A review of fungal endometritis in the mare

Fungal endometritis is a relatively rare cause of infertility in the mare, accounting for only 1–5% of all cases of endometritis. However, it remains a challenge to the clinician due to difficulties in diagnosing and effectively treating affected mares, resulting in a high rate of recurrence and a guarded prognosis for ongoing fertility. Often occurring as an opportunistic infection, the most common causes of fungal endometritis in the mare are yeasts (Candida spp.) and moulds with septated hyphae (Aspergillus spp.). Early detection and identification of the causative agent are vital when choosing appropriate treatment as sensitivities to commonly used antifungals vary significantly. Assessing in vitro sensitivity for each isolate is accordingly recommended. Treatment of mares with fungal endometritis is multifaceted and includes; correction of any anatomical defects, uterine lavage and systemic and/or intrauterine infusion of antifungals. Concurrent bacterial infection is common so anticipation and subsequent treatment of bacterial endometritis is also often required.     

Endometrial biopsy of the mare. A review and update

The endometrial biopsy is a safe and effective means of predicting a mare's prognosis for foaling. A thorough understanding of the normal cyclic and seasonal pattern displayed by the normal endometrium is necessary before interpreting pathologic changes. Several systems for prognostic classification have been proposed, including a recent one that combines many of the criteria used in the other systems.     

Ascending placentitis in the mare: A review

Ascending placentitis is a condition that occurs late in pregnancy when bacteria enter the sterile uterus from the lower reproductive tract. It leads to abortion or the birth of premature and weakened foals. Early detection and treatment of this condition is vital for ensuring the production of a viable foal.Mares with ascending placentitis often present in late term pregnancy with signs of premature udder development and premature lactation. There may be a vulvar discharge. Early detection of placental problems is possible using trans-abdominal or trans-rectal ultrasonography. Hormones such as progesterone and relaxin may be measured as indicators of foetal stress and placental failure. Postpartum foetal membranes may be thickened and contain a fibronecrotic exudate. The region most affected is the cervical star. Definitive diagnosis of ascending placentitis is by histopathological examination of the chorioallantoic membrane.Ideal treatment strategies are aimed at curing the infection and prolonging the pregnancy to as close to term as possible and consist of anti-microbials, anti-inflammatories and hormonal support.Swabs are taken from affected mares to determine antibiotic sensitivity and to aid in treatment of foals born from these mares which are at risk of becoming septic. If detected early enough, the chances of producing a viable foal are greatly increased.     

A review of mare endometritis in Iran

One hundred eleven mares were examined and selected on the basis of some criteria (history of recent genital discharge and/or abortion, dystocia, retained placenta, rectovaginal rupture and/or failing to conceive after repeated services), rectal palpation, and ultrasound examination of genital tract. The mares were classified in 3 groups (young, middle age and old). During estrus, a specimen was taken by uterine swab and endometrial biopsy. Endometritis was diagnosed and graded on the basis of pathology results and treatment was done on the basis of culture and antibiogram tests. At the first step of treatment, uterine lavage with warm saline followed by intrauterine administration of a specific antibiotic, or povidone iodine solution, was done daily during estrus. If the mare had not responded to the first treatment, in the next steps systemic antibiotic therapy was also added to the mentioned treatment. The results showed that Escherichia coli was the most frequently isolated pathogen and response to the treatments was significantly better in the young mares with category IIA fibrosis of uterine pathology than that of two other groups. It was also found that there is no relationship among age and kind of pathogen to mare endometritis.

Introduction

Bacterial endometritis is the most common cause of subfertility.[1, 2, 3 and 4] In 1992, Kenney argued against the general use of the term “endometritis” to describe the two often quite separate conditions of endometrium: the degenerative changes often associated with age and parity. He suggested the use of the term “endometriosis” instead of the term “chronic degenerative endometritis” (CDE): the inflammatory infection that is divided to “acute endometritis” and “chronic infiltrative endometritis” (CIE). [5]In some mares, the bacteria becomes established and uterine infection develops in which the sources of uterine contamination include coitus, parturition, and reproductive examination.[2, 4 and 6] These mares remain persistently infected and are termed “susceptible” mares, which may have conformation defects such as pneumovagina, uterine pooling, and foaling injuries, which predispose them to endometritis. [7] There are some data indicating that age, parity, and barren years may have important bearing on the breeding prognosis of the mare. [8 and 9] In general, loss of resistance to infection is associated with advancing age and multiparity, factors that are frequently associated with increasing value of mares. [10] By far, Streptococcus zooepidemicus followed by E coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae are the most frequently isolated pathogens,[7 and 10] but there are a few reports that E coli, K pneumoniae, and Corynebacterium spp. are the most frequent isolates.[4 and 11] Endometrial cytology and culture samples often reveal evidence of inflammation and infection. To improve reproductive management of mares in Iran, this study was conducted to assess main causes of mare endometritis and also the relation of age and kind of pathogen to mare endometritis, plus the efficacy of treatment methods in problem mares.

