Comparison of clinical and inflammatory parameters in dogs with pyometra before and after ovariohysterectomy.

This study aimed to identify potential biomarkers of canine pyometra and their correlations with clinical parameters. First, 90 dogs with pyometra and 26 healthy female dogs were compared. Then, paired samples (before and after ovariohysterectomy) from 22 dogs with pyometra and 9 healthy controls from the initial cohort were compared. Concentrations of acute inflammatory proteins, C-reactive protein (CRP) and serum amyloid A (SAA), and cell-free DNA (cfDNA), were significantly higher in dogs with pyometra than in clinically healthy dogs. Cell-free DNA was the most sensitive biomarker for systemic inflammation, based on the receiver operating characteristic curve analysis (area under the curve = 0.959). In addition, cfDNA and CRP were significantly associated with inflammation and organ injury-related clinical parameters. Following the surgical removal of the inflamed uterus, interleukin-6 (IL-6), high-mobility group box 1 (HMGB1), and procalcitonin (PCT) significantly decreased, whereas changes in CRP, SAA, and cfDNA were not significant. These findings indicate that cfDNA, CRP, and SAA are potential clinical biomarkers of systemic inflammation in dogs with pyometra and PCT, IL-6, and HMGB1 are potential biomarkers of clinical recovery.

Cette étude visait à identifier les biomarqueurs potentiels du pyomètre canin et leurs corrélations avec les paramètres cliniques. Tout d'abord, 90 chiens avec pyomètre et 26 chiennes en bonne santé ont été comparés. Ensuite, des échantillons appariés (avant et après ovariohystérectomie) de 22 chiens avec pyomètre et neuf témoins sains de la cohorte initiale, ont été comparés.Les concentrations des protéines inflammatoires aiguës, protéine C réactive (CRP) et amyloïde sérique A (SAA), et d'ADN acellulaire (cfDNA), étaient significativement plus élevées chez les chiens atteints de pyomètre que chez les chiens cliniquement sains. L'ADN acellulaire était le biomarqueur le plus sensible pour l'inflammation systémique, sur la base de l'analyse de la courbe caractéristique de fonctionnement du récepteur (aire sous la courbe = 0,959). De plus, le cfDNA et la CRP étaient significativement associés à l'inflammation et aux paramètres cliniques liés aux lésions aux organes.Après l'ablation chirurgicale de l'utérus enflammé, l'interleukine-6 (IL-6), la protéine HMGB1 (« high-mobility groupe box 1 ¼) et la procalcitonine (PCT) ont significativement diminué, alors que les changements de CRP, SAA et cfDNA n'étaient pas significatifs. Ces résultats indiquent que cfDNA, CRP et SAA sont des biomarqueurs cliniques potentiels de l'inflammation systémique chez les chiens avec pyomètre et PCT, IL-6 et HMGB1 sont des biomarqueurs potentiels de récupération clinique.(Traduit par Docteur Serge Messier).

Pyometra Management Practices in the High Quality, High Volume Spay-Neuter Environment.

Pyometra management in the high quality, high volume spay-neuter (HQHVSN) environment is not well documented. The goal of this study was to identify pyometra management practices and patient outcomes in the HQHVSN environment. An electronic survey was piloted and distributed to HQHVSN clinics using Survey Monkey via email lists and social media. A total of 118 responses were received from June to July 2020. Respondents were distributed across the United States with the majority of clinics associated with a shelter (75%). Clinics performed a median of 25 spays and neuters per day and 5000 per year. Most clinics (86%) were willing to treat nonincidental pyometras at least sometimes, and nearly all of these clinics (97%) were willing to accept pyometra referrals. Of these clinics, nearly all (95%) felt they had the necessary resources to treat most pyometras that presented and that a pyometra case was only modestly disruptive to their surgery flow. Most clinics (70%) charged a fee for treatment, charging a median of $200 for dogs and $125 for cats. This is much lower as compared to the estimated ranges for private practice ($600-$2500) and emergency hospitals ($1500-$3579). The majority of patients that HQHVSN clinics accepted for treatment were seen the same day (50%) or next day (42%). These clinics estimated that of the animals who presented, 76% were BAR or QAR, 20% were depressed or nonambulatory, and 4% were obtunded and lateral. Estimated survival for these treated groups were 98%, 80%, and 38%, respectively. HQHVSN clinics may represent a resource for treating pyometras when treatment is disruptive to the schedule of a private practice or clients present with financial limitations. There is an opportunity for HQHVSN and private practice to form a partnership to leverage the strengths of both models and improve access to care for pets.

A randomized controlled clinical trial on the effect of acupuncture therapy in dairy cows affected by pyometra.

