Canine pyometra

Pyometra, literally meaning pus in the uterus, is a common disease entity of intact bitches. Similar conditions occur, including hydrometra and mucometra [De Bosschere H, Ducatelle R, Vermeirsch H, Van Den Broeck W, Coryn M. Cystic endometrial hyperplasia-pyometra complex in the bitch: should the two entities be disconnected? Theriogenology 2001;55:1509-19]. The exact etiology is unknown; however the repeated and prolonged response to estrogen followed by long intervals of progesterone dominance in the intact bitch leads to hormonally mediated changes in the endometrium. The endometrium changes when impacted by bacterial infiltration; changes in endometrial steroid receptors can result in the clinical syndrome described as pyometra. This paper will describe the signalment, risk factors, prevalence, proposed etiologic events, and both medical and surgical therapies. In addition, the prognosis for successful outcome and effects on future reproduction will also be described.     

Cystic endometrial hyperplasia-pyometra complex in the bitch: should the two entities be disconnected?

The uteri of 26 clinically healthy bitches and 42 bitches with a clinical suspicion of pyometra were examined histologically using a computerized image analysis system. Histologic lesions were characterised mainly by thickening or atrophy of the endometrium and by varying degrees of cystic changes of the glands. These lesions were observed in most of the clinically healthy bitches as well as in all of the clinically ill animals. In most of the ill bitches a variable degree of inflammation also was found. Some bitches with clinical signs indicative for pyometra had no inflammatory reaction in the uterus. These bitches were misdiagnosed as suffering from pyometra, confirming the difficulty of diagnosing pyometra by simple clinical examination. Determination of sex hormone serum levels revealed that all dogs in both groups were either in metestrus or in anestrus. Based on the results of this study the cystic endometrial hyperplasia-pyometra complex can be divided in two entities: a cystic endometrial hyperplasia-mucometra complex and an endometritis-pyometra complex. Both entities bear many similarities with each other, except for the inflammatory reaction in the endometritis-pyometra complex. It is concluded from this study that the latter complex probably does not necessarily follow the former, but that both can arise de novo.     

Hydrometra in goats: Diagnosis with real-time ultrasound and treatment with prostaglandins or oxytocin

This paper describes the diagnosis, treatment and outcome of treatment in 10 cases of hydrometra in goats. Seven animals had recorded mating dates and three showed permanent anoestrus. During real-time ultrasound scanning of the right ventro-lateral abdominal wall, large fluid compartments were seen to be separated by thin tissue walls in cases of a well-developed hydrometra. As no such tissue trabeculae were found within the uterus of one animal during laparatomy, these tissue walls represent other segments of the same uterus seen through the walls of the curved, fluid-filled uterine horns. In two animals the hydrometra appeared less developed, and the final diagnosis was based on the absence of fetuses, membranes, and placentomes.In plasma samples obtained from eight animals, elevated progesterone concentrations (2 to 10 ng/ml) were measured before treatment. Spontaneous discharge of uterine fluid (“cloudburst”) in one goat on Day 157 after mating was accompanied by a fall in the plasma progesterone concentration.Single prostaglandin injections were given intramuscularly (i.m.) to five animals, and three animals were treated with 50 IU oxytocin i.m. twice daily for four consecutive days. Both treatments resulted in luteolysis, discharge of the uterine fluid and oestrous behaviour between 1.5 and 4 days after the start of treatment. However, some fluid remained in the uterus of five does, and additional oxytocin had to be given to two of them to achieve complete uterine involution.The luteolysis resulting from the oxytocin treatment indirectly indicates that in cases of hydrometra the uterine wall is still capable of producing prostaglandins. Six animals became pregnant from matings after treatment.     