Materials and methods

One hundred eleven mares of different breeds (Thoroughbred, Arab, cross-bred, and two native breeds including Kord and Turkaman) from 4 to 26 years of age were examined and selected during April 1996 to June 2001. They had a history of recent genital discharge and/or abortion, dystocia, retained placenta, rectovaginal rupture, and/or failing to conceive after repeated services. The sanitary condition of the foaling boxes was also noted. The mares were classified in three groups according to the age: (1) young (4-9 years old), (2) middle age (10-14 years old), and (3) old age (≥15 years old).Each mare was restrained in a stock. The vulvar discharge and pneuomovagina were recorded if present. Rectal palpation and ultrasound examination of genital tract were done to determine uterine tone and presence of uterine fluid. During the estrus, a double-guarded swab was passed per vagina into the uterus. The swab was kept in contact with the endometrium for a minimum of 20 seconds and was placed in transport media. In the laboratory the swab was cultured as described by Rickets.[12] An endometrial biopsy specimen was also taken, fixed, and processed as described by Rickets. [13] Endometritis was graded as described by Kenny and Doig. [14] Briefly, they are Grade I (Absent), Grade IIA (Mild), Grade IIB (Moderate), and Grade III (Severe). After specifying the causal organism of endometritis, treatment was done on the basis of culture and antibiogram tests as described by Asbury et al, [10] the antibiotics used for treatment were: gentamicin (intrauterine administration, 2-3 g), amikacin (2 g, intrauterine administration), potassium penicillin G (5 million units, intrauterine administration), and chloramphenicol (3 g, intrauterine administration). [10 and 15] A diluted solution of povidone iodine (0.2%) as uterine lavage was also used in cases whose uterine culture results were yeasts. The following protocol was carried out to treat bacterial endometritis at the first step:Uterine lavage with warm saline followed by intrauterine administration of specific antibiotic or povidone iodine (on the basis of uterine culture and antibiotic sensitivity test results) was done daily during estrus. Casslick operation was done in pneuomovaginal cases. In the next estrus, the uteri were examined by rectal palpation and ultrasonography procedure. If they were involuted, had enough tone and had no fluid, the mares were clinically defined to be treated and bred artificially with fresh semen collected from an approved fertile stallion (about 500 million progressive motile sperm) in Kenney's extender. If there was recurrent endometritis or the uterus was not involuted and/or had not enough tone or had some fluid in it, another specimen was taken by a double-guarded swab. On the basis of culture and antibiotic sensitivity test results, mares that had not responded to the first treatment were treated again with the first step protocol plus systemic antibiotic therapy (gentamicin, amikacin, or procaine penicillin G in bacterial-caused endometritis) or just flushed the uterus with saline and 0.2% povidone iodine solution (in yeast-caused endometritis and/or endometriosis). This treatment was also carried out daily during the estrus. Some of the mares that had not responded to the second treatment protocol were treated again (based on uterine culture and antibiotic sensitivity test results) for one to two times more in the next estrus phases as in the second step. The data were analyzed by χ² test.

Results

Table 1 shows the pathogens isolated in three successive cultures from the uteri of the mares. Among 197 swabs were taken from the uteri of 111 mares, the cultures were positive in 175 instances in which the mixed organisms were isolated in 20 cases. The interesting point in these 3 successive cultures was the persistence of one Klebsiella infection detected in a mare belonging to the second group, in the all-performed treatments. The isolated P aeruginosa in a mare belonging to the third group had the same result. The combination of Candia albicans with E coli and/or E coli with Enterobacteriaceae were the most common feature of mixed micro-organisms isolated in the culture plates.     

