14. Infectious Infertility in the Mare

What is it called when there is a uterine infection involving the only endometrium?

Endometritis

What is it called when there is an uterine infection involving the deeper layers of the uterus (myometrium

Metritis

What is it called when there is an accumulation of excessive amounts of purulent material within the uterus?

Pyometra

Do most mares do well and recover well with a pyo?

yes (weird)

T/F Normal mares are resistant to persistent endometritis

True

Mares susceptible to what exhibit a breakdown in this defense system?

Endometritis

What is the key to improving fertility in susceptible mares?

identify them before breeding and manage them correctly

What are some of the different parts of a physical exam?

•Physical Exam (general)

•Perineal Conformation

•Transectal Palpation/Ultrasound

•WASH

•Culture and Cytology

•Vaginal/Cervical exam

-Digital

-Speculum

•Biopsy

What are some things that make a mare susceptible to infectious infertility?

•Age

•Parity

•Perineal conformation

•Lack of uterine tone

•Fluid of any amount during diestrus

•Fluid more than 2 cm during estrus

What are FOUR sources of infection in susceptible mares?

•Anatomical Defects

•Parturition

•Breeding

Iatrogenic Contamination

Where are THREE common anatomical defects that lead a mare to susceptible infertility?

•Vulva

•Vestibulovaginal Sphincter

•Cervix

In normal mares, we like to see more than __%__of the vulva below the pelvic brim.

75%

T/F the cervix can also be problematic if if cannot relax properly, such as with excess scarring.

True

When do you typically see the cervix being an issue when it comes to being a good physical barrier?

during estrus (you lose the physical tone of the cervix)

Why do equine vets recommend tying the placenta up above the level of the hocks?

retained placentas also place the mares at risk for EM that may lead to life threatening things such as endotoxemia and laminitis and the placenta can also act as a wick for bacteria into the cervix

What do you need to make sure happens to the stallion during the breeding process?

-Wash

-Culture

-Antibiotics in extender

Stallions can harbor bacteria on their ___ and ___ and can contaminate mares physically during live cover breeding, or through artificial insemination if the bacteria is in the semen

penis, sheath

Stallions should be washed with warm water prior to breeding, even in a live cover breeding program. Is the meant to sterilize the penis?

no, just meant to remove gross debris

To (decrease/increase) the bacterial load in semen, most extenders contain antibiotics that help eliminate this source of bacterial contamination in the mare

decrease

T/F Mares that are susceptible to EM associated with breeding tend to have a problem with decreased uterine clearance which is a major cause of recurrent EM.

True

If there is decreased clearance post breeding, what are TWO things that can happen because of this?

•Dependent (saggy) uterus

•Suboptimal myometrial contractions

Due to iatrogenic contamination, you have to make sure that there is proper cleaning to what area of the mare?

perineal area

T/F Veterinarians can cause endometritis

True

How should you clean the perineal area?

- Proper cleaning technique needs to include an antibacterial soap such as betadine or nolvasan.

- The tail needs to be secured out of the way, ideally with a tail bag. The scrub needs to be a sterile scrub starting at the vulvar lips and extending outwards.

- This should be repeated at least 3 times for a contact time of at least 5 min. The area then needs to be dried, starting at the vulvar lips.

- Any water left from cleaning can drip into the vulva or onto your sterile sleeve and carry bacteria with it.

this mare, the ___ ___ has a tremendous amount of debris, which, if not cleaned, can be unknowingly carried into the uterus

clittoral fossa

What are the THREE signs that are associated with endometritis?

•Fluid accumulation

•Vulvar discharge

•Failure to Conceive

What is the most common sign associated with endometritis?

free fluid in the uterus on ultrasound

What is the THREE part process in diagnosing endometritis?

-Determine if inflammation is present

-Determine infectious agent

-Determine most effective treatment

When should you not do a BSE because you are not sure if she truly is having a hard time getting bred or the mare is just "shutting" off for the season?

anestrous

When doing a culture, what do you need to make sure that you use? Why?

double guarded swab to make sure that you get a uterine swab not a vaginal one

What are the FOUR bacteria that will be seen on a uterine culture? (remember this)

-Streptococcus zooepidemicus

-Escherichia coli

-Klebsiella pneumoniae

-Pseudomonus aeruginosa

What are the THREE fungi that are typically seen on a uterine culture?

-Candida

-Aspergillus

-Mucor

How do you do a low volume lavage?

gather a low volume of fluids and swish it around to get everything out

When is a low volume lavage usually used?

if there is an infection

What TWO things should you also do to help with diagnosis of a infectious cause?

cytology and culture

When trying to diagnose a cause, what is the FIRST thing you should do?

culture first ( this is so it is the most "normal" environment)

T/F A cytology is easy to obtain

True

What are the TWO immediate indicators that there is an active infection?

- neutrophils

- bacteria

What are the limits of doing cytology alone? Why?

negative cytology does not rule out endometritis. This is because sometimes there can be a deep and chronic infection or sample technique

If an owner has limited funds, what should you do because it is the definative diagnosis for endometritis?

Biopsy

What are FOUR thigs that a Biopsy can tell you with regards to endometritis?

-Degree of inflammation

-Type of inflammation

-Cystic glands

-Lymphatic lacunae

What are the grades of biopsies?

