Downloaded from http://vetrecordcasereports.bmj.com/ on September 9, 2015 - Published by group.bmj.
com
Advetia Vet Specialty Practice,
5 rue Dubrunfaut, Paris
75012, France
Correspondence to
Dr Jean-François Quinton,
quinton@advetia.fr
Received 13 March 2014
Revised 29 April 2014
Accepted 30 April 2014
To cite: Quinton J-F,
Valentin S, Ruel Y. Vet Rec
Case Rep Published online:
[please include Day Month
Year] doi:10.1136/vetreccr-
2014-000075
Quinton J-F, et al. Vet Rec Case Rep 2014;2:e000075. doi:10.1136/vetreccr-2014-000075
COMPANION OR PET ANIMALS
A case of infectious pericardial effusion and
tamponade in a guinea pig (Cavia porcellus)
associated with a multiresistant staphylococcus
Jean-François Quinton, Suzy Valentin, Yannick Ruel
SUMMARY
A three-year-old female guinea pig was presented for an
acute onset of lethargy and dyspnoea and was
subsequently diagnosed with pericardial effusion and
cardiac tamponade. Bacterial culture of the fluid
obtained from ultrasound-guided pericardiocentesis
revealed a coagulase-negative multiresistant
staphylococcus. Pericardiocentesis and antibiotic therapy
resulted in complete resolution of the pericardial
effusion. As the staphylococcus was resistant to many
antibiotics and the owner was diagnosed a few weeks
prior with cutaneous multiresistant staphylococcal
infection, it was speculated that the source of the septic
pericardial effusion may have been the owner.
BACKGROUND
Pericardial effusion (PE) is an important clinical dif-
ferential in guinea pigs with dyspnoea; however,
this disease is poorly documented and causes
remain unclear in this species.
The clinical presentation, imaging findings, diag-
nostic testing and treatment are described thor-
oughly. To the author’s knowledge, this is the first
case report of septic PE and tamponade in a guinea
pig. The possibility of the owner as a source of
infection is an interesting speculation.
CASE PRESENTATION
Introduction
Although cardiac disease in guinea pigs is commonly
encountered in clinical practice, few reports exist in
the veterinary literature. One case of dilated cardio-
myopathy (Franklin and Sanchez-Migallon 2006)
and two cases of PE of undetermined origin have
been documented in guinea pigs (Dzyban and others
2001, Perry and others 2012). To the author’s knowl-
edge, this is the first case report of a confirmed septic
PE in a guinea pig.
Case report
A three-year-old 1.2-kg, female intact guinea pig
(Cavia porcellus) was presented to the Advetia
Specialty Practice for an acute onset of inappetence,
lethargy and dyspnoea. The animal was kept in a
cage with bedding renewal completed once a
month.
Physical examination revealed a good body con-
dition. Marked abdominal effort associated with
open mouth breathing was noted. The remainder
of the physical examination was unremarkable.
Thoracic auscultation revealed tachypnoea (110
Veterinary Record Case Reports
breaths/minute) and tachycardia (380 bpm) asso-
ciated with muffled heart sounds (normal ranges
40–100 breaths/minute and 230–380 bpm)
(Heatley 2009). No cardiac murmur was
auscultated.
INVESTIGATIONS
The patient was placed in an oxygen cage to allevi-
ate respiratory distress and was sedated with mida-
zolam 0.25 mg/kg intramuscularly (Midazolam,
Aguettant, Lyon, France) to avoid a life-threatening
exacerbation of the clinical signs during handling
for radiography. Dorsoventral and right lateral
radiographs of the thorax were acquired (Figs 1
and 2). They revealed a generalised increased
opacity of the thoracic cavity associated with a
dorsal tracheal deviation, more marked at the level
of the carina. Thin fissure lines were visible in the
caudal right thorax, consistent with mild pleural
effusion. There was increased opacity in the ventral
lung field causing border effacement of the cardiac
silhouette, most likely due to alveolar lung pattern.
The pulmonary vasculature was difficult to assess
due to the increased thoracic opacity, but the pul-
monary vessels seemed subjectively enlarged in the
caudal lung fields. These changes were consistent
with a marked cardiomegaly associated with cardio-
genic pulmonary oedema and mild pleural effusion.
However, a mediastinal mass or lung disease (such
as pneumonia and lung collapse secondary to
pleural effusion and marked cardiomegaly) could
not be ruled out. An echocardiography and thor-
acic ultrasound were performed in order to assess
the cardiac function and morphology. A 12–4 MHz
phased-array transducer was used with a paraster-
nal right and left location. Both right atrium (RA)
and right ventricle were markedly enlarged during
all cardiac cycle, both on long (Figs 3 and 4,
Table 1) and short axis, as shown by increased
RIVDd/LIVDd (0.7) and RA/LA (2.5) as compared
with normal ratios in dogs and cats. Maximum
systole and diastole were subjectively determined
by maximum and minimum ventricular diameters
on transventricular short axis view, as small patient
size precluded simultaneous ultrasonograpy and the
placement of ECG leads. Left heart dimensions
were within normal limits.
The atrioventricular and arterial flows were
laminar and have normal velocities comparing with
normal values in dogs and cats as no reference
values are available in this species. No valvular
