Equine - Mare Infertility: Infectious Flashcards
What is the etiology of vaginitis and cervicitis?
Irritation from air, urine, particulate matter or chemicals or breeding or foaling trauma
How is vaginitis and cervicitis diagnosed?
speculum exam +/- culture
What will you see on a speculum exam with a mare that has vaginities and cervicitis?
hyperemic mucosa +/- discharge
What is the treatment for vaginitis and cervicitis?
Caslick’s procedure, +/- lavage with sterile saline, maybe antibiotics
How is vaginitis and cervicitis prevented?
Use a breeding roll with maiden mares, attend all foalings, and a Caslick’s procedure
What is salpingitis?
the inflammation of the fallopian tube
What is the etiology of salpingitis?
isthmitis, ampullitis, infundibulitis
80% of cases of isthmitis occur with _______.
endometritis
What causes ampullitis?
an ascending infection from endometritis
Why does it take longer for the ampulla to recover from infection?
because it has a highly folded mucosal surface
What causes infundibulitis?
adhesions from Strongylus edantatus larval migration
How is salpingitis diagnosed?
It is very difficult to diagnose - diagnosis by elimination
What is the treatment for salpingitis?
no definitive treatment - prostaglandin may be helpful
What is pyometra?
accumulation of excessive amounts of purulent material within the uterus
What is endometritis?
uterine infection involving the only endometrium
What is metritis?
uterine infection involving all of the layers of the uterus - endometrium, myometrium, and serosa
What diffenses does the uterus have?
uterine clearance and immune response
What are the mechanisms of uterine clearance?
muscular expulsion, open cervix, uterine position, and lymphatic drainage
Susceptible’ mares have what in regards to the immune response?
Diminished opsonic antibody mediated elimination activity, factors within uterine secretions that interfere with PMN phagocytosis, and a deficiency in antigen processing within the uterus due to decreased macrophage response
What is the pathogenesis of pyometra?
chronic infectious endometritis results in loss of endometrial glands and cervical fibrosis
What are the clinical signs of pyometra?
prolonged anestrus (or diestrus), +/- vulvar discharge, no systemic signs
Do you need a CL to have pyometra?
nope
How is pyometra diagnosed?
transrectal palpation and ultrasound, and vaginal speculum examination
What will transrectal palpation and ultrasound show in a mare that has pyometra?
enlarged, edematous, fluid-filled uterus, +/- CL on the ovary
What may you find on vaginal speculum examination on a mare with pyometra?
It may or may not have purulent discharge
How is pyometra treated?
prostaglandin and uterine lavage or surgery
How do you surgically treat pyometra?
create a cervical laceration to create an incompetent cervix to allow for future drainage
What is the most common cause of infertility in mares?
endometritis
What do mares that are susceptible to endometritis exhibit?
a breakdown in their defense system - immune response + physical barriers
What are the predisposing factors to endometritis?
contamination during breeding, compromised uterine defenses, pneumovagina and fecal aspiration, may also occur following prolonged antibiotic treatment, cervical adhesions, or hyperadrenocorticism
What makes a mare more susceptible to endometritis?
age, parity, poor perineal conformation, lack of uterine tone, diestral fluid, and estral fluid
What are the sources of infeciton in a mare?
anatomical defects, breeding, iatrogenic combination, and parturition
What anatomical defects can lead to infection?
defects in vulvar lips, vestibulovaginal sphincter, or cervix
True or False: We always create a mild form of metritis during breeding.
TRUE
How can breeding cause infection?
contamination in the semen due to bacteria on the penis and sheath, semen is foreign to the uterus, and susceptible mares are more at risk due to decreased clearance post-breeding
How can we iatrogenically contaminate a mare?
improper cleaning of perineal area and not using asceptic techniques
How can parturition lead to endometritis?
infection from the environment, trauma, and retained placenta
What are the clinical signs associated with pyometra?
dam is not systemically ill, shortened diestrus, uterine fluid accumulation +/- vulvar discharge (matting of tail hairs), and failure to conceive
How is endometritis diagnosed?
history and clinical signs, transrectal palpation, ultrasound, vaginoscopy, culture, cytology, and biopsy
What will you see on ultrasound in a mare with endometritis?
echogenic particles within intraluminal fluid +/- thickened uterine wall
What will you see on vaginoscopy in a mare with endometritis?
hyperemic mucosa +/- exudate
What bacterial agents are commonly associated with endometritis?
Strep zoo, E. coli, K. pneumoniae, P. aeruginosa
What fungal agents are commonly associated with endometritis?
