Bacterial complications of involution in cattle (cause, symptoms, diagnostics, treatment)

Question 1

Puerperal metritis

Answer 1

• Acute, putrid inflammation of all uterine layers

* Most often around day 4 to 10 after calving, but can occur until day 21

Question 2

Puerperal metritis

Pathogensa

Answer 2

• Escherichia coli
• Fusobacterium necrophorum and other Gram-negative anaerobs
• Trueperella pyogenes

Question 3

Puerperal metritis

Risk factors

Answer 3

• dystocia
• assisted calving
• twins
• RFM
• NEB
• hypocalcaemia
• BUT! a number of cases happen without any of the above present!

Question 4

Puerperal metritis

Pathogenesis

Answer 4

• infection through the open cervix
• bacteria multiply quickly in the lochia and colonise the uterine wall – proteolysis – putrid
metritis
• endotoxins from dead Gram-negative bacteria are absorbed from the uterine wall due to it not
being covered by epithelium, and enter the blood stream– endotoxaemia

If the disease is characterised by endotoxaemia, it is called toxic puerperal metritis

Question 5

Puerperal metritis

Clinical signs

Answer 5

• Local findings:
o copious, reddish-brown, watery, smelly discharge that contains tissue debris
o rectal examination: uterus is large, the uterine wall atonic, sometimes thin, large
amount of fluid in the lumen
• General clinical signs (endotoxaemia):
o decreased milk yield!!!
o fever, tachycadia, decreased ruminal movements, anorexia, depression, dehydration,
recumbency
o prognosis of toxic puerperal metritis is poor

Question 6

Puerperal metritis

Diagnosis

Answer 6

• large-scale dairy farm – automatic detection of decreased milk yield/planned involution check – veterinary examination
• small farms – decreased milk yield + anorexia + sometimes foul smell– noticed by owner/worker – veterinary examination
• Examination:
o anamnesis
o body temperature ↑, heart rate ↑, ruminal contractions ↓
o rectal or vaginal examination (by hand or vaginoscope) – discharge is pathognomonic

Question 7

Puerperal metritis

Treatment

Answer 7

• endotoxaemia:
o fluid therapy - large volume – flushing the kidneys
o NSAID: (flunixin meglumine), ketoprofen, carprofen, meloxicam
• putrid metritis:
o AB: systemic cephalosporins (ceftiofur – Naxcel inj.), or local oxytetracyclin (Tetra-
bol 2000 uterine tablets) in case of a still sufficiently open cervix
o uterine contractions: oxytocin (until day 4 or 5), then PGF2α
o non-AButerinetreatments–ozone,iodofoam
o NO UTERINE FLUSHING

Question 8

Puerperal metritis

Prevention

Answer 8

• general hygiene
• calving hygiene
• hygiene of post partum uterine treatments
• nutrition during the dry peroid – avoid NEB and hypocalcaemia

Question 9

Clinical endometritis

Answer 9

• inflammation of the endometrium – other layers not affected
• after day 21
• Mucopurulent discharge
• Cervix diameter bigger than 7.5 cm
• No signs of general illness
• Self-healing ability
• Metabolic status influences
• PVD: purulent vaginal discharge = endometritis + vaginitis + cervicitis

Question 10

Clinical endometritis

Pathogen

Answer 10

• Trueperella pyogenes

Question 11

Clinical endometritis

Risk factors

Answer 11

• NEB
• puerperal metritis
• CL – P4 – immunosuppression

Question 12

Clinical endometritis

Pathogenesis

Answer 12

• local immunosuppression due to NEB or high P4 (after the first ovulation)
• uterine clearance ↓ - pyogenic bacteria ↑
• but! regeneration of the endometrial epithel is – barrier – remains localised

Question 13

Clinical endometritis

Clinical signs

Answer 13

• only local findings in the majority of cases: yellowish-white discharge with pus, uterus is bigger than normal, filled with thick, echodense fluid

Question 14

Clinical endometritis

Diagnosis

Answer 14

• routine involution check:
    o rectalpalpation/US
    o vaginoscopy
    o sample collection with a gloved hand 
    o Metricheck
• Discharge score:
    o 0: clear, translucent
    o 1:somepusflakes
    o 2: with pus but less than 50% 
    o 3:pusover50%

Question 15

Clinical endometritis

Treatment

Answer 15

• AB: uterine infusion (e.g. Metricure – cefapirin)
• iodofoam/ozone
• PGF2α

Question 16

Clinical endometritis

Prevention

Answer 16

• hygiene

* nutrition

Question 17

Subclinical endometritis

Answer 17

• inflammation of the endometrium WITHOUT CLINICAL SIGNS
• after day 21
• PMN: polymorphoneutrofils cells, inflammation in uterine lumen

Question 18

Subclinical endometritis

Pathogen

Answer 18

• Trueperella pyogenes

Question 19

Subclinical endometritis

Risk factors

Answer 19

• NEB
• puerperal metritis
• CL – P4 – immunosuppression

Question 20

Subclinical endometritis

Pathogenesis

Answer 20

• bacteria colonise the endometrium but multiply in a lower rate than in the clinical form
• PMN (polymorphonuclear) cells – e.g. neutrophils – appear in the uterine lumen
• local inflammation impairs endometrial function but the cycle can remain intact

Question 21

Subclinical endometritis

Clinical signs

Answer 21

• no clinical signs!!!

* fertility ↓ - affected animals fail to concieve after multiple services –recognizable when herd- level problem

Question 22

Subclinical endometritis

Diagnosis

Answer 22

• cytology:
    o cytobrush!!
    o (lavage)
• laboratory examination of the cytological sample:
    o PMN%:
        ▪ day 21 to 33: >18%
        ▪ after day 34: >10%
• Inflammation markers In sera
    o Haptoglobulins
    o Alpha 1 glycoproteins

Question 23

Subclinical endometritis

Treatment

Answer 23

• herd-level problem – find the cause (hygiene)
• individual:
    o AB(Metricure) 
    o iodofoam
    o ozone
• economy – culling of affected animals

Question 24

Pyometra

Answer 24

• inflammation of the endometrium with a closed cervix - rare
• after day 21

Question 25

Pyometra

Pathogen

Answer 25

• Trueperella pyogenes

Question 26

Pyometra

Pathogenesis

Answer 26

• clinical endometritis
• due to the inflammation of the endometrium the production of PGF2α is decreased or the produced PGF2α is used up locally – not enough in the bloodstream to induce luteolysis – persistent corpus luteum – cervix remains closed – fluid accumulation
• BUT! problem remains localised – no general clinical signs (↔ small animal)

Question 27

Pyometra

Clinical signs

Answer 27

• no obvious outward clinical signs, no estrus

* rectal examination: enlarged uterine horns filled with echodense fluid, presence of CL

Question 28

Pyometra

Diagnosis

Answer 28

• routine involution check (or pregnancy check)
• no discharge, uterine horns ↑, CL
• uterus US (differentiate from pregnancy)

Question 29

Pyometra

Treatment

Answer 29

• PGF2α – luteolysis (make sure it is not a pregnancy)

* wait 3 days– cervix opens– treat as clinical endometritis