Bacterial colonization of the ovarian bursa in dogs with clinically suspected pyometra and in controls

Septic peritonitis occurs relatively commonly in dogs. Secondary septic peritonitis is usually associated with perforation of intestines or infected viscera, such as the uterus in pyometra cases. The aim of this study was to evaluate the bacterial flora in the ovarian bursae of intact bitches as a potential source of contamination. One hundred forty dogs, clinically suspected of pyometra, were prospectively enrolled. The control group consisted of 26 dogs that underwent elective ovariohysterectomies and 18 dogs with mammary gland tumors that were neutered at the time of mastectomy. Bacteriology samples were taken aseptically at the time of surgery from the bursae and the uterus in all dogs. Twenty-two dogs that were clinically suspected of pyometra had sterile uterine content (“mucometra” cases); the remaining 118 had positive uterine cultures (“pyometra” cases) and septic peritoneal fluid was present in 10% of these cases. Of the 118 pyometra cases, 9 had unilateral and 15 had bilateral bacterial colonization of their ovarian bursae. However, the bacteria from the ovarian bursa were similar to those recovered from the uterine pus in only half of the cases. Furthermore, positive bursae were also seen in one mucometra dog (unilateral) and in four control dogs (two unilateral and two bilateral). The data illustrate that the canine ovarian bursa can harbor bacteria. The biological importance of these isolations remains unclear.     

Radiographic and ultrasonographic findings in a dog with emphysematous pyometra

Background

Emphysematous pyometra is a rare canine disease characterized by gas-forming bacteria infecting the uterus and causing an accumulation of both gas and infectious exudate in the uterine lumen. While radiological features of emphysematous pyometra have been previously described in dogs, the ultrasonographic appearance has not been reported.

Case presentation

A 7-year-old intact female Labrador Retriever was presented because of a 1 day history of vomiting, anorexia, mild polyuria/polydipsia and signs of fatigue. On physical examination the dog had a swollen vulva with a sparse amount of yellow discharge. Lateral and ventrodorsal radiographs showed a dilated predominantly gas-filled tubular structure located in the mid and cranial abdomen traversing from left to right and ending dorsally at the level of the 12th thoracic vertebra. A small intestinal ileus was initially suspected. Following the radiographic examination, abdominal ultrasound was performed. In the left mid and caudal abdomen there were two thin-walled gas-containing tubular structures. One had the typical layered appearance of an intestinal wall and represented the descending colon. The second structure had a similar thickness but homogenously hypoechoic wall and contained gas and echogenic fluid in the lumen. By use of several positional changes of the dog aiming to alter the location of the intraluminal gas, the second structure was traced to the right ovary cranially and the uterine body caudally, confirming that the structure was the right uterine horn. A final diagnosis of emphysematous pyometra was made.

Conclusion

Ultrasound can be used as a non-invasive diagnostic method to differentiate between small intestinal ileus and emphysematous pyometra.

     

Concentrations of cardiac Troponin I before and after ovariohysterectomy in 46 female dogs with pyometra

Background  

Canine pyometra is a common disease in countries where routine spaying of young dogs is not common practice. This disease is known to lead to systemic inflammation potentially affecting multiple organs in the body, including the heart. Cardiac-specific Troponin I (cTnI) is a sensitive marker of myocardial cell damage, which can result from ischemia, trauma, toxins or inflammation. Dogs with pyometra are also exposed to anaesthesia which can potentially result in myocardial cell damage. The aims of the study were 1) to evaluate the occurrence of myocardial cell damage as indicated by increased serum concentrations of cTnI in dogs with pyometra and relate these to presence of systemic inflammation and 2) to evaluate the change in cTnI-concentrations after anaesthesia and surgery.     

Serum insulin-like growth factor-I,iron, C-reactive protein,and serum amyloid A for prediction of outcome in dogs with pyometra