reflux was observed. A circumferential PE
1
 Downloaded from http://vetrecordcasereports.bmj.com/ on September 9, 2015 - Published by group.bmj.com
Veterinary Record Case Reports
FIG 1: Right lateral radiograph of the thorax of the guinea pig. The
cardiac silhouette is markedly enlarged, displacing the carina dorsally
(arrowhead)
associated with a diastolic collapse of the RA (cardiac tampon-
ade) was visible, explaining the increased size of the cardiac sil-
houette on the radiographic examination. No cardiac mass was
identified. A mild amount of pleural fluid was also present. A
small hypoechoic mass with internal hyperechoic foci and rever-
beration artefacts was visible at the heart base consistent with a
consolidated/collapsed pulmonary lobe.
DIFFERENTIAL DIAGNOSIS
As in other species, working diagnosis at this point was idio-
pathic, cardiogenic, neoplastic or infectious PE.
TREATMENT
A pericardiocentesis was planned in order to alleviate the
cardiac tamponade, which was presumed to be the cause of
respiratory distress, and to prevent subsequent cardiac collapse.
FIG 2: Dorsoventral projection of the thorax, slightly rotated, showing
an increased opacity. A thin fissure line is visible in the right caudal
thorax (arrowhead) and the pulmonary vein (black arrows) seems mildly
larger than the artery (white arrows) in the right caudal lung lobe
2 Quinton J-F, et al. Vet Rec Case Rep 2014;2:e000075. doi:10.1136/vetreccr-2014-000075
A light plane of anaesthesia was induced via face mask with 3.5
per cent isoflurane in oxygen (1.5 litres/minute). The lateral
thorax was shaved and surgically prepared and ultrasound-
guided pericardiocentesis was performed at the 5th costrochon-
dral junction using a sterile 20 mm 19G butterfly catheter. Ten
millilitres of straw-coloured fluid were drained, and the ultra-
sound demonstrated alleviation of the cardiac tamponade.
Refractometric analysis of the fluid revealed a specific gravity
of 1.025 and total protein concentration of 3.2 g/l. A cytological
analysis and aerobic and anaerobic culture were also performed.
The patient was then placed back into the oxygen cage.
Within a few hours after the tap, respiratory signs markedly
improved and appetite and defecation returned.
The guinea pig was discharged with an angiotensin-
converting enzyme inhibitor: ramipril, 0.125 mg/kg PO once a
day (Vasotop, Intervet, Angers, France) and enrofloxacin 10 mg/
kg per os twice a day (Tenotryl, Virbac, Carros, France) as the
radiographic alveolar pattern might have been consistent with
infectious pneumonia.
OUTCOME AND FOLLOW-UP
Upon recheck, five days later, the guinea pig was alert and had a
good appetite. Auscultation revealed cardiac and respiratory
rates within reference ranges.
Cytological analysis of the pericardial fluid revealed mesothe-
lial cells, occasional non degenerate neutrophils, but no visible
bacteria. Cell counts were not performed. Culture and sensitiv-
ity indicated heavy growth of a multiresistant coagulase-negative
staphylococcus (Table 2). At this point, the owner revealed
having been hospitalised for a few days one month prior for
cutaneous staphylococcal infection, which had required treat-
ment with various antibiotics.
Clindamycin, the only effective antibiotic reported in the
panel (a standard panel for dogs and cats), is contraindicated
due to risk of fatal enterocolitis in this species (Koop 1979) and
no expanded sensitivity test was available. As no other tested
antibiotics demonstrated sensitivity, enrofloxacin was replaced
with chloramphenicol 50 mg/kg per os twice a day (Mycolicine,
Virbac) due to this drug’s broad-spectrum activity and accept-
able tolerance in guinea pigs. Three weeks following initial
diagnosis, a recheck echocardiography was performed demon-
strating resolution of the PE, and reduction of right atrial and
ventricular size (Table 1).
Resolution of the pleural effusion and pulmonary consolida-
tion/collapse were also observed. Ramipril was discontinued and
chloramphenicol was continued for two more weeks. At two
years postdiagnosis and treatment, the patient continued to do
well.
Guinea pigs with cardiac failure are typically presented for
dyspnoea and lethargy. While radiographs allow differentiation
between dyspnoea secondary to respiratory or cardiac disease in
the majority of canine and feline cases, in guinea pigs the small
thoracic and lung field sizes, associated with the large space
occupied by the cardiac silhouette, make this distinction more
difficult. Ultrasonography is often mandatory to achieve a diag-
nosis and to aid emergency pericardiocentesis in case of cardiac
tamponade. However, there is little information on normal
ranges in guinea pigs. Data published until now are based in
values obtained under sedation with ketamine and xylazine
(Çetin and others 2005). Conversely, ketamine has been proven
to cause negative inotropic effects and cardiovascular depression
in guinea pigs (Endou and others 1992, Ramsey 2008). For this
reason, new reference values obtained in non-sedated guinea
pigs or using more innocuous drugs are necessary.
 Downloaded from http://vetrecordcasereports.bmj.com/ on September 9, 2015 - Published by group.bmj.com

