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.     

Ovarian teratoma and endometritis in a mare

An 8-year-old Arabian mare was admitted for a large ovarian anovulatory follicle. A clinical diagnosis of ovarian tumor and endometritis was established. Histological examinations revealed an ovarian teratoma and a grade II endometritis. Three months after unilateral ovariectomy, the mare was confirmed pregnant and eventually gave birth uneventfully.     

Subclinical fungal endometritis in an 8-year-old Hanoverian mare

Clinical and subclinical endometritis are leading causes of reduced reproductive efficiency in the mare. Clinical endometritis is relatively easy to diagnose during routine physical and ultrasonographic reproductive examinations, whereas the diagnosis of subclinical endometritis requires a more detailed work-up. The goal of this paper is to review the various options, and describe the regimen chosen in a mare with subclinical fungal endometritis.     

Persistent breeding-induced endometritis after hysteroscopic insemination in the mare

Low-dose insemination has been proposed to reduce persistent breeding-induced endometritis (PBIE) in mares with delayed uterine clearance (DUC). Others proposed that hysteroscopic insemination induces an exaggerated inflammatory response and should be avoided in DUC mares. The objectives here were to evaluate presence and severity of PBIE in normal and DUC mares after hysteroscopic insemination with fresh semen, and to determine if hysteroscopy could be used in DUC mares without inducing excessive inflammation. Reproductively normal (n = 4) and DUC (n = 5) mares received four treatments in random order: uterine body insemination (UB, 1 × 10(9) spermatozoa, 20 ml), hysteroscopic insemination (HYST, 5 × 10(6) spermatozoa, 0.5 ml), sham hysteroscopic insemination (SHAM, semen extender, 0.5 ml) and hysteroscopic infusion of seminal plasma (SP, 0.5 ml). Significantly more DUC (50%) mares than normal (14%) mares accumulated intrauterine fluid 24 h post-treatment. The difference in fluid accumulation between DUC (40%) mares and normal (7%) mares was also significant 48 h post-treatment. Fluid scores were not significantly different between treatments in normal mares. However, treatments HYST and SHAM resulted in significantly higher fluid scores 24 h but not 48 h post-treatment in DUC mares. There was no effect of treatment or mare group on the percentage and total number of neutrophils in uterine fluid 48 h post-treatment. Percentage of neutrophils was correlated with duration of hysteroscopy in normal mares, with procedures lasting ≥ 9 min associated with PBIE. There was no effect of mare group, treatment or duration of hysteroscopy on pregnancy rate. Hysteroscopy induces a transient inflammation that is not more severe than that after conventional artificial insemination, suggesting no contraindication to its use in DUC mares.     

Equine post-breeding endometritis: A review

The deposition of semen, bacteria and debris in the uterus of the mare after breeding normally induces a self-limiting endometritis. The resultant fluid and inflammatory products are cleared by 48 hours post cover. Mares that are susceptible to persistent post-breeding endometritis (PPBEM) have impaired uterine defence and clearance mechanisms, making them unable to resolve this inflammation within the normal time. This persists beyond 48 hours post-breeding and causes persistent fluid accumulation within the uterus. Mares with PPBEM have an increased rate of embryonic loss and a lower overall pregnancy rate than those without the condition. To enhance conception rates, mares at high risk need optimal breeding management as well as early diagnosis, followed by the most appropriate treatment. This article reviews the pathogenesis, diagnosis and treatment of PPBEM and the management of affected mares.     

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.     

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.     

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.     

