Case Report on the Effect of AlpaWash® on the Healing of a Post-surgical Wound in a Female Canine Initially Diagnosed with Pyometra.

Pyometra is a common disease in intact female canines characterized by an infection of the uterus. If it is not treated immediately, it could result in various complications such as fistulous tract development, sepsis, hemorrhage, uveitis, conjunctivitis, pyelonephritis, urinary tract infection, and myocarditis. In this case report, we highlight the benefits of the application of a topical ointment on wound healing after ovariohysterectomy in canine Pyometra. Following surgical intervention, the dog developed necrosis in her nipples and lost a portion of her mammary tissues. A large cyst formed and later ruptured, leaving the animal with a large wound. The vet applied a topical ointment, AlpaWash, to the affected area and prescribed antibiotic, analgesic, and antiinflammatory drugs to help manage the condition. The vet reported complete healing of the wounds within one month from the commencement of the treatment regimen.

Management of Pyometra Using a Novel Image-Guided Percutaneous Technique: A Case Report.

Pyometra is a uterine infection that causes pus to accumulate in the uterine cavity. Pyometra primarily affects postmenopausal women. Multiple aetiologies, including cervical stenosis, have been identified. Medical therapy using intravenous antibiotics and surgical evacuation are the conventional treatment options for pyometra. Here, we present a unique case of a novel therapy for pyometra in a geriatric patient; percutaneous alleviation of the causative cervical stenosis was performed using balloon dilatation, along with endometrial drainage of the infected fluid through her vagina, a natural route. This technique has overcome the need for other invasive therapies. The patient's clinical condition improved significantly after this minimally invasive treatment. Percutaneous balloon dilatation of the cervix for stenosis or occlusion in patients with pyometra facilitates drainage of the infected endometrial fluid. This alternative management technique ensured a satisfactory postoperative course and tolerance in the short-term follow-up. Furthermore, the technique ensured good aesthetic results, with its minimally invasive approach in selected patients, compared to other means of evacuation.

Antimicrobial use in the surgical treatment of canine pyometra: A questionnaire survey of Arizona-licensed veterinarians.

BACKGROUND: Recent studies and consensus statements in veterinary and human medicine recommend more judicious use of antimicrobials. While guidelines have been provided for some veterinary diseases, others have poorly elucidated guidelines. Postoperative treatment of canine pyometra is a condition with minimal guidelines regarding antimicrobial use. OBJECTIVE: To identify and investigate patterns of antimicrobial use following surgically treated canine pyometra. METHODS: A 23-question survey, sent to 863 small and mixed animal practitioners, investigated demographics, patterns of antibiotic use, rate of culture submission and participant's recollection of outcomes of surgically treated pyometra cases. Responses were analysed for relationships between demographics, patterns of antibiotic use and culture results to better understand reasoning for antibiotic protocols. RESULTS: One hundred and fifty-two responses were received. Overall, 76% of veterinarians stated they always use preoperative and perioperative antibiotics, and 74% stated they always use postoperative antibiotics. A total of 16 different antibiotics were reported. Twelve per cent of respondents regularly submitted a culture. Culture submission was impacted by cost, prior experience, poor owner compliance, result turnaround time and anticipated results. CONCLUSIONS: Most respondents always used antibiotics and rarely or never submitted a culture. To optimise patient care, future clinical studies are needed to determine specific guidelines for the use of culture and antibiotics in the treatment of canine pyometra following ovariohysterectomy.

Postoperative complications and antibiotic use in dogs with pyometra: a retrospective review of 140 cases (2019).

BACKGROUND: Pyometra is commonly seen in intact bitches and is usually treated by ovariohysterectomy. Few studies have reported the frequency of postoperative complications, particularly beyond the immediate postoperative period. Swedish national antibiotic prescription guideline provides suggestions about which antibiotics should be used and when in individuals undergoing surgery. Studies on how well clinicians adhere to these guidelines, and on the outcome for these patients, have not been evaluated for cases of canine pyometra. This retrospective study conducted at a private Swedish companion animal hospital assessed complications that developed within 30 days of pyometra surgery, and whether clinicians followed the current national guidelines in regard to antibiotic use. We also assessed whether antibiotic use affected the rate of postoperative complications seen in this cohort of dogs, where antibiotics were predominantly used in cases presenting with a more severely depressed general demeanour. RESULTS: The final analysis included 140 cases, 27 of which developed complications. In total, 50 dogs were treated with antibiotics before or during surgery and in 90 cases, antibiotics were either not given at all or treatment was initiated postoperatively (9/90) due to a perceived risk of infection developing. Superficial surgical site infection was the most common complication, followed by an adverse reaction to the suture material. Three dogs died or were euthanised during the immediate postoperative period. Clinicians adhered to national antibiotic prescription guidelines on when antibiotics should be given in 90% of cases. SSI only developed in dogs that were not given pre- or intra-operative antibiotics, while suture reactions did not appear to be affected by antibiotic use. Ampicillin/ amoxicillin was used in 44/50 cases given antibiotics before or during surgery, including most cases showing signs of concurrent peritonitis. CONCLUSION: Serious complications following the surgical treatment of pyometra were uncommon. Excellent adherence to national prescription guidelines was observed (90% of cases). SSI was relatively common and only seen in dogs that were not given antibiotics before or during surgery (10/90). Ampicillin/ amoxicillin was an effective first choice antimicrobial in cases requiring antibiotic treatment. Further studies are needed to identify cases benefiting from antibiotic treatment, as well as the duration of treatment needed to reduce the infection rate while also avoiding unnecessary preventive treatment.