Pyometra (PYO) is a reproductive disease characterized by the accumulation of purulent or mucopurulent material within the uterine lumen, in the presence of an active corpus luteum (CL). As the CL continues secreting progesterone, PYO would develop following endometritis. Due to prohibited use of artificial luteolytic hormones in US certified organic dairies, conventional therapies consisting of administration of prostaglandin F2α, are not applicable. The objective of this study was to evaluate the efficacy of two acupuncture procedures on the treatment of persistent CL in cows with PYO. We hypothesized that acupuncture would reduce CL diameter and serum progesterone (P4) concentrations, leading to regression of PYO. Holstein cows with PYO, at an USDA certified organic dairy farm in Northern Colorado, were enrolled in a randomized controlled clinical trial and assigned to 1 of 3 treatments: (1) control pyometra (CP; no treatment; n = 17); (2) electroacupuncture (EAP; n = 15); and (3) laser acupuncture (LAP; n = 15). Each cow received three 9-min (EAP) or 20-min (LAP) acupuncture sessions in alternate days. All study cows had blood samples collected for determination of serum progesterone concentration at d0, and at d2, d4, d11, d18, and d25 after first treatment. The ovaries were scanned by transrectal ultrasonography at -3d, d0, d2, d4, d11, and d18 to determine the diameter of the CL. The effect of treatment in the outcome variables was evaluated by ANOVA and by repeated measures analyses, accounting for baseline data (CL diameter and progesterone serum concentration). Average ± SE change in CL diameter from d0 to d18 were 0.94 ± 1.0 mm, 0 ± 1.0 mm, and - 0.33 ± 1.0 mm for CP, EAP, and LAP, respectively. The repeated measures analysis indicated no significant differences for CL diameter among groups. None of the study cows had serum progesterone values <1 ng/ml by the end of the monitoring period (d25) and average ± SE change from d0 to d25 were - 4.0 ± 1.97 ng/ml, -0.76 ± 2.1 ng/ml, and 3.24 ± 1.9 ng/ml for CP, EAP, and LAP, respectively. The repeated measures analysis indicated no significant differences for serum progesterone concentrations among groups. On farm cow records reviewed 150 d after treatment indicated that 2 cows in EAP and 1 cow in LAP conceived 38 d, 68 d, and 38 d, after treatment completion. In conclusion, acupuncture was not an effective treatment for persistent CL in cows with PYO, during the monitoring period.

Stump Pyometra Secondary to Human Topical Estrogen Hormone Exposure in a Spayed Female Chihuahua.

A 6 yr old female spayed Chihuahua was presented for evaluation of intermittent vulvar discharge, stranguria, and vomiting. This dog had an ovariohysterectomy as a puppy and did not experience any evidence of estrous until 4.5 yr later. The owner had been using a topical hormone replacement therapy (estradiol spray) twice daily for the duration of the dog's clinical signs of 1 yr. On presentation, the dog had truncal alopecia, comedones, enlarged vulva with a malodorous, and purulent discharge. Bloodwork showed a leukocytosis with a neutrophilia, döhle bodies, and moderate toxic changes. An abdominal ultrasound revealed an enlarged uterine stump with a thickened wall, ovoid projection cranially, and echogenic luminal contents. An exploratory laparotomy identified an enlarged cervical stump. Histopathology revealed chronic suppurative vaginitis with endometritis, necrosis, and intraluminal coccoid bacteria. The dog recovered well from surgery. A baseline estrogen level post operatively was measured at 56.4 pg/mL (<50.0 pg/mL for a spayed bitch), at this time, the dog had been separated from the owner for 7 days. After surgery, the clinical signs disappeared, and the dog's dermatologic changes improved. This is the first reported case of stump pyometra following exposure to the owner's topical estradiol replacement medication.

Use of a cervical stent for long-term treatment of pyometra in the mare: A report of three cases.

An effective long-term treatment is necessary for mares with pyometra, because the condition tends to recur. In many affected animals, several conformational or anatomical anomalies contribute to impaired uterine clearance. Ovariohysterectomy is the surgical procedure of choice. Conservative therapy consists of draining and flushing the uterus, and systemic anti-inflammatory and antimicrobial treatment. Uterine secretions tend to accumulate again after local treatment, especially in mares with poor vaginal conformation or cervical adhesions. Herein, we describe three cases in which a cervical stent was used in mares after mechanical or manual dilation of the cervix to achieve permanent draining of the uterus. The mares remained symptom-free for up to 6 years and exhibited good clinical progress and good performance in competitions. Potential complications of the procedure include loss of the stent and obstruction caused by viscous secretion. A cervical stent is a relatively easy and low-cost option for the long-term treatment of pyometra in mares, particularly in cases where excessive costs of surgery and risks of a general anaesthesia are to be avoided.

A case of pyometrocolpos with Bifidobacterium species.

Bifidobacterium species, a normal commensal of the human gastrointestinal tract, female genitourinary tract and vagina is usually considered non-pathogenic and is being used therapeutically as probiotic due to its beneficial effects. However, there are several case reports implicating Bifidobacteria as the causative agent in various infectious conditions. Infections with Bifidobacteria are often ignored or underreported as they are part of the normal gut microbiome. Here we discuss a case of pyometrocolpos with Bifidobacterium species. Clinical outcome of the patient was good after emergency drainage and antibiotic treatment with Cefoperazone sulbactam and Metronidazole.