Advances in synchronizing estrus and ovulations in the mare: A mini review

Synchronization of estrus (SE) in mares has been achieved, but not of ovulation (SO). Progestins followed by PGF_2a are useful for SE only. In the two studies reviewed here, SE and SO were attempted by using CIDR-B, an intravaginal (itv) progesterone (1.9 g) releasing device, alone (study 1) or accompanied by estradiol (10 mg) given also itv (study 2). In both studies, Ovuplant™ (OT), an implant containing 2.1 mg of the GnRH analog deslorelin was used for the control of ovulation. Eighty cycling Hanoverian mares, 40 each in studies 1 and 2, received CIDR-B itv for 12 days, with PGF_2a given once at CIDR-B removal. In study 1, 15 mares each received OT when the lead follicle had reached 40 mm (A) or on Day 3 of estrus (B); 10 controls received no OT (C). In study 2, E2 was used in addition on Day 0 (CIDR-B insertion) (10 mares; group II), or on Days 0 and 7 (10; group III) or not (20; groups I and IV). Mares in groups I to III received OT as in study 1 (A); group IV (10) remained untreated. Ovaries were examined and blood samples were taken in studies 1 and 2 from all mares in 1, 2 or 4-day intervals, respectively, and concentrations of FSH, LH, progesterone and estradiol were determined by RIA. In study 1, CIDR-B treatment achieved SE, but not SO as shown by a wide spread of days on which follicles were reaching 40 mm; OT treatment assured ovulations in 48 hours in 93.3% of treated mares vs. 44.4% in controls (P<0.05. In study 2, SE was achieved and SO, but only when estradiol was given once (itv) on Day 0 (group II) but not twice on Days 0 and 7 (group III). In both studies, CIDR-B prevented estrus but stimulated follicle growth: 8 mares in study 1 ovulated with CIDR-Bs in place and 2 in trial 2, respectively. Only when estradiol was used together with CIDR-B, follicle growth was retarded (group II) or suppressed (group III: P<0.05 vs. groups I and IV). The pregnancy rate in study 2 from a single breeding at the first estrus was 52.8% with no significant differences between groups. FSH rose until Day 4 or 8 and had dropped sharply at Day 12; after CIDR-B removal FSH rose most quickly in group II, study 2. LH declined slightly until Day 12 and rose thereafter, reaching peak levels by Day 18 or 20, respectively. In both studies, estradiol had dropped slightly by Day 4 but increase steadily thereafter until ovulation had occurred. Preovulatory rise and postovulatory drop was seen earlier in group II, study 2. Values for progesterone had risen uniformly by Day 4, had declined slowly by Day 12 and precipitously in response to PGF_2a by Day 14. Treatment of cyclic mares with CIDR-B for 12 days, followed by PGF_2a at the day of CIDR-B removal and by Ovuplant™ a deslorelin implant when a follicle had reached 40 mm, resulted in synchronization of estrus. Adding to this scheme a single dose of estradiol (10 mg, intravaginal) on Day 0 resulted also in synchronization of ovulation.     

A critical review of current methods for induction of parturition in the mare.

The efficacy and safety of oxytocin, dexamethasone and prostaglandin, used alone or in combination as inducing agents, are discussed. It is contended that insufficient evidence exists to support the routine application of any of these methods in practice. Oxytocin has been the most widely used and it is claimed by some to be free from side effects. However, the synthetic prostaglandin analogue, fluprostenol, seems to pose the least risk to the foetus and dexamethasone appears to be either ineffective, or too dangerous to use at all. The main indications for induced foaling are managerial convenience or for research and teaching purposes. There are few clinical indications, although ventral rupture and cases of prolonged gestation have been mentioned by various workers. It is considered that foetal maturity is the pre-requisite before a decision to induce should be made in practice, and 3 criteria are essential: 1) a gestational length of greater than 320 days, 2) substantial mammary development, 3) the presence of colostrum in the mammae.     

Abnormal umbilical cord attachment sites in the mare: A review illustrated by three case reports

Abnormal cord attachment can be a manifestation of an inappropriate fixation position of the conceptus in the uterus, or it may result from disorientation of the conceptus post fixation. The potential for this resulting in fetal and neonatal compromise is reviewed in the light of previous reports and to which 3 cases within the authors' experience are added.     