Idiopathic pyometra and tubo-ovarian abscess in a postmenopausal patient treated conservatively.

Background: Pyometra is a rare gynecological condition and is characterized by pus accumulation in the uterine cavity. It occurs more frequently in postmenopausal women than tubo-ovarian abscesses, which constitute a more common gynecological complication among premenopausal women. Objective: A 72-year-old woman was admitted to our emergency department with lower abdominal pain, diarrhea and fever for the last three days. The laboratory results were indicative to sepsis. The clinical examination revealed sensitivity by palpation of the lower abdomen without any signs of acute abdomen. The gynecological assessment showed pus outflow through the cervix and a pus culture was done. The ultrasound examination found an enlarged uterus, full of hypoechoic fluid, unclear borders between endometrium-myometrium, a mixed echogenicity adnexal mass and no free fluid in the pouch of Douglas. A computed tomography (CT) of the abdomen showed the presence of pyometra and a tubo-ovarian abscess of the right adnexa. Method: The patient was treated with intravenous antibiotic therapy. When the patient was hemodynamically stable and afebrile, she underwent ultrasound-guided dilatation and curettage of the cervical canal and the endometrium in order to exclude an underlying malignancy, under general anesthesia. Results: The patient responded promptly to the intravenous antibiotic therapy which was adapted to the pus culture result. The laboratory results withdrew to normal values and the patient was discharged after fifteen days of hospitalization in an afebrile and hemodynamically stable condition. Conclusion: Pyometra and tubo-ovarian abscess in postmenopausal women could be a lethal complication of pelvic inflammatory disease. The key in treatment is the dilatation of the cervix and drainage of the pyometra. The administration of intravenous antibiotics and drainage through the cervix could be a suitable method of treatment for pyometra in older patients or those with poor performance status if only the histological examination is negative for malignancy.

First reported case of Robinsoniella peoriensis pyometra and bloodstream infection: A case report and review of the literature.

We report on a 47-year-old woman with jejunal adenocarcinoma and concurrent endometrial cancer, admitted with sepsis. Uterine fluid and blood cultures were positive for Robinsoniella peoriensis. This is the first case report of Robinsoniella peoriensis in Canada. We encourage clinicians to publish their experience treating gynecologic infections caused by Robinsoniella peoriensis. Failure to recognize this pathogen as causative for pyometra, may result in insufficient antimicrobial treatment, and death.

Successful Treatment of Pyometra Caused by Pseudomonas aeruginosa Infection in a Rabbit.

This article reports an unusual presentation of pyometra in a pet rabbit. A 2-year-old mixed-breed female rabbit with pelvic limb paralysis was referred for abdominal distension associated with prolonged depression and decreased appetite. Clinical examination and diagnostic imaging (radiographs and ultrasound) led to the provisional diagnosis of pyometra that was caused by the presence of an enlarged organ containing fluid material and occupying most of the caudal abdomen. Exploratory laparotomy was performed under general anesthesia. After abdominal wall incision along the linea alba, the uterus was immediately evident and the uterine wall was over-distended and damaged, with purulent material free in the abdominal cavity. Ovariohysterectomy was performed and uterine wall samples were sent for microbiological examination and antimicrobial susceptibility testing. The agent causing the pyometra was found to be Pseudomonas aeruginosa, which was resistant to enrofloxacin and ceftazidime. This is the first report of pyometra caused by P. aeruginosa in a pet rabbit, based on a literature search. Furthermore, a peculiarity of the present case is the occurrence of pyometra in a rabbit with no history of mating or parturition.

Singleton pregnancy with concurrent pyometra in the contralateral horn in a bitch with a live puppy outcome.