Veterinary Record Case Reports

FIG 3: Right parasternal long-axis

four-chamber ultrasound image,
showing enlarged right cardiac cavities
and a pericardial effusion (PE). LV, left
ventricle; LA, left atrium; RV, right
ventricle; RA, right atrium

Although the anaesthetic risk in patients with congestive heart
failure is high, general anaesthesia is recommended to perform
pericardiocentesis in guinea pigs to avoid complications asso-
ciated with uncontrolled movements or forceful restraint of the
animal. A light plane of anaesthesia with isoflurane and oxygen
by mask and experienced handling contribute to a speedy pro-
cedure and minimised risks. Placement of an ECG during the
procedure is complicated due to overall patient size.
Pericardiocentesis is a life-saving procedure in guinea pigs
with cardiac tamponade. Prognosis for dogs and cats with PE
depends on the origin of the disease. In dogs, the most common
causes of PE are tumours (cardiac hemangiosarcoma, chemodec-
toma), cardiac insufficiency and idiopathic origin (Shaw and
Rush 2007a), whereas in cats the most common origins include
feline infectious peritonitis, hypertrophic cardiomyopathy and
neoplasia (Owens 1977, Hall and others 2007, Davidson and
others 2008). PE is known to occur in approximately 8 per cent
of dogs and 6 per cent of cats with clinical signs of cardiac
disease (Tobias, 2005). Causes of spontaneous PE in guinea pigs
are unknown.
Two other reported cases in guinea pigs showed a moderate
enlargement of the left atrium (Dzyban and others 2001) for
one and a moderate right-sided ventricular and atrial dilation
for the other (Perry and others 2012). Guinea pigs models of
human heart failure show that systemic hypertension induces
left ventricular remodelling, leading to heart failure charac-
terised by left ventricular hypertrophy, PE, pleural effusion
and ascites (Tiritilli, 2011). A retrospective study over a
two-year time period (2010–2012) at Advetia specialty prac-
tice in a population of 810 guinea pigs revealed 18 (2.22 per
cent) guinea pig with cardiomegaly. In these 18, 10 (55.5
per cent) demonstrated PE (Quinton and Maguire 2012).