Pyometra, accumulation of pus in the uterus, is a bacterial infection that frequently initiates systemic inflammation. The disease may have lethal consequences when the systemic effects are severe or complications occur. Markers for identifying high-risk patients and predicting outcome are therefore in high demand. The objective of this study was to measure serum concentrations of insulin-like growth factor-I (IGF-I), iron, C-reactive protein (CRP), and serum amyloid A (SAA) in bitches with pyometra and to explore the possible value of these variables for detection of increased morbidity. In total, 31 bitches were diagnosed with pyometra and destined for surgical treatment (ovariohysterectomy) and 17 healthy bitches were included in the study. Concentrations of IGF-I and iron were lower in the pyometra group (mean concentration 221.2 ± 22.5 ng/mL and 16.9 ± 1.6 μmol/L, respectively) compared with the healthy control group (mean concentration 366.7 ± 46.2 ng/mL and 38.1 ± 2.7 μmol/L, respectively). In contrast, concentrations of CRP and SAA were significantly higher in bitches with pyometra (mean concentrations 212.9 ± 17.3 mg/L and 119.9 ± 8.5 mg/L, respectively) compared with the control group (<5 mg/L and <10 mg/L, respectively). None of the explored variables were associated with morbidity as measured by duration of postoperative hospitalization. In conclusion, IGF-I and iron concentrations were decreased in pyometra, whereas SAA and CRP concentrations were increased in the disease. Although unspecific, measurement of these variables may be valuable as adjunctive markers for prognosis in cases of pyometra.     

Effect of Actinomyces pyogenes and gram-negative anaerobic bacteria on the development of bovine pyometra

Fifteen lactating Holstein cows were used in a trial designed to evaluate the effectiveness of intrauterine inoculation (challenge) of Actinomyces pyogenes (A) alone or in combination with Fusobacterium necrophorum (F) and Bacteroides melaninogenicus (B) to induce pyometra. Cows were assigned to one of five groups: A (n = 3), AB (n = 3), AF (n = 3), ABF (n = 3) or C (control, broth medium alone; n = 3). All cows exhibited estrus 12 or 13 d prior to challenge (Day 0=first day of challenge). During the prechallenge period, the reproductive tract of each cow was palpated per rectum and uterine fluid aspirates for culture and uterine biopsies were also obtained. All cows received an intravenous injection of 5,000 IU of human chorionic gonadotropin (hCG; Day 5) and an intrauterine infusion of 40 ml of 0.7% iodine solution (Day 1). Cows were then inoculated on Days 0, 1 and 2 of the experiment. Sequential palpations of the reproductive tracts, samples of uterine fluid for culture and uterine biopsies were performed for a total of 30 d after the first inoculation. A cow was diagnosed as having pyometra when purulent uterine fluid and a corpus luteum were detected by palpation per rectum. The number of cows that developed pyometra in Group A was 2 of 3, in Group AB 3 of 3, in Group AF 3 of 3, in Group ABF 3 of 3 and in Group C 0 of 3. Cows with pyometra did not exhibit estrus. In 7 of 11 cows, pyometra persisted for more than 21 d. In cows that developed pyometra, the same species of bacteria infused into the uterus were usually recovered one or more times during the postchallenge period. When clinical pyometra was diagnosed, histologic endometritis was invariably present. Histologic endometritis and concurrent isolation of A . pyogenes alone or A . pyogenes with gram-negative anaerobic bacteria occurred in 91.7% of samples during the postchallenge period. Regardless of bacterial treatment, gram-negative anaerobic bacteria were frequently isolated with A . pyogenes during this period.     

Ciliochoroidal effusion

An accumulation of an abnormal amount of serous fluid in the suprachoroidal space is termed ciliochoroidal effusion. This entity is often associated with hypotony, intraocular surgery and inflammation. However, ciliochoroidal effusions can be idiopathic and have no signs or symptoms. This clinical review takes an in depth look at the pathophysiology and various etiologies of a ciliochoroidal effusion as well as associated conditions. Clinical features, differential diagnoses, complications and treatment strategies are also reviewed.     

