Equine Endometritis, Venereal Disease, Retained Cups Flashcards
Endometritis involves only the _______
Endometrium
Metritis involves ______
Deeper tissues, including the myometrium
- severe sequela include peritonitis and laminitis
______ is the #1 cause of reduced fertility in mares
Endometritis
Uterus is contaminated via
- parturition
- natural breeding
- repro exams
- AI
- poor conformation
How do normal mares respond to uterine contamination?
Transient inflammatory response
- PMNs, phagocytosis, uterine contractions, PGs
- able to clear bacteria/infection and fluid
Susceptible mares
Unable to clear the infection due to a breakdown in their uterine defense mechanisms
- prone to persistent post-mating endometritis, chronic endometritis
- 15% of mare population are “susceptible”
Mating induced endometritis
Inability to clear uterus of fluid after breeding
- 15% of broodmare population affected
- must examine mares after breeding, observe fluid
Bacterial causes of endometritis
- streptococcus zooepidemicus
- e coli
- pseudomonas aeruginosa
- klebsiella pneumoniae
Yeast/fungi causes of endometritis
- candida
- aspergillus
- mucor
Diagnosis of endometritis
- external signs
- speculum findings
- endometrial swabs
- endometrial biopsy
- small volume uterine lavage/cytology
Treatment options
- correct underlying problem
- antimicrobials
- ecbolic agents
- uterine lavage
- intrauterine antiseptics
How to correct conformational defects
- caslick’s (pneumovagina)
- urethral extension (urine pooling)
- cervical injuries
Local antibiotics
Intrauterine vs infusion
- penicillins, ceftiofur, gentamicin, ticarcillin
- use caution “resistance”
Systemic antibiotics
Some antibiotics reach therapeutic level in the uterus after systemic administration
- baytril, amikacin, TMS/SMZ
When do you use antibiotics?
Treat concurrently during same cycle they are bred
Uterine lavage
Large bore catheter placed in uterus
- lavage with large volumes of LRS or saline (3 liters)
- add antiseptics (5cc of betadyne/liter)
- physically flushes uterus of contamination and stimulates influx of neutrophils
Fungal metritis
Secondary to repeated antibiotic administration
- chronic
- hyphae seen on cytology/biopsy
- cultured from uterus
- guarded prognosis
Fungal metritis - treatment
- correct any conformational defects
- antifungal agents
- other
Ecbolic agents
Stimulates myometrial contractions, which expel fluid from the uterus
- oxytocin: immediate response
- cloprostenol (synthetic prostaglandin): prolonged response (2-4 hrs), can cause mild colic
Newer therapies
- acetyl cysteine
- DMSO
- buffered chelating agents
- corticosteriods
Managing susceptible mare
- use minimal contamination breeding
- uterine lavage prior to max inflammation
- ecbolics as needed
- follow-up exam to verify fluid has been evacuated
Venereal disease - route of transmission
- coitus
- contaminated instruments
- personnel can act as mechanical vector
- common in natural mating situations (prevalence is low in situation of AI use)
Contagious equine metritis
Taylorella equigenitalis
- gram neg microaerophilic coccobacillus
Transmission of CEM
- coitus
- careless handling of genitalia
- contaminated instruments: breeding roll, artificial vagina, speculum
- many mares are infected, but few become carriers
- clitoral fossa is preferential site of colonization
Clinical signs of CEM
- copious vaginal discharge (grey, 8-10 days after breeding)
- no clinical signs in stallions
- mares go unnoticed
Diagnosis of CEM
- culture: most reliable, amies transport media w/ charcoal or chocolate agar + 10% horse blood
- serologic testing (mares only)
CEM - mare treatment
- antibiotics for 3-5 days
- pack clitoral fossa: nitrofurazone, chlorhexadine, silver sulfadiazine
- clitoral sinusectomy
- culture to confirm clearance
CEM - stallion treatment
- thorough cleaning of penis and prepuce (chlorhexidine)
- apply nitrofurazone dressing
- repeat for 5 days
- culture to confirm clearance
- treatment/control is highly regulated by USDA
Control of CEM
- strict hygiene
- ID of positive animals and treatment
- use of sterile disposable equipment
- quarantine of imported animals with testing protocol
- reportable disease
Pseudomonoas and Klebsiella
Venereal route of infection
- sexual transmission depends on balance of organisms on the penis of stallions –> discourage vigorous cleaning of stallion penis
- need for normal commensal organisms –> compete with pathologic bacteria
E coli and Strep zoo
Seen in mares with marginal to poor perineal conformation
- not thought to be transmitted by venereal route
- treat and manage like routine endometritis
Retained endometrial cups
- formed at 35-45 days of pregnancy
- remain until day 120-140 of pregnancy, even if fetus dies
Cups produce _____
eCG
- retained cups cause erratic and frustrating cycles with pregnancy never occurring
- dx with US/endoscopy and eCG testing
