quot;">此圖為組織病理學鏡檢主動脈瓣,可見炎症細胞浸潤於組織間。</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;; mso-fareast-font-family:標楷體"><o:p></o:p></span></p>


<p>&nbsp;<span style="font-family: 'Times New Roman', serif;">(Courtesy of G. Hestyik)</span></p>
<p class="MsoNormal"><span style="mso-bidi-font-size:12.0pt;font-family:標楷體;
mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;">圖四</span><span style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;
mso-fareast-font-family:標楷體"> </span><span style="mso-bidi-font-size:12.0pt;
font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:
&quot;Times New Roman&quot;">此為犬隻心臟超音波影像,可見主動脈瓣肥厚且無法運動而造成血液逆流。</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;
mso-fareast-font-family:標楷體"><o:p></o:p></span></p>
Close<p>&nbsp;<span style="font-family: 'Times New Roman', serif;">(Courtesy of G. Hestyik)</span></p>
<p class="MsoNormal"><span style="mso-bidi-font-size:12.0pt;font-family:標楷體;
mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;">圖四</span><span style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;
mso-fareast-font-family:標楷體"> </span><span style="mso-bidi-font-size:12.0pt;
font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:
&quot;Times New Roman&quot;">此為犬隻心臟超音波影像,可見主動脈瓣肥厚且無法運動而造成血液逆流。</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;
mso-fareast-font-family:標楷體"><o:p></o:p></span></p>

<p>&nbsp;<span style="font-family: 'Times New Roman', serif;">(Courtesy of G. Hestyik)</span></p> <p class="MsoNormal"><span style="mso-bidi-font-size:12.0pt;font-family:標楷體; mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;">圖四</span><span style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;; mso-fareast-font-family:標楷體"> </span><span style="mso-bidi-font-size:12.0pt; font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family: &quot;Times New Roman&quot;">此為犬隻心臟超音波影像,可見主動脈瓣肥厚且無法運動而造成血液逆流。</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;; mso-fareast-font-family:標楷體"><o:p></o:p></span></p>


參考文獻

1. Fuentes VL, Johnson LR, Dennis S. Infective endocarditis. In: Haggstrom J. Canine and feline cardiorespiratory medicine. 2nd ed. BSAVA, USA, 195-199, 2010.

2. King JM, Lee RCT. Nervous system. In: An atlas of general pathology volume II. 3rd ed. Council of agriculture, executive yuan, Taiwan, 350, 1983.

3. Nelson RW, Couto CG. Acquired valvular and endocardial disease. In: Small animal internal medicine. 4th ed. Mosby Elsevier, St. Louis, USA, 114-127, 2008.

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