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Canine Pyometra

Vivek Joshi
Ph.D Scholar
Division of Medicine
Overview
1. Introduction
2. Types
3. Predisposing Factors
4. Aetio-pathogenesis
5. Clinical signs
6. Diagnosis
7. Differential diagnosis
8. Treatment
9. Control
10. Conclusion
Introduction

 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


Pyometra

 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-Complex
Cystic Endometritis Pyometra
endometrial
hyperplasia
cysts 1 mm-1 uterine uterine
or more cm intraluminal intraluminal
diameter of diameter of
< 1 cm > 1 cm
CEH-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 diffuse acute Chronic


endometrium plasma cell endometritis endometritis,
with infiltration metritis or squamous
translucent pyometra metaplasia
cysts
“Open” or “Closed” cervix

1. Closed pyometra

2. Open pyometra

3. Stump pyometra
 inflammation/ bacterial infection→uterine body
remnant

 Severity of signs : cervix patency


INCIDENCE

Pyometra : 23-24% before 10 yrs


(Egenvall et al, 1999)
(Tamilnadu J. Veterinary & Animal Sciences 7 (5) 252-253, September-
October, 2011)
Predisposing 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)
Pathogenesis
1) Hormonal influence on uterus
2) Virulence of infecting bacteria
3) Ability of bitch to combat infection
4) Individual sensitivity

 Growth factors & their receptors (growth factors


receptors, GFs)
(Gama et al. 2009)
Hormonal 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 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; rare
light brown, green or
yellow
Temperature normal/ slightly elevated/ sub-normal
elevated (toxemic bitch)
Lethargy/ depression + +

Vomiting + +

Polyuria/ polydipsia + +

 Clinical signs : 4-8 wks following last standing heat


Diestrus bitch with purulent vaginal discharge
Mechanism 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 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


Ultrasonography
 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
Radiography
Abdominal Radiography
 tubular structures of fluid density/ opacity in caudal
abdomen

 Not specific for pyometra


Clinical 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)
Treatment

Surgical
 Ovariohysterectomy is treatment of choice

 severely ill bitches : aggressive fluid therapy & broad


spectrum antibiotics

Transcervical Endoscopic Catheterisation (TECT)


(Verstegen et al., 2008)
Medical

Indications:
 further breeding

 O.H. not possible : intercurrent disease (CHF)

 owner refuses surgery


1. Antibiotics
 in every case
 G(-) and G(+) efficacy
 according resistogram as soon as possible

 Quinolones (Enrofloxacin/Marbofloxacin)
 Gentamicin
 Cefalosporins
2. Prostaglandin F₂α/ PGE

Natural
0.02 mg/kg SC PGF₂α Synthetic
bid 7-10 days 0.001– PGF₂α
0.002 mg/kg SC OD
7-10 days

Day 1 : 0.1 mg/kg Longer duration of action


Day 2 : 0.2 mg/kg
Day 3-7 : 0.25 mg/kg OD

Dinoprost Cloprostenol
(Lutalyse®) (Cyclix®)
3. Antiprogestins

 Aglepristone
10 mg/kg SC

 day 1, day 2, day 7

 once a week
4. Antiprolactins
Cabergoline (Cabgolin®)
 0.005 mg/kg PO OD 7-10 days
5. Supportive therapy

 IV fluids (Lactated Ringer’s sol. /Glucose 5%)


 H₂ blocker : Metoclopramide
(vomiting / nausea)
 NSAIDs
 Antihistaminics
 Anticholinergics (excess salivation)
Prostaglandins Open-Cervix Closed-Cervix
Results Pyometra Pyometra

Complete 94 % 31 %
resolution

Whelped litter 88 % -

Recurrence 26- 40 % within 1 year

(Feldman & Nelson: Canine and Feline Endocrinology and


Reproduction, 2004)
Control
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


Conclusion
 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