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Canine PyometraCanine Pyometra
Vivek JoshiPh.D Scholar
Division of Medicine
OverviewOverview1. Introduction2. Types3. Predisposing Factors4. Aetio-pathogenesis5. Clinical signs6. Diagnosis7. Differential diagnosis8. Treatment9. Control10. Conclusion
IntroductionIntroduction
Canine pyometra → intact bitches → uterine bacterial infection → systemic illness
Etiology: Escherichia coli clones from normal flora
Early diagnosis & intervention to avoid disastrous consequences
Closed-cervix pyometra : medical emergency
PyometraPyometra
Greek: pyo = pus, metra = uterus
Accumulation of pus in uterus
Infection overlying CEH → intrauterine purlent fluid
Diestrual disorder of intact adult bitches (Dow, 1959) Chronic purulent endometritis post estrum, with/ without multisystemic effects (Hardy & Osborne, 1974)
CEH-Pyometra-ComplexCEH-Pyometra-Complex
Cystic endometrial hyperplasia
Endometritis Pyometra
cysts 1 mm-1or more cm
uterine intraluminal diameter of< 1 cm
uterine intraluminaldiameter of> 1 cm
CEH-Pyometra-ComplexCEH-Pyometra-Complex CEH precedes pyometra
CEH & pyometra → two separate entities → clinical manifestations & morphohistological differences
(De Bosschere et al, 2001)
Four gradations of CEH-Pyometra complex(Dow, 1959)
Type I Type II Type III Type IV
thickened endometrium with translucent cysts
diffuse plasma cell infiltration
acute endometritismetritis or pyometra
Chronic endometritis, squamous metaplasia
““Open” or “Closed” cervixOpen” or “Closed” cervix
1. Closed pyometra
2. Open pyometra
3. Stump pyometra inflammation/ bacterial infection→uterine body
remnant
Severity of signs : cervix patency
INCIDENCEINCIDENCE
Pyometra : 23-24% before 10 yrs(Egenvall et al, 1999)
(Tamilnadu J. Veterinary & Animal Sciences 7 (5) 252-253, September-October, 2011)
Predisposing FactorsPredisposing Factors
Age middle-aged or old bitches (> 4 years) 8.2 years (Dow, 1959) 2.4 years (Kersey, 2004)
Parity nulliparous, intact bitches
Oestrous characteristics long diestrus
Breed wire-haired Dachshund/ Mongrels: ↓ risk
Rottweiler, rough-haired Collie,Cavalier King Charles Spaniel/ Golden Retriever: ↑ risk
(Susi Arnold, 2006)
No breed influence on pyometra development(Niskanen & Thrusfield, 1998)
PathogenesisPathogenesis
1) Hormonal influence on uterus2) Virulence of infecting bacteria3) Ability of bitch to combat infection 4) Individual sensitivity
Growth factors & their receptors (growth factors receptors, GFs)
(Gama et al. 2009)
Hormonal influence on uterusHormonal influence on uterus
Progesterone in aetiology of canine pyometra & its potentiation by estrogen
Teunissen (1952)
Prolonged stimulation of uterus by progesterone from cystic corpora lutea
Hardy & Osborne (1974)
Steroid hormones influence conc. & distribution of steriod receptors in uterus & cause pyometra
Dhaliwal et al (1999)
Virulence of infecting bacteriaVirulence of infecting bacteria
Bacterial infection- not primary cause
Predominant bacteria (in 82–100% of clinical cases): Escherichia coli
E. coli isolates → O serogroups (O4, O6)(Wadas et al, 1996)
Uropathogenic virulence factors (UVFs) for extra-intestinal infection
(Yuri et al, 1999)
Genes Products
pap P fimbriae
fim Type1 fimbriae
sfa S fimbriae
hlyA α-haemolysin
cnf1 cytotoxic necrotising factor 1
iuc aerobactin
afa afimbrial adhesin 1 or Afa1
P fimbriae PapGIII adhesin binds to Galα1–4Gal glycolipids &
Forssman Ag
bacterial adhesion & colonization
α-haemolysin/ CNF1 : tissue damage
E. coli isolates : 5, 3 or more UVF genes
genetic linkage- UVF genes & pathogenicity associated islands (PAIs) : cnf1, hlyA; hlyA, pap; cnf1, hlyA, papGIII