FIG 4: Right parasternal

four-chamber ultrasonographic image
during diastole showing right atrial
collapse or tamponade (arrow). LV, left
ventricle; LA, left atrium; RV, right
ventricle; RA, right atrium; PE,
pericardial effusion

Quinton J-F, et al. Vet Rec Case Rep 2014;2:e000075. doi:10.1136/vetreccr-2014-000075 3

 Downloaded from http://vetrecordcasereports.bmj.com/ on September 9, 2015 - Published by group.bmj.com

Veterinary Record Case Reports

The pathophysiology of septic pericarditis in this case is

TABLE 1: Echocardiographic measurements at first presentation,
unknown, but may have spread from a pulmonary infection.
five-day recheck and reference values (Çetin and others 2005)
Although impossible to confirm, the original source may have
First Five-day Reference range (Çetin been the owner who had suffered from a similarly resistant
Parameter presentation recheck and others 2005) staphylococcal dermatitis one month prior. Coagulase-negative
LVIDd (mm) 7.0 6.5 6.30–7.50
Staphylococcus is a commensal bacteria of skin and mucosa that
LVIDs (mm) 4.5 4.3 4.20–4.60
has been demonstrated as a cause of opportunistic endocarditis
LVPWd 2.3 2.3 1.50–2.70
in humans (Caputo and others 1987). Other possible sources of
(mm) septic pericarditis in this patient included environmental, espe-
LVPWs 3.5 3.2 1.90–3.50 cially considering lack of regular cage cleaning, and contamin-
(mm) ation during the procedure itself, which was considered unlikely
IVSd (mm) 1.4 1.6 1.30–2.10 given the sterile method used to collect the sample.
IVSs (mm) 2.2 2.5 1.70–2.70 Chloramphenicol did not appear among the tested antimicro-
LA (mm) 5.4 5.0 4.60–5.40 bials for this organism. Response to therapy suggests chloram-
AO (mm) 4.9 4.9 4.40–5.00 phenicol may have been efficacious. In addition, in a study of
RVIDd (mm) 5.0 1.8 coagulase-negative staphylococcal bacteraemia in humans, chlor-
RA (mm) 13.8 4.5 amphenicol demonstrated an efficacy rate of 87 per cent
FS (%) 35.7 33.8 32–41 (Koksal and others 2009).
AO, aorta; FS, fractional shortening; IVSd, interventricular septum diastole; IVSs, In conclusion, bacterial culture of the PE fluid in guinea pigs
interventricular septum systole; LA, left atrium; LVIDd, left ventricular internal is an exam of interest as septic pericarditis may occur, especially
diameter diastole; LVIDs, left ventricular internal diameter systole; LVPWd, left
ventricular parietal wall diastole; LVPWs, left ventricular parietal wall systole; RA,
if other lesions such as pulmonary lesions are observed.
right atrium; RVIDd, right ventricular internal diameter diastole.
Contributors J.-F.Q provided the case and wrote the case report; S.V. brought
intern medicine contribution and editing; Y.R. brought imaging contribution and
editing.
Therefore, PE seems to be a common finding in guinea pig Competing interests None.
with heart disease. Provenance and peer review Not commissioned; externally peer reviewed.
In our case, pericardial fluid cytology showed a mesothelial
proliferation without evidence of neoplasia. In dogs, reactive
mesothelial cells are often present even when the underlying
process is benign (Shaw and Rush, 2007b). Septic pericarditis is REFERENCES
rare in dogs and cats (Calvert and Wall 2006). In dogs, the most ARONSON L. R., GREGORY C. R. (1995) Infectious pericardial effusion in five dogs.
frequent origin of bacterial pericarditis is the migration of a Veterinary Surgery 24, 402–407