Candida, Aspergillus, Mucor
What possible contaminants agents are associated with endometritis cultures?
Staph, Alpha-hemolytic streptococcus, Bacillus
Cytology is an immediate indicator of an _____ infection.
active
Does a negative cytology rule out endometritis?
no
What would a biopsy be done to determine with endometritis?
degree and type of inflammation
What can you assess on biopsy in an endometritis case?
cystic glands and lymphatic lacunae
What is the treatment for endometritis?
three-fold attack - uterine lavage, ecbolics, and antibiotics
What is the purpose of a uterine lavage?
to remove pathogens and debris
What is recommended to do to the fluid prior to uterine lavage?
it is recommended to warm it to increase uterine tone/circulation
What fluids can be used for a uterine lavage?
LRS, saline, or distilled water + salt (34 grams per gallon - 25 cc or one 60cc cap full)
What would you add to a uterine lavage to treat fungal infections?
2% vinegar
What would you add to a uterine lavage to improve opsonization?
homologous plasma
What would you add to a uterine lavage to inhibit endometrial adherence of S. zoo, E. coli, and P. aeruginosa?
Monosaccharide sugar solutions
What would you add to a uterine lavage for a post partum lavage?
betadine - 5cc per liter
What are the benefits of uterine lavage?
remove debris, improve uterine tone, and it can be performed 4-6 hours after insemination
What is the purpose of ebolics?
to enhance uterine contractility
When is the optimal time to use ecbolics?
use 4-12 hours post-insemination
What are the ecbolics that can be used for treatment of endometritis? What is the most common?
Oxytocin (most common), Lutalyse (dinoprost), and Estrumate (cloprostenol)
What antibacterials can be used to treat endometritis?
Gentamicin and Amikacin, Ampicillin and Penicillin, Ticarcillin, and Ceftiofur (Naxel)
What antifungals can be used to treat endometritis?
Clotrimazole, Miconazole, and Lufenuron (Program)
What are Gentamicin and Amikacin inactivated by?
organic material so make sure to do a uterine lavage beforehand
Ticarcillin is a ____ specrtrum antibiotic, but it is not effective against ______.
broad; Klebsiella
What antibacterial is safe to use around breeding? Characterize it?
Ceftiofur - broad spectrum, water soluble, and non-irritating
True or False: Only the uterus needs to be treated with anti-fungals.
false - the entire uterus, cervix, and vaginal vault are treated
When may Clotrimazole be indicated?
If there is a Candida fungal endometritis
When may Miconazole be indicated?
If there is a Candida or restistant fungal endometritis
What is the prognosis if there is a fungal endometritis?
poor
What are the options for systemic antibiotic treatment and are they recommended?
SMZ-TMP or Enrofloxacin - Not the best choice because therapeutic levels intrauterine are questionable, duration of therapy is usually prolonged, and it can get expensive
What is the pathogenesis of postpartum metritis?
Uterine defenses are compromised and the uterus becomes contaminated with a variety of pathogenic and nonpathogenic microorganisms
What are the predisposing factors to postpartum metritis?
Uterine inertia, uterine torsion, hydrops, dystocia, retained placenta, dirty foaling area, being a draft mare, and lack of exercise
When does postpartum metritis occur?
within 2 days postpartum
What clinical signs are associated with postpartum metritis?
voluminous, malodourous, reddish-brown, watery discharge and systemic illness
What systemic signs may a mare have with postpartum metritis?
febrile, depression, anorectic, ileus, tachycardia, tachypnea, endotoxemia, injected mucous membranes, laminitis, decreased milk production, increased neonatal losses
What agents may cause fatal toxemia in postpartum metritis cases?
Clostridium tetani and perfringens
How is postpartum metritis diagnosed?
Subinvoluted uterus, culture, cytolog, hemogram, and abdominocentesis
What diagnostic test is not recommended for postpartum metritis?
culture
What will you see on hemogram in a mare with postpartum metritis?
Increased PCV, leukocytosis with immature neutrophilia or neutropenia with toxic changes, increased fibrinogen, increased muscle enzymes and pre-renal azotemia
What is the treatment for postpartum metritis?
Correct the underlying problem, supportive care, systemic antibiotics and anti-inflammatories, uterine lavage, and ecbolics (oxytocin and prostaglandin)
When may you suspect biofilm as the cause of infertility in a mare?
The mare is having recurrent infections despite proper diagnositics/treatment
What are the treatment options for biofilm?
Infusions (n-Acetylcysteine, Tris EDTA, others), uterine lavages (following infusion), and intrauterine antibiotic therapy
When should a pre-insemination lavage be done?
immediately prior to breeding
What is the benefit to doing a pre-insemination lavage?