Mucometra, cystic endometrial hyperplasia, and pyometra in the bitch: advances in treatment and assessment of future reproductive success

Pyometra is a common reproductive disorder which affects nearly one fourth of all female dogs before they reach 10 y of age. An association between pyometra and the most common uterine disease of the bitch, cystic endometrial hyperplasia, has been established, as the latter allows commensal bacteria originating from the vagina to proliferate in the uterus at the end of estrus. The progressive degenerative process in the development of cystic endometrial hyperplasia is usually proposed as the initiating lesion for pyometra in bitches; this is mediated by progesterone and potentially aggravated by estrogens. However, a separate process caused by local uterine irritation to trophoblastic reaction and bacterial proliferation has been recently proposed as an alternate mechanism leading to the development of pyometra. Pyometra is clinically distinct in pathogenesis, signs, treatment and prognosis from postpartum metritis or mucometra. Treatment of pyometra has historically involved ovariohysterectomy, however, during the last 10 y, numerous effective treatments have been proposed to treat both open and closed cervix pyometra with good success and future fertility. Among the treatments available, the use of repeated low doses of prostaglandins alone or in association with either dopamine agonists or progesterone-receptor antagonists has been demonstrated to be a viable alternative for valuable breeding dogs.     

Cardiac troponin I levels in canine pyometra

Background  

Myocardial injury may contribute to unexpected deaths due to pyometra. To detect myocardial damage, measurement of cardiac troponin I (cTnI) is currently the most sensitive and specific method. The aims of the present study were to evaluate presence of myocardial damage in canine pyometra by analysis of cTnI, to explore whether myocardial injury was associated with systemic inflammatory response syndrome (SIRS) and to evaluate whether other clinical or laboratory parameters were associated with cTnI increase.     

A study of two protocols combining aglepristone and cloprostenol to treat open cervix pyometra in the bitch

To compare the efficacy and safety of two protocols using a combination of aglepristone and cloprostenol for the treatment of open cervix pyometra in the bitch and to describe the progesterone (P4) serum profiles before and during treatments, 15 bitches were randomly allocated into two treatment groups: I (n = 8): aglepristone was administered at 10mg/kg, s.c., on Days 1, 3, 8, and 15 (if not cured), combined with cloprostenol at the dose of 1 microg/kg, s.c., on Days 3 and 8, and II (n = 7): received the same treatment with aglepristone as Treatment I but cloprostenol on Days 3, 5, 8 10, 12, and 15 (if not cured). Before the beginning of the treatments and then on Days 8, 15, and 29 all bitches were evaluated for clinical signs, side effects, hemogram, serum P4 concentrations, and uterus diameters. Bitches in both treatment groups, with (n = 6) or without (n = 9; > or =1.2 ng/ml) initial basal P4 serum concentrations, achieved treatment success without side effects and no significant differences, either on Day 15 (6/8 for Treatment I and 4/7 for Treatment II) or on Day 29 (2/8 for Treatment I and 3/7 for Treatment II). In both treatments groups, clinical signs, blood parameters, and uterine diameters improved to normal values throughout the experiments. A significant interaction between day and treatment was found for percentage change in P4 when all bitches were considered together. Redevelopment of pyometra in the next estrous cycle occurred in 20% of the bitches. One nonrecurrent bitch was mated and whelped a normal litter. It is concluded that these two combined protocols proved to be efficient and safe in reversing clinical signs of open cervix pyometra independently of initial P4 concentrations and that the number of cloprostenol administrations seemed to have an effect on P4 serum changes throughout treatments.     

Clinical spectrum of invasive candidiasis in critically ill non-neutropenic patients

Invasive Candida spp. infections in non-neutropenic critically ill patients admitted to intensive care units can be classified as focal and systemic. Both types of infection usually occur after episodes of candidemia, although some focal infections may be of exogenous development, like those occurring after trauma or be device-related.The clinical spectrum of invasive Candida spp. infections includes focal urinary tract, abdominal, ocular, respiratory tract, renal and hepato-biliary infections, as well as systemic infections like candidemia and acute systemic candidiasis with multiorgan involvement after hematogenous seeding. Candida spp. isolates in "significant" samples, like synovial fluid, cerebrospinal fluid and blood cultures, represent true infection. However, the diagnosis of invasive infection based on "non-significant" samples, like surgical drains and digestive tract exudates, requires additional criteria. The total number of isolates from different sites, the presence of risk factors, the clinical host response, as well as severity of illness need to be taken into account for the diagnosis of invasive candidiasis. The clinical signs of systemic infection due to Candida spp. are completely non-specific and cannot be differentiated from bacterial peritonitis, urinary tract infection or bacteremia. These infections may be associated with signs of sepsis,severe sepsis, septic shock or multiorgan dysfunction. In the future clinical multicentre observational and interventional studies are necessary to reach agreement on clinical definitions and classification of invasive Candida spp. infections in critically ill non-immunocompromised patients.     