A 20-month-old, 48-day pregnant female American Bulldog was presented for intermittent bloody vaginal discharge of 4-day duration. The bitch was clinically healthy with a mild neutrophilia. Transabdominal ultrasound revealed a viable foetus in the left uterine horn and fluid in the right uterine horn. She was treated with amoxicillin/clavulanic acid and re-examined at regular intervals to monitor for deterioration of the bitch or foetus. The uterine fluid progressively decreased in volume, and the puppy remained viable. A Caesarean section was performed on the bitch's expected due date, resulting in a healthy puppy. This is only the second published report of a pregnancy and concurrent pyometra with a live puppy outcome. This case is unique in that the bitch's pyometra resolved grossly during pregnancy.

Prostaglandin release by cultured endometrial tissues after challenge with lipopolysaccharide and tumor necrosis factor α, in relation to the estrous cycle, treatment with medroxyprogesterone acetate, and pyometra.

To better understand the pathogenesis of endometrial changes in cats associated with administration of progestagen contraceptives and with pyometra, we examined local variability of the prostaglandin synthesis system after challenge with either tumor necrosis factor α (TNF-α) or lipopolysaccharide (LPS) in organ cultures of endometrial tissues derived from cyclic cats, cats treated with medroxyprogesterone acetate (MPA), or cats with pyometra, as well as in cultured endometrial epithelial and stromal cells. In addition, spontaneous prostaglandin secretion was compared in endometria from different experimental groups. Data gathered in the present study show that the concentration of PGE2 in supernatants was increased only in endometrial organ cultures from cats with pyometra (P < 0.001) compared with other groups. This was also true for PGF2α in pyometra, compared with cats treated either short- or long-term with MPA and cats during late diestrus (P < 0.001), anestrus (P < 0.01), and estrus and middiestrus (P < 0.05). Treatment with LPS and TNF-α combined stimulated PGE2 secretion in all groups compared with the control (P < 0.001 for endometria of cats during anestrus or middiestrus, cats treated short-term with MPA, and those with pyometra; P < 0.01 for endometria of cats treated long-term with MPA; and P < 0.05 for the endometria of cats during estrus and late diestrus). The combined treatment with LPS and TNF-α increased PGF2α secretion in the endometria of cats treated short-term with MPA (P < 0.001), during anestrus and pyometra (P < 0.01 for both), and estrus and middiestrus (P < 0.05 for both), compared with the control. Spontaneous secretion of prostaglandins was several times greater in the endometria of queens with pyometra, compared with other groups, which may further regulate the local inflammatory response. Data gathered from endometrial cell culture and endometrial organ culture lead to the conclusion that disturbances in prostaglandin release contribute to pyometra in cats.

Aglepristone: A review on its clinical use in animals.

Aglepristone (RU 46534) is a competitive progesterone antagonist that is indicated for the treatment of various progesterone-dependent physiological or pathologic conditions. Aglepristone has proven to be an effective means of terminating pregnancy in most species. When used to induce parturition, aglepristone was effective in all cases in the bitch, cow, and goat, with no apparent adverse effects on neonatal health or milk production. When used to schedule an elective cesarean section, aglepristone treatment was deemed safe for dams and puppies, providing that the ovulation date had been accurately assessed at the time of breeding. Irrespective of the stage of pregnancy at injection, treatment with aglepristone has no apparent negative effects on subsequent fertility. Aglepristone is also a safe and relatively effective means of treating pyometra. However, given the high level of septic risk and the likelihood of rapid deterioration, such therapy is not recommended in emergency situations. Treatment of feline fibroadenomatosis using aglepristone has given promising results, but repeat treatment may be necessary in cats previously treated with long-acting progestagens. The use of aglepristone in other progesterone-dependent diseases has yet to be fully evaluated but may prove valuable, especially in the treatment of insulin-resistant diabetes mellitus, acromegaly, and the treatment of some vaginal tumors in the bitch.

Molecular Expression Profile Reveals Potential Biomarkers and Therapeutic Targets in Canine Endometrial Lesions.