Mammary secretions in normal spontaneous and induced premature parturition in the mare

Total calcium, total protein, albumin and globulin content were determined in 49 samples of mammary secretions from 37 crossbred and Thoroughbred mares. The mares were divided into three categories: Group 1--post partum samples from spontaneous full term Thoroughbred deliveries (n = 20); Group 2--pre- and post partum samples from spontaneous full term Thoroughbred deliveries (n = 6); Group 3--pre- and post partum samples from induced premature deliveries in crossbred mares (n = 11). Calcium concentrations of the mammary secretions proved useful in predicting full term and also in assessment of the chances of foal survival in prematurely induced parturition. Mean (+/- se) calcium levels in full term mares that foaled spontaneously (Group 1) were 10.6 +/- 2.7 mmol/litre on the day of parturition. However lower values than this did not necessarily mean parturition would not take place. In Group 2 mares, calcium levels were 4.1 +/- 0.8 mmol/litre just before foaling and rose to 9.2 +/- 1.5 mmol/litre within 20 mins of parturition; an increase of 124 per cent. Group 3 mares, induced prematurely, showed poor foal survival if pre-partum calcium levels were less than 3 mmol/litre. Total protein, albumin and globulin concentrations showed a similar trend but the increase just before or during parturition was much less marked.     

Use of dexamethasone for induction of parturition in goats

Parturition was induced in 5 goats of Beetal and Beetal x Black Bengal cross in advanced stages of pregnancy, using intramuscular injection of 10 mg of dexamethasone. Goats required 47.7 +/- 1.26 hours on average after injection for parturition. There were no deleterious effects of induction on placental expulsion, kid weight, kid survival, and postpartum fertility of does. Plasma concentrations of progesterone and oestradiol 17 beta followed a similar trend in controls and treated animals. While plasma progesterone concentrations declined before parturition, the oestradiol concentration rose to its peak on the day of parturition.     

Massive rupture of the abdominal wall with herniation in a mare at parturition

Abstract

Extract

Roberts (1956) Roberts, S. J. 1956. Veterinary Obstetrics and Genital Diseases, 1st ed., 99–100. Ithaca, N.Y.: Author.  [Google Scholar] refers to this condition as rupture of the prepubic tendon. While the condition he describes is nearly identical with that reported here, there was, in the present case, rupture of individual muscle layers cranial to the prepubic tendon. Another inconsistency is that this was a relatively light hack whereas Roberts describes the condition as occurring most commonly in heavier draught mares.     

Transmural rectal intestinal evisceration associated with parturition in a primiparous mare

A 6-year-old, primiparous standardbred mare was presented with a history of intestinal protrusion from the rectum shortly after parturition. A subacute grade IV rectal tear was diagnosed. The unusual nature of the tear led to speculation of a possible owner palpation accident. A grave prognosis was given and the mare was euthanized.     

A review of equine rectal tears and current methods of treatment

Rectal tears are a risk of rectal palpation during equine clinical examination and can be life‐threatening; prompt medical and surgical intervention is required to improve patient outcome. Depending on the degree of the tear, conservative treatment or surgical management may be warranted. Surgical management involves either direct suturing or faecal diversion techniques, such as colostomy or a temporary indwelling rectal liner. The prognosis for a horse with a rectal tear depends on size of the tear, grade and location of the tear, and time between occurrence and first aid measures.     

Granulosa cell tumours in the mare: A review of 52 cases

Granulosa cell tumour (GCT) is reported to be the most common ovarian neoplasm in the mare. A multicentre retrospective study evaluating the medical records of horses undergoing ovariectomy for treatment of a GCT was undertaken, documenting the presenting clinicopathological features, treatment and outcome. Follow‐up information was obtained by telephone questionnaire. Fifty‐two mares were included. Most presented with behavioural/reproductive abnormalities, including stallion‐like behaviour (50%), aggression (31%), prolonged oestrus or nymphomania (19%), and persistent anoestrus (8%). Most (93%) affected ovaries had a multilocular appearance when examined ultrasonographically. Only 60% of horses with histopathologically confirmed GCTs demonstrated elevations in serum inhibin concentrations. Twenty‐five percent of horses had histopathologically confirmed bilateral GCTs. Ninety‐four percent of horses that underwent ovariectomy were discharged from the hospital. Standing laparoscopic ovariectomies had a lower complication rate (34%) than other surgical methods. Long‐term complications were uncommon (11%). In conclusion, histopathologically confirmed GCTs can occur in the presence of normal serum inhibin concentrations. The high prevalence of bilateral GCTs indicates that thorough evaluation of the contralateral ovary is necessary. Surgical ovariectomy for treatment of GCTs has favourable short‐ and long‐term outcomes. Standing laparoscopic ovariectomy may be associated with a lower complication rate than other surgical methods.