Microbial,Immunological and Toxicological Aspects of Canine Pyometra

There is agreement that uterine infection is necessary for the development of the varied picture of clinical pyometra which includes changes in the kidneys and other organs (Børresen 1975). Some important clinical manifestations of the pyometra syndrome have been explained in terms of an endotoxinaemia (Asheim 1964, Schalm 1965).     

Blood lactate levels in 31 female dogs with pyometra

Background  

Canine pyometra is a life-threatening disease common in countries where spaying of dogs is not routinely performed. The disease is associated with endotoxemia, sepsis, systemic inflammatory response syndrome (SIRS) and a 3–4% mortality rate. Blood lactate analysis is clinically valuable in predicting prognosis and survival, evaluating tissue perfusion and treatment response in human and veterinary critical care settings. The aims of the present study were to investigate 1) the blood lactate levels of female dogs with pyometra by a hand-held analyser and 2) if these levels are related with the clinical status or other biochemical or hematological disorders.     

Differential roles of IL-18 in allergic airway disease: induction of eotaxin by resident cell populations exacerbates eosinophil accumulation

Cytokine regulation during an allergic response can dictate the severity of the inflammation and resulting injury. In the present study, we have examined the systemic and local effects of IL-18, a Th1-associated cytokine, on a cockroach allergen-induced airway response. In initial studies, temporal increases in IL-18 levels were observed within the lungs. When IL-18 was neutralized systemically the allergen-associated eosinophil accumulation was significantly accelerated 5-fold by 8 h postchallenge, suggesting a regulatory role for IL-18. Recombinant IL-18 (200 ng) was instilled into the airway at the time of allergen challenge to examine whether a direct impact on local eosinophil accumulation could be induced. When IL-18 was instilled, a significant increase in peribronchial eosinophil accumulation was observed in allergic mice as well as in nonallergic mice. A possible mechanism was observed in a significant increase in eotaxin, but not other eosinophil chemotactic factors, in bronchoalveolar lavage fluid after IL-18 instillation. The role of eotaxin was confirmed using eotaxin -/- mice, which demonstrated significantly less eosinophil accumulation compared with littermate controls. IL-18 was subsequently shown to induce eotaxin production from bronchial epithelial cells and isolated macrophages in in vitro assays. The clinical relevance of these findings was determined in treated mice and demonstrated that neutralization of IL-18 exacerbated, whereas exogenous IL-18 had no effect on airway hyperreactivity. Altogether, these data demonstrate that IL-18 may have multiple functions during an immune response that differ depending upon the local or systemic effects.     

Effect of systemic venous pressure elevation on lymph flow and lung edema formation

Pulmonary lymph drains into the thoracic duct and then into the systemic venous circulation. Since systemic venous pressure (SVP) must be overcome before pulmonary lymph can flow, variations in SVP may affect lymph flow rate and therefore the rate of fluid accumulation within the lung. The importance of this issue is evident when one considers the variety of clinical interventions that increase SVP and promote pulmonary edema formation, such as volume infusion, positive-pressure ventilation, and various vasoactive drug therapies. We recorded pulmonary arterial pressure (PAP), left atrial pressure (LAP), and SVP in chronic unanesthetized sheep. Occlusion balloons were placed in the left atrium and superior vena cava to control their respective pressures. The superior vena caval occluder was placed above the azygos vein so that bronchial venous pressure would not be elevated when the balloon was inflated. Three-hour experiments were carried out at various LAP levels with and without SVP being elevated to 20 mmHg. The amount of fluid present in the lung was determined by the wet-to-dry weight ratio method. At control LAP levels, no significant difference in lung fluid accumulation could be shown between animals with control and elevated SVP levels. When LAP was elevated above control a significantly greater amount of pulmonary fluid accumulated in animals with elevated SVP levels compared with those with control SVP levels. We conclude that significant excess pulmonary edema formation will occur when SVP is elevated at pulmonary microvascular pressures not normally associated with rapid fluid accumulation.     