CALVERT C. A., WALL M. (2006) Cardiovascular infections. In Infectious Diseases
foreign body (Aronson and Gregory, 1995), but it may occasion- of the Dog and Cat. 3rd edn. Ed C. E. Greene. St Louis: W.B. Saunders Elsevier.
ally develop in both species secondary to spontaneous bacterial pp 841–865
or fungal infections (Rush and others 1990, Luis Fuentes and CAPUTO G. M., ARCHER G. L., CALDERWOOD S. B., DINUBILE M. J., KARCHMER A. W.
others 1991, Stafford Johnson and others 2003, Lobetti 2007, (1987) Native valve endocarditis due to coagulase-negative staphylococci: clinical and
microbiologic features. The American Journal of Medicine 83, 619–625
Casamian-Sorrosal and others 2008, Majoy and others 2013). CASAMIAN-SORROSAL D., FOURNIER D., SHIPPAM J., WOODWARD B., TENNANT K.
In guinea pigs, two cases of infectious myocarditis associated (2008) Septic pericardial effusion associated with pulmonary and pericardial
with Streptococcus have been documented (Rae 1936, Zydeck botryomycosis in a dog. Journal of Small Animal Practice 49, 655–666
and others 1970). ÇETIN N., ÇETIN E., TOKER M. (2005) Echocardiographic variables in healthy guinea pigs
anesthetized with ketamine-xylazine. Lab Animal 39, 100–106
DAVIDSON B. J., PALING A. C., LAHMERS S. L., NELSON O. L. (2008) Disease association
and clinical assessment of feline pericardial effusion. Journal of the American Animal
TABLE 2: Antibiotic sensitivity of the coagulase-negative Hospital Association 44, 5–9
DZYBAN L. A., GARROD L. A., BESSO J. G. (2001) Pericardial effusion and
staphylococcus culture pericardiocentesis in a guinea pig (Cavia porcellus). Journal of the American Animal
Penicillin R Hospital Association 37, 21–26
ENDOU M., HATTORI Y., NAKAYA H., GOTOH Y., KANNO M. (1992) Electrophysiologic
Amoxicillin R
mechanisms responsible for inotropic responses to ketamine in guinea pig and rat
Amoxicillin/clavulanic acid R myocardium. Anesthesiology 76, 409–418
Ceftiofur R FRANKLIN J. M., SANCHEZ-MIGALLON G. (2006) Dilated cardiomyopathy and congestive
Cefalexin R heart failure in a guinea pig. Exotic DVM 7, 9–13
Cefovecin R HALL D., SHOFER F., MEIER C. K., SLEEPER M. M. (2007) Pericardial effusion in cats: a
retrospective study of clinical findings and outcome in 146 cats. Journal of Veterinary
Cefoxitin R Internal Medicine 21, 1002–1007
Fusidic acid I HEATLEY J. J. (2009) Small mammal cardiology. Veterinary Clinics of North America 12,
Erythromycin R 99–113
Clindamycin S KOKSAL F., YASAR H., SAMASTI M. (2009) Antibiotic resistance patterns of
coagulase-negative staphylococcus strains isolated from blood cultures of septicemic
Gentamicin R
patients in Turkey. Microbiologic Research 164, 404–410
Doxycycline R KOOP F. C. (1979) Clindamycin-associated enterocolitis in guinea pigs: evidence for a
Trimethoprim/sulfa R bacterial toxin. Infection and Immunity 23, 31–33
Enrofloxacin R LOBETTI R. G. (2007) Anaerobic bacterial pericardial effusion in a cat. Journal of the
Nalidixic acid R South African Veterinary Association 78, 175–177
LUIS FUENTES V., LONG K. L., DARKE P. G. (1991) Purulent pericarditis in a puppy.
Polymixin B R Journal of Small Animal Practice 32, 585–588
Marbofloxacin R MAJOY S. B., SHARP C. R., DICKINSON A. E., CUNNINGHAM S. M. (2013) Septic
I, intermediate; R, resistant; S, sensitive pericarditis in a cat with pyometra. Journal of Veterinary Emergency and Critical Care
23, 68–76