Excessive fluid accumulation and known fertility issues
What is the benefit to doing a post-insemination lavage?
Persistant post-breeding endometritis AKA delayed uterine clearance
When should post-insemination lavage be performed?
no sooner than 4 hours post insemination (usually wait 6-8 hours)
What is Persistent Post-breeding Endometritis aka Delayed Uterine Clearance (DUC)?
Inability to clear intraluminal fluid within 12-48 hours post-breeding
What is the pathogenesis of DUC?
Normal inflammatory response post insemination leads to an influx of PMNs into uterine lumen due to chemotactic effect of sperm. There is then a sustained inflammatory process after ovulation results in luteolysis +/- early embryonic death (prostaglandin release from endometrium)
What is DUC most common in?
Mares bred with frozen/thawed semen > cooled, shipped > liver cover
Use extender to mitigate
How is DUC diagnosed?
via ultrasound
What will you see on ultrasound in a mare with DUC?
excessive, echogenic, intraluminal fluid > 12 hours post breeding
How is DUC treated?
Uterine lavage (4-12 hours post-breeding) and Ebolics (4-24 hours post-breeding)
What ecbolics can be used to treat DUC?
Oxytocin and Cloprostenol
The probability of a successful pregnancy in a mare with DUC is significantly lower if a mare is bred more than _ cycles?
3
How is DUC prevented?
Use minimal contamination breeding techniques, clean mare and stallion before breeding, extend semen with appropriate antibiotics, use minimum insemination dose, and do not indiscriminately use intrauterine antibiotics
What are the three important equine venereal diseases?
Contagious equine metritis (CEM), coital exanthema, and Dourine
What is Contagious Equine Metritis caused by?
Taylorella equigenitalis
How is Contagious Equine Metritis transmitted?
Venereally, fomites, or in utero or intrapartum
Where does Taylorella equigenitalis live in the reproductive tract?
In the clitoral sinuses of the mare and urethral fossae of stallions
What clinical signs are associated with Contagious Equine Metritis?
Shortened diestral periods, copious mucopurulent discharge, severe and acute endometritis, and early abortion
When does Contagious Equine Metritis resolve?
In 14 days
How is Contagious Equine Metritis diagnosed?
clitoral sinus swabs
What is the process for getting a Contagious Equine Metritis diagnosis?
- Swab the clitoral sinus swab
- Transport the sample in Amies medium supplemented with charcoal within 24 hours off colleciton
- Cultured on chocolate blood agar by an accreditied lab
- The culture is incubateed for 48-72 hours under microaerophilic and aerobic conditions
Is Contagious Equine Metritis reportable?
yes
What is the recommended treatment for Contagious Equine Metritis?
It is sensitive to a wide range of antibiotics and antiseptics, intrauterine antibiotics, thorough cleaning of the clitoral fossa and sinuses, and a clitoral sinusectomy in mares that still culture positive after treatment
What do you want to clean the clitoral fossa and sinuses with in a mare with Contagious Equine Metritis?
chlorhexidine and packing with chlorhexidine or nitrofurazone ointment for 5-7 days
How is Contagious Equine Metritis prevented?
Mares should have a negative clitoral culture before and after arrival at a breeding farm AND a negative endometrial and clitoral culture during early estrus prior to breeding
What causes coital exanthema?
EHV-3
What clinical signs are associated with coital exanthema?
1-3mm painful vesciles (pustules/ulcers), appears 5-7 days after contact, genital area of mares and stalilions, permanent loss of pigmentation is common
When do mares typically heal from coital exanthema?
in 7-10 days
How is coital exanthema diagnosed?
clinical signs, serology, and intranuclear inclusion bodies in a histopathology sample
How is coital exanthema treated?
No breeding until the lesions resolve, antiseptic ointment can be used to prevent secondary bacterial infection
What causes Dourine?
Trypanosoma equiperdum
Where is Dourine found?
Africa, South America, Middle East, and Asia
What clinical signs are associated with dourine?
low-grade chronic fever, urticara, muscle wasting, collapse, death
What mare specific clinical signs are associated with Dourine?
mucoid vaginal discharge, edema
What stallion specific clinical signs are associated with Dourine?
scrotal and preputial edema extends to the ventral abdomen and chest
How is Dourine diagnosed?
Clinical signs/history, organism observed on smears/aspirates of plaques, discharges, CSF, and blood, and serologic testing
What is the treatment for Dourine?
none - euthanize to prevent spread