Cystic endometrial hyperplasia (CEH), mucometra, and pyometra are common uterine diseases in intact dogs, with pyometra being a life threatening disease. This study aimed to determine the gene expression profile of these lesions and potential biomarkers for closed-cervix pyometra, the most severe condition. Total RNA was extracted from 69 fresh endometrium samples collected from 21 healthy female dogs during diestrus, 16 CEH, 15 mucometra and 17 pyometra (eight open and nine closed-cervixes). Global gene expression was detected using the Affymetrix Canine Gene 1.0 ST Array. Unsupervised analysis revealed two clusters, one mainly composed of diestrus and CEH samples and the other by 12/15 mucometra and all pyometra samples. When comparing pyometra with other groups, 189 differentially expressed genes were detected. SLPI, PTGS2/COX2, MMP1, S100A8, S100A9 and IL8 were among the top up-regulated genes detected in pyometra, further confirmed by external expression data. Notably, a particular molecular profile in pyometra from animals previously treated with exogenous progesterone compounds was observed in comparison with pyometra from untreated dogs as well as with other groups irrespective of exogenous hormone treatment status. In addition to S100A8 and S100A9 genes, overexpression of the inflammatory cytokines IL1B, TNF and IL6 as well as LTF were detected in the pyometra from treated animals. Interestingly, closed pyometra was more frequently detected in treated dogs (64% versus 33%), with IL1B, TNF, LBP and CXCL10 among the most relevant overexpressed genes. This molecular signature associated with potential biomarkers and therapeutic targets, such as CXCL10 and COX2, should guide future clinical studies. Based on the gene expression profile we suggested that pyometra from progesterone treated dogs is a distinct molecular entity.

Treatment of canine pyometra with the gonadotropin-releasing hormone antagonist acyline: a case series.

To describe the effect of the third-generation gonadotropin-releasing hormone antagonist acyline in the treatment of 4 diestrous bitches with the cystic endometrial hyperplasia-pyometra complex. The 4 bitches were treated with 330 µg/kg of subcutaneous acyline on day 0 and antibiotics, and followed up for 2 weeks. One closed-cervix case showed cervical dilatation 36 hours after treatment, and all the 4 animals showed resolution of clinical signs starting on day 3 posttreatment. Ultrasonographic uterine diameters and luminal contents decreased in the bitches having high progesterone serum concentrations before treatment but not in those with low levels. Serum progesterone importantly decreased from high to basal concentrations in the 3 "ultrasonographically cured" animals. No local or systemic side effects related to the treatment were observed. The gonadotropin-releasing hormone antagonist acyline may have a promising place for the medical treatment of cystic endometrial hyperplasia-pyometra complex in dogs.

Pyometra in childhood.

BACKGROUND: Pyometra, an accumulation of pus in the uterine cavity, occurs rarely in children but should be considered in the differential diagnosis of an intra-abdominal or pelvic abscess. CASE: A 10-month-old infant presented with an increasing abdominal mass. She had previous respiratory and diarrheal illnesses. She was underweight, febrile, and tachycardic with an 8×6-cm mobile tender mass in her lower abdomen. Investigations demonstrated leukocytosis and ultrasonogram confirmed a cystic mass. At laparotomy a pyometra was found. Needle aspiration and washout of the uterine cavity were performed but a second procedure was required to place a drain into the cavity. CONCLUSION: Pyometra occurs rarely in childhood. A review of cases associates a hypoestrogenized endometrium exposed to transient bacteremia with obstruction to uterine drainage. Treatment should include continuous drainage of the uterus.

Pyometra in elderly post-menopausal women: a sign of malignity.

PURPOSE: To describe the clinical and histopathological characteristics of 12 patients with pyometra and highlight the increased incidence of gynecological malignancy in these patients. MATERIALS AND METHODS: The authors examined the medical records of 12 patients with pyometra, who were treated between 2009 and 2013. RESULTS: All patients were post-menopausal, and their mean age was 70.83 ± 6.978 years (min = 61, max = 82). To remove purulent fluid via dilation and because of the probability of malignancy, three patients (25%) underwent cervical biopsy and endometrial curettage; the other nine patients (75%) underwent curettage alone, with suitable antibiotic therapy. Of the 12 patients, nine (75%) had gynecologic malignancy [(endometrial cancer, n = 5, 41.6%), (cervical cancer, n = 3, 25%), (uterine leiomyosarcoma, n = 1, 8.3%)]. In three (25%) patients, the cause of pyometra was benign pathologies, among which the most common were leiomyomas (n = 2, 66.6%). CONCLUSION: Pyometra diagnosed during the post-menopausal period should be considered a complication caused by gynecological malignancy until proven otherwise.

Effectiveness of a modified administration protocol for the medical treatment of canine pyometra.