Prevalence of human visceral leishmaniasis in Iran: A systematic review and meta-analysis

Leishmania infantum is the main cause of human visceral leishmaniasis (HVL; also known as kala-azar) in the Middle East and may be fatal if left untreated. This disease was first reported in 1949 in Iran. Despite marked improvements in hygiene and sanitation conditions, the disease is still endemic in some parts of Iran. It is difficult to determine the current prevalence of HVL in Iran due to the scarcity of comprehensive studies in this regard. In response to this gap, a systematic review and meta-analysis was conducted to gain better understanding of HVL epidemiology in the general population of Iran. English and Persian databases were searched for studies reporting the prevalence and risk factors associated with HVL in the Iranian people from January 1995 to December 2019. The reported data were selected according to inclusion and exclusion criteria. The pooled prevalence of HVL infection and its 95 % confidence intervals were calculated. Quality assessment, heterogeneity testing and publication bias assessment were also done. Literature search revealed 3634 studies, of which 35 studies met our eligibility criteria, with a total of 50,716 individuals. The meta-analysis was performed on 31 out of 35 included studies. The estimated pooled prevalence of HVL infection according to seropositivity was 2% (95 % CI: 1–2%) in the general population of Iran in which western and northern provinces had the lowest and the highest prevalence, 0.5 % (95 %CI, 0.2−0.7%) and 3% (95 %CI, 1–5 %), respectively. The seroprevalence of HVL among females (2%; 95 %CI, 1–2 %) was more than males (1%; 95 %CI, 1–2 %). The ≤10 and >10 years age groups had similar seroprevalence rates (1%, 95 %CI, 1–2 % versus 1%, 95 %CI, 0–1 %, respectively). There was no significant difference in terms of geographic area, age and sex. Of 31 studies included in the meta-analysis, the most common diagnostic test was the direct agglutination test (96.77 %). To the best of our knowledge, this is the first systematic review of the prevalence of HVL in Iran. The results showed a low seroprevalence of HVL infection. However, the lack of published reports of HVL in an area does not exclusively mean the absence of the disease or carrier. We therefore recommend further studies in this regard.     

A case of verminous mastitis in a mare

This report describes bilateral mammary gland infection with a previously unidentified Cephalobus species of nematode. Only one previous case of verminous mastitis due to a Cephalobus species has been reported, pre-dating the widespread use of molecular diagnostics. This report describes the case presentation and management, as well as the morphological and molecular methods of nematode identification.     

Subclinical endometritis in dairy cattle and its effect on fertility--a review of recent publications

Reduced reproductive performance in dairy cattle is often caused by uterine disorders. Beside acute metritis and chronic endometritis recent reports on a negative impact of subclinical endometritis on reproductive performance have been published. Diagnosis of subclinical endometritis can be performed by ultrasonography or cytological examination of the uterus. The cytological examination is based on uterine lavage or the cytobrush-method. Prevalence of subclinical endometritis in different studies ranges from 16 to 90 percent and depends on the diagnostic method and the time postpartum when the examination is performed. Affected cows showed significantly decreased conception rates, prolonged days to first service and days open as well as a reduced number of cows pregnant. Studies on the treatment of subclinical endometritis with prostaglandin F2alpha or analogues, intrauterine antibiotics or proteolytic enzymes showed heterogeneous results and do not allows valid recommendations for veterinary practice.     

A review of the contemporary knowledge of bovine tuberculosis and government policy in Iran

In 1931 Carpantier reported bovine TB (BTB) in Iranian cattle. Some eighty years on with a national test-and-slaughter programme in place for over four decades, the efforts to vanquish Mycobacterium bovis (M. bovis) infection in cattle have been in vain as the vast majority of the 30 Iranian provinces still have reports of BTB in their cattle herds every year. This paper reviews the present epidemiology of BTB in Iran and in the region and evaluates the success of government policy in controlling this disease.