Peripheral plasma prolactin and progesterone levels in pseudopregnant goats during bromocryptine treatment

Persistence of luteal function and accumulation of fluid within the uterus (hydrometra) are characteristics of pseudopregnancy in goats. To study the luteotrophic role of prolactin in this condition, seven seudopregnant goats were treated with bromocryptine (1 mg subcutaneously, twice daily) for 6 to 10 d. Plasma progesterone (P4) and prolactin (PRL) were measured by radioimmunoassay (RIA) in samples taken twice daily by venipuncture. Ultrasound scanning took place at regular intervals to visualize the presence of fluid within the uterus. Bromocryptine treatment effectively reduced the plasma PRL concentration in six goats. In all seven goats, a gradual decrease of the plasma P4 concentration to levels < 1.8 ng/ml occured during treatment. After bromocryptine treatment, P4 concentrations reached basal levels (<0.1 ng/ml) in two animals. In four goats, P4 concentrations remained close to 1.0 ng/ml, or even temporarily rose above the 2.0 ng/ml level. Spontaneous discharge of uterine fluid took place during (two goats) or within 4 d after bromocryptine treatment (three goats). These results indicate that prolactin plays an important luteotrophic role during pseudopregnancy in goats.     

Recovery, morphological quality, and in vitro maturation of follicular oocytes from bitches with pyometra

The objective of this study was to collect oocytes from ovaries of bitches with pyometra and to characterize the quality of the oocytes recovered. In 10 of 12 cases of pyometra, follicles with a diameter of 500 microm to 1mm were observed in the ovaries. A total of 710 oocytes were collected from 10 bitches by puncturing individual follicles after slicing the ovarian tissues. Oocyte recovery was successful from a bitch with severe clinical signs of pyometra. Of the oocytes collected, 53.5% were surrounded by > or =2 layers of cumulus cells, and 55.0% of these cumulus-oocyte complexes (COCs) had a darkly pigmented ooplasm >110 microm in diameter (large-dark COCs). The number of large-dark COCs per bitch varied from 1 to 72. A germinal vesicle with fine filaments of chromatin (Type A) was observed in 51.8% (range 21.1-100%) of the oocytes of large-dark COCs. Out of 50 oocytes cultured for 72 h, 6.0% developed to Metaphase II. In conclusion, there were many follicles with a diameter of 500 microm to 1mm in ovaries of bitches with pyometra, and many oocytes recovered from these follicles underwent meiotic maturation in vitro. The number of oocytes and COCs, and the morphological quality of the germinal vesicles varied among individual bitches.     

Effect of induced pyometra on luteal lifespan and uterine fluid concentrations of prostaglandins and interferons in cows

The objective was to determine whether occurrence of persistent corpora lutea in cows with pyometra could be explained by accumulation of prostaglandins and interferons in the uterus. Pyometra was induced by treatment with hCG, followed by intrauterine infusions of iodine and Actinomyces pyogenes . Five of the seven treated cows developed pyometra as indicated by extended estrous cycles (30-37 + d) and presence of purulent uterine exudate at slaughter (Day 37 after estrus). Mean (+/- standard error) concentrations of prostaglandins E(2) and F(2alpha) for the cows with pyometra were 34.7 +/- 14.4 and 96.3 +/- 28 ng/ml, while the concentrations in uterine flushings in the remaining 2 cows averaged 1.85 +/- 0.7 and 0.9 +/- 0.2 ng/ml, respectively. Based on Western blotting, none of the cows had detectable concentrations of either interferon-alpha or interferon-tau in uterine secretions. In conclusion, pyometra results in increased uterine prostaglandin secretion. While increased secretion of cytokines associated with bacterial infection may be contribute to this effect, there was no evidence in this study to suggest that interferons are involved in the mechanism which causes persistence of the corpus luteum in bovine pyometra.