Clinical signs Open-cervix Close-cervix
Vaginal discharge Watery- creamy;light brown, green or yellow
rare
Temperature normal/ slightly elevated
elevated/ sub-normal (toxemic bitch)
Lethargy/ depression + +
Vomiting + +
Polyuria/ polydipsia + +
Clinical signs : 4-8 wks following last standing heat
Diestrus bitch with purulent vaginal dischargeDiestrus bitch with purulent vaginal discharge
Mechanism of PolyuriaMechanism of Polyuria
Multifactorial
Reduced permeability for water in DCT of kidney(Asheim, 1964)
Deposition of immune complexes in glomeruli causes membranoproliferative glomerulonephropathy
(Sandholm et al, 1975)
Renal tubular insensitivity to ADH due to tubular damage by E.coli endotoxins
Abdominal palpationAbdominal palpation
Open-cervix pyometra thickened, irregular & slightly turgid uterine horns
Closed-cervix pyometra greater degree of uterine distension visible abdominal enlargement
Care taken to avoid rupturing a distended uterus
UltrasonographyUltrasonography
In early diagnosis of canine pyometra(Bigliardi et al; 2004)
Most valuable in closed-cervix pyometra
Uterine wall- increased thickness/ hypoechoic Uterine lumen- grossly dilated/ anechoic fluid with small echogenic particles
RadiographyRadiography
Abdominal Radiography tubular structures of fluid density/ opacity in caudal abdomen
Not specific for pyometra
Clinical pathologyClinical pathology
Haematology not pathognomic for pyometra
Leukocytosis TLC : 15,000- 60,000/mm³
(Bigliardi & Pamigiani, 2004) Neutrophilia (degenerative left shift) : PBN >3%
Anemia Normocytic, normochromic, non-regenerative
Hyperglobulinemia
Hypoalbuminemia
↑ ALP, BUN
↑ PG-metabolite (SIRS); cTnI / CRP (myocardial injury→ endotoxemia, septicemia, DIC, secondary uremia)
(Hagman et al, 2007) Urinalysis Hyposthenuria (sp. gravity < 1.030)
TreatmentTreatment
Surgical Ovariohysterectomy is treatment of choice
severely ill bitches : aggressive fluid therapy & broad spectrum antibiotics
Transcervical Endoscopic Catheterisation (TECT)(Verstegen et al., 2008)
MedicalMedical
Indications: further breeding
O.H. not possible : intercurrent disease (CHF)
owner refuses surgery
1. Antibiotics1. Antibiotics in every case G(-) and G(+) efficacy according resistogram as soon as possible
Quinolones (Enrofloxacin/Marbofloxacin) Gentamicin Cefalosporins
Natural PGF₂α Synthetic PGF₂α
0.02 mg/kg SC bid 7-10 days 0.001– 0.002 mg/kg SC OD 7-10 days
Day 1 : 0.1 mg/kgDay 2 : 0.2 mg/kgDay 3-7 : 0.25 mg/kg OD
Longer duration of action
Dinoprost(Lutalyse®)
Cloprostenol(Cyclix®)
2. Prostaglandin F₂α/ PGE
Aglepristone 10 mg/kg SC
day 1, day 2, day 7
once a week
3. Antiprogestins
4. Antiprolactins4. Antiprolactins
Cabergoline (Cabgolin®) 0.005 mg/kg PO OD 7-10 days
5. Supportive therapy5. Supportive therapy
IV fluids (Lactated Ringer’s sol. /Glucose 5%) H₂ blocker : Metoclopramide (vomiting / nausea) NSAIDs Antihistaminics Anticholinergics (excess salivation)
Prostaglandins Results
Open-Cervix Pyometra
Closed-Cervix Pyometra
Complete resolution
94 % 31 %
Whelped litter 88 % -
Recurrence 26- 40 % within 1 year
(Feldman & Nelson: Canine and Feline Endocrinology and Reproduction, 2004)
ControlControl
1. O.H. at 6 months of age or before after breeding years
2. Post-partum reproductive system checking
3. Very rarely use contraceptive drugs
ConclusionConclusion
Canine pyometra : infectious cause of infertility
Occurrence : any bitch → clinical signs → after diestrus regardless of age
Confirmatory diagnosis : combination of diagnostics
OH : therapy of choice
PGF₂α therapy : ↑ success rates in open-cervix pyometra