4 Quinton J-F, et al. Vet Rec Case Rep 2014;2:e000075. doi:10.1136/vetreccr-2014-000075

 Downloaded from http://vetrecordcasereports.bmj.com/ on September 9, 2015 - Published by group.bmj.com

Veterinary Record Case Reports

OWENS J. M. (1977) Pericardial effusion in the cat. In Veterinary Clinics of North
America: Small Animal Practice 7th edn. Ed Owens, J. M. Saunders, Philadelphia:
Elsevier. pp 373–383
PERRY B. H., RAMER C., PARIAUT R., NEVAREZ J. (2012) Pericardial effusion,
pericardocentesis, and thoracocentesis in a guinea pig (Cavia porcellus). Proceedings of
the Association of Exotic Mammals Veterinarians. San Francisco, USA, October 23 to
26. pp 48–49
QUINTON J. F., MAGUIRE R. (2012) Cardiac disease in guinea pigs. Proceedings of the
Association of Exotic Mammals Veterinarians. San Francisco, USA, October 23 to 26. pp 33–35
RAE V. (1936) Epizootic streptococcal myocarditis in guinea pigs. Journal of Infectious
Diseases 59, 236–232
RAMSEY I. (2008) BSAVA Small Animal Formulary. 7th edn. Gloucester, UK. British Small
Animal Veterinary Association. p 56
RUSH J. E., KEENE B. W., FOX P. R. (1990) Pericardial disease in the cat: a retrospective
evaluation of 66 cases. Journal of the American Animal Hospital Association 26, 39–46
SHAW S. P., RUSH J. E. (2007a) Canine pericardial effusion: pathophysiology and
cause. Compendium on Continuing Education for the practicing Veterinarian 29,
405–411
SHAW S. P., RUSH J. E. (2007b) Canine pericardial effusion: diagnosis, treatment and
prognosis. Compendium on Continuing Education for the practicing Veterinarian 29,
400–403
STAFFORD JOHNSON M. J., MARTIN M. W., STIDWORTHY M. F. (2003) Septic fibrinous
pericarditis in a cocker spaniel. Journal of Small Animal Practice 44, 117–120
TIRITILLI A. (2011) DOCA-salts induce heart failure in the guinea pig. European Journal of
Heart Failure 3, 545–555
TOBIAS A. H. (2005) Pericardial disorders. In Textbook of Veterinary Internal Medicine.
6th edn. Eds S. J. Ettinger, E. C. Feldman. St Louis: W.B. Saunders. pp 1107–1108
ZYDECK F. A., BENNET R. B., LANGHAM R. F. (1970) Subacute pericarditis in a guinea
pig caused by Diplococcus pneumoniae. Journal of the American Veterinary Medical
Association 157, 1945–1947

Copyright 2014 British Veterinary Association. All rights reserved. For permission to reuse any of this content visit
http://group.bmj.com/group/rights-licensing/permissions.
Veterinary Record Case Reports subscribers may re-use this article for personal use and teaching without any further permission.
Become a Veterinary Record Case Reports subscriber today and you can:
▸ Submit as many cases as you like
▸ Enjoy fast sympathetic peer review and rapid publication of accepted articles
▸ Access all the published articles
▸ Re-use any of the published material for personal use and teaching without further permission
For information on Institutional subscriptions contact consortia@bmj.com
Visit vetrecordcasereports.bvapublications.com for more articles like this and to become a subscriber

Quinton J-F, et al. Vet Rec Case Rep 2014;2:e000075. doi:10.1136/vetreccr-2014-000075 5

 Downloaded from http://vetrecordcasereports.bmj.com/ on September 9, 2015 - Published by group.bmj.com

A case of infectious pericardial effusion and

tamponade in a guinea pig ( Cavia porcellus)
associated with a multiresistant
staphylococcus
Jean-François Quinton, Suzy Valentin and Yannick Ruel

Vet Rec Case Rep 2014 2:

doi: 10.1136/vetreccr-2014-000075

Updated information and services can be found at:

http://vetrecordcasereports.bmj.com/content/2/1/e000075

These include:

References This article cites 22 articles, 4 of which you can access for free at:
http://vetrecordcasereports.bmj.com/content/2/1/e000075#BIBL

Email alerting Receive free email alerts when new articles cite this article. Sign up in the
service box at the top right corner of the online article.

Topic Articles on similar topics can be found in the following collections

Collections Cardiovascular medicine (10)
Companion or pet animals (102)
Companion or pet animals: Rodents and lagomorphs (9)
Ehrlichia (15)
Radiology (10)

Notes

To request permissions go to:

http://group.bmj.com/group/rights-licensing/permissions

To order reprints go to:

http://journals.bmj.com/cgi/reprintform

To subscribe to BMJ go to:

http://group.bmj.com/subscribe/