•Grade I

-Normal

-Greater than 80% chance of carrying a foal to term

•Grade IIA

-50-80% chance

•Grade IIB

-10-50%

•Grade III

-Less than 10% chance

T/F If a mare gets a grade III biopsy, then she is like this forever

False, the grades just look at the uterus at that point in time so it can change with medication or season

Will a biopsy tell you what bacteria is in there?

no

If a mare has a grade III biopsy, does this mean that she cant get pregnant?

no, it means that she is less likely to carry the foal to term

If you get a slide back and you can see neutrophils heading towars the lumen of the uterus, what does this tell you?

there is an acute infection because they are actively trying to get into the uterus to kill something

What other cell can you see with acute infection?

eosinophil

What cell is usually present in chronic inflammation and causes microabcesses?

lymphocyte

What can you find on biopsy in a susceptible mare that causes the uterus to not contract very well?

cystic gland distention

What can be present on biopsy that does not culture well and turns into a endometrial cyst?

Lymphatic Lacunae

What is the only thing on biopsy that you can find that you cannot treat?

firbosis ( can see ringing around the gland)

What can some bacteria make that makes it harder to get rid of the infection because of it?

biofilm

What are the TWO most common isolates that are going to have a biofilm?

-Pseudomonas

-E. Coli

You have a 17 year-old Appaloosa that comes in for a bacterial infection. You treat it correctly and the mare comes back with a recurrent infection. You culture the mare and it comes back Pseudomonas. Why do you think the mare has recurrent infection?

Pseudomonas is known to make a biofilm which causes recurrent infections

What are TWO drugs that you can give to break down the biofilm and treat infection?

-N Acetyl Cystein

-Tris EDTA

What is the three fold attack to treat endometritis?

-Lavage

-Antibiotics

-Ecbolics

What is one of the most common antibiotics used to treat endometritis but is VERY acidic? What should you do about this?

- Gentamicin

- •Mix with 1.5-2 times volume of 8.4% sodium bicarbonate

What is Gentamicin inactivated by so it is important that you lavage the uterus before giving the antibiotics?

organic material

What antibiotic is cheap and less irritating that genatmicin?

Ampicillin and Penicillin

You go out to a farm to treat a case of EM. At the farm, the client has a bottle of procaine penicillin and asks you to use it in the uterus. What do you tell her.

You tell her that you cannot use procaine penicillin in the uterus because the additives stay there

What antibiotic is best for Pseudomonas treatment but is hard to find?

Ticarcillin

T/F Ticarcillin is effective against Klebsiella

false, it is not

What is the broad spectrum antibiotic that is water soluble, non irriatating and safe to use around breeding?

Ceftiofur (Naxcel®)

What are some of the places that a fugal infection can arise so you need to make sure that these areas are treated?

entire uterus, cervix, and vaginal vault

What weird ahhhh thing can you do for a funagl infection? What does this do?

vinegar lavage to change the pH

What are the TWO drugs that can be used to treat fungal infections?

- Clotrimazole

- Miconazole

What is the prognosis for fungal endometritis? (this is bolded)

poor

What are some of the drugs that can be used for systemic antibiotic treatment?

- SMZ-TMP

- Enrofloxacin

- Excede

What is the BEST fluid source for a uterine lavage but it can get expensive?

LRS

What are some other fluid sources that can get used?

- Betadine

-Saline

-Distilled water

T/F Isotonic fluids are best and cause less irritation to the uterus but LRS and saline are ideal

True

What are TWO benefits to using a lavage?

•Remove debris

•Improve uterine tone

A lavage increases uterine tone. What TWO things does this help with?

-Decrease cystic glands

-Decrease lymphatic lacunae

Name THREE ecbolics go

- Oxytocin

- •Lutalyse® (dinoprost)

- Estrumate® (cloprostenol

What are THREE things that you can do for prevention of infectious endometritis?

•Correct predisposing factors

•Identify high risk mares

•Preemptive treatment

What is the gram negative, microaerophilic organisms that causes Contagious Equine Metritis?

•Taylorella equigenitalis

How is CEM transmistted?

mares by stallion

(•Equipment (biopsy forceps)

•Semen for AI

•Carriers

Mare to mare does not seem to occur)

What are some signs that your mare has CEM? (3)

-Infertility

-Acute - 2-10 days after mating- copious gray-white purulent discharge

-Early return to estrus

If you suspect CEM, where are some places that you should culture in the stallion and the mare?

•Stallion: urethral fossa, prepuce

•Mare: Clitoral fossa and clitoral sinuses

What is super cool fun and different about the culture and transport of CEM?

•Amies with charcoal

•Chocolate Agar plates ( you must plate within 12 hours)

T/F if you do not use a chocolate agar plate, all of the other bacteria will outgrown Taylorella equigenitalis

True

What should you do if you suspect a horse has CEM?

call the state vet bc it is a FAD

How do you treat CEM?

Daily intrauterine infusions -Penicillin, Ampicillin, Neomycin, Nitrofurazone

How do you treat the clitoral fossa and sinuses?

-4% chlorhexidine for 5 days

-Pack with chlorhexiderm or nitrofurazone ointment

What virus causes Coital Exanthema?

EHV-3

What are the clinical signs of Coital Exanthema?

-1-3mm painful vesicles (pustules - ulcers)

-Appears 5-7 days after contact

-Genital area of mares and stallions

-Heal 7-10 days

-Permanent loss of pigmentation is common

How do you diagnose EHV3?

•Clinical signs

•Serology

•Intranuclear inclusion bodies in histo sample and scrapes of affected tissue

How do you treat EHV3?

•Do not breed until lesions resolve

•Antiseptic ointment may be used to prevent secondary bacterial infection

•No vaccine

No long term fertility effects

What is the causative agent of Dourine?

•Trypanosoma equiperdum

What are the clinical signs of Dourine?

-Low-grade chronic fever

-Urticaria dollar-like plaques of edema on skin esp. flanks

-Mare: mucoid vaginal discharge, edema

-Stallion: scrotal and preputial edema extends to ventral abdomen and chest

Muscle wasting -collapse -death

What is the treatment for Dourine?

nothing they will prob die