Canine pyometra: What is new?

Pyometra is a common disease in countries where elective spaying is not routinely performed. Hormonal and bacterial factors are fundamental in the pathogenesis of the disease, which manifests itself as a potentially life-threatening bacterial infection of the uterus. Surgical ovariohysterectomy is the safest and most effective treatment for pyometra, and it has recently been shown that laparoscopically assisted methods for surgical treatment are feasible to use in selected cases. New protocols for improved medical treatment alternatives have also been tested with promising results. To be able to predict outcome and presence of complications early would be valuable in clinical practice for optimizing therapy and increasing survival. Results of commonly investigated clinical and laboratory investigations have been shown to be useful as predictive markers, with leucopenia being associated with increased risk of peritonitis as well as prolonged post-operative hospitalization after surgical treatment. A cage-side rapid and cost-effective diagnostic test would be highly valuable in clinical practice, and detection of pyometra-specific upregulated genes in the uterus and the corresponding products is a potential start in identifying novel markers suitable for such as test. The focus of the present review is to highlight recent findings on pathogenesis, prediction of outcome, diagnosis and treatment. Additionally, central research questions and suggestions for future investigations about several aspects of canine pyometra will be addressed.

Clinical Significance of Pyometra.

OBJECTIVE: To review the clinical profiles and management outcomes of patients with pyometra. STUDY DESIGN: A retrospective review of all women admitted with a confirmed diagnosis of pyometra over an 8-year period (January 2003 to December 2010). The medical records, including operation notes, histological and microbiological results, were reviewed. RESULTS: A total of 57 patients accounting for 76 admissions were identified. The mean patient age was 82.0 ± 11.3 years. The most common presenting symptom was postmenopausal bleeding (59.2%), followed by vaginal discharge (40.8%), fever (6.6%), and abdominal pain (5.3%). Drainage of pyometra was either by uterine Foley catheter insertion (48 patients [84.2%]) or repeated endometrial aspiration (2 patients [3.5%]). Antibiotics were prescribed to 49 patients (86.0%). Diagnostic hysteroscopy with mechanical cervical dilation was performed in 6 patients (10.5%). Gynecological malignancy was identified in only 1 patient, while colorectal cancer was identified in 2 patients. No patient had spontaneous uterine perforation or sepsis. Sixteen patients had recurrent pyometra within a mean follow-up period of 5.1 ± 5.8 months (range, 0.5-23 months). CONCLUSION: Pyometra usually presents with postmenopausal bleeding and can be treated with drainage and antibiotics treatment. In contrast to previous reports, our study indicates that spontaneous uterine perforation and gynecological malignancies are not commonly associated with pyometra.

Clinical and molecular characteristics of pyometra in female dogs.

Pyometra is a common disease of female dogs. In Sweden, where approximately 90% of the dog population is intact (not neutered), nearly 25% of all female dogs are diagnosed with the disease before 10 years of age. In certain high-risk breeds, this risk of developing pyometra exceeds 50%. Various clinical signs associated with the genital tract as well as with systemic disease are present in dogs with pyometra. A frequent and serious consequence of the uterine infection is endotoxaemia and progression into the systemic inflammatory response syndrome (SIRS), or sepsis, and the disease is then regarded as a medical emergency. Acute phase proteins and inflammatory markers associated with SIRS and with the outcome as measured by length of hospitalization have been identified in blood samples. Recently, the inflammatory response in infected uterine tissue during pyometra has been more closely explored. The expression of many genes associated with chemokines, cytokines, inflammatory cell extravasation, anti-bacterial action, the complement system and innate immune responses and also a large panel of proteases are upregulated in the uterine tissue in pyometra. Products of certain upregulated genes may be detected systemically and used for diagnostic or prognostic purposes provided that tests are developed in the future. More knowledge of the complex local and systemic inflammatory response in pyometra may allow identification of novel disease biomarkers or future targets for treatment. In this article, clinical as well as molecular characteristics of the disease are reviewed.

Ultrasound-guided percutaneous drainage of neonatal pyometrocolpos under local anesthesia.

Hydrometrocolpos is an uncommon congenital disorder with cystic dilatation of the vagina and uterus that occurs as a result of accumulated secretions from the reproductive tract due to distal genital tract obstruction. Secondary infection may also occur, resulting in pyometrocolpos, a potentially lethal disease. Immediate drainage of the cystic mass in patients determined to have pyometrocolpos is required to prevent or treat uropathy and septicemia until definitive corrective surgery can be performed. We report an unusual cause of obstructive uropathy in three infants: pyometrocolpos due to lower genital tract atresia. Ultrasound-guided percutaneous drainage of the pyometrocolpos resulted in dramatically improved clinical and laboratory findings in these patients. Ultrasound-guided percutaneous drainage under local anesthesia is a simple, minimally invasive, safe, and effective procedure that facilitates later successful corrective surgery and avoids the need for more complex drainage procedures.