Pyometra is one of the most common diseases in intact bitches. The aim of this study was to evaluate the effectiveness of a modified aglepristone protocol for the medical treatment of pyometra in the bitch. Of these, 73 bitches affected by pyometra of different breeds and age (2-14 years old) were enrolled. They were randomly assigned to a control group (CTG - 26 bitches) treated with classical protocol (aglepristone at 0, 1 and 6 days - day 0 = day of the diagnosis) and a modified treated group (MTG - 47 bitches) treated with a different administration protocol (aglepristone at 0, 2, 5 and 8 days). The classical protocol with the anti-progestagen aglepristone was effective in 88.5 % (23/26) of CTG bitches while the modified protocol was effective in all (47/47) of MTG bitches. One of the 23 CTG bitches received a further administration on day 14, which resolved the pyometra, while in the three cases of CTG bitches, in which the treatment was ineffective, an ovariohysterectomy was carried out. The modified protocol showed a success rate of 100 %, compared with the classical protocol proposed in the literature, and no recurrence of the disease was recorded in the 24 months follow up. After treatment, the oestrus onset was earlier than expected (interoestrus of 128 ± 32 days). In this study, the modified treatment protocol showed high efficacy and lack of recurrence within 24 months, suggesting a complete recovery of reproductive function in the bitch, with a normal fertility.

A retrospective study of bitches with pyometra, medically treated with aglepristone.

Pyometra is a common and life-threatening disease of intact bitches caused by hormonal influence of the uterus in combination with bacterial infection. The treatment of choice is ovariohysterectomy, but several purely medical options are available. Common drugs used for medical treatment in combination with antimicrobials are progesterone receptor blockers, prostaglandins, and dopamine agonists. The aim of this study was to evaluate long-term recovery and fertility after treatment with the progesterone receptor blocker aglepristone in bitches with pyometra. Data from 28 bitches with pyometra, admitted to the University Animal Hospital, Swedish University of Agricultural Sciences, during a 9-year period, were studied retrospectively and followed up by telephone interviews with the owners. The bitches had been treated with aglepristone at a dose of 10 mg/kg on a median of four occasions. All bitches had also been treated with antimicrobial drugs for a mean duration of 23 days, the most frequently used being enrofloxacin. Escherichia coli were the most commonly isolated bacteria from cranial vagina. The outcome was assessed for up to 6 years after treatment. The success rate, determined as restored clinically healthy status, was 75% (21/28 bitches), and the recurrence rate of disease was 48% (10/21 bitches). The mean time until recurrence was 10.5 months after the end of treatment. After treatment, 69% (9/13) of the mated bitches produced puppies. Of the seven bitches that did not have a successful treatment, six were ovariohysterectomized and one was euthanized. In conclusion, medical treatment with aglepristone in combination with antimicrobial therapy was successful in 75% of the bitches studied and the recurrence rate was 48%.

Medical treatment for pyometra in dogs.

Pyometra is a reproductive disorder very common in bitches over 8 years of age in which physiological effects of progesterone on the uterus play a major role. The traditional therapy for pyometra is ovariohysterectomy. The main advantage of ovariohysterectomy over medical management is that it is both curative and preventive for recurrence of pyometra. However, surgery is associated with the risk of anaesthesia and renders the bitch sterile. During the last 10 years, numerous medical treatments have been proposed to treat both open and closed cervix pyometra. The most effective medical treatment with minor side effects seems to be the repeated administration of aglepristone with or without the additional treatment with low doses of prostaglandins.

Decreased postoperative C-reactive protein production in dogs with pyometra through the use of low-dose ketamine.

OBJECTIVE: To determine the effects of subanesthetic ketamine in dogs with pyometra on C-reactive protein (CRP) concentrations following surgery. DESIGN: Prospective, nonconcealed, alternating allocation controlled trial. SETTING: Veterinary teaching hospital. ANIMALS: Sixteen dogs diagnosed with pyometra. INTERVENTIONS: The tentative diagnosis of canine pyometra was based on compatible history, physical examination findings, ultrasonographic findings, and hematological evaluation. Two different anesthesia and analgesic protocols with and without low-dose ketamine were used during and following ovariohysterectomy in 16 female dogs (n = 8 per group) that were diagnosed with naturally occurring pyometra. Dogs were sequentially allocated to treatment groups in an alternating fashion without concealment. Serum was collected before, 24, and 48 hours after surgery for CRP measurement. MEASUREMENTS AND MAIN RESULTS: Perioperative physical parameters in the 2 groups of dogs were similar. The serum concentrations of CRP in both groups were essentially the same before surgery, but significantly increased in the control group and decreased in ketamine group at 48 hours after surgery. CONCLUSIONS: Low-dose ketamine attenuated the postoperative concentration of serum CRP in dogs with pyometra compared with dogs that did not receive ketamine in the perioperative period. Further studies are warranted to determine the clinical implications of these findings.

Cloprostenol treatment of feline open-cervix pyometra.

Treatment with cloprostenol, a prostaglandin synthetic analogue, was evaluated in five queens with open-cervix pyometra. Cloprostenol was administered (5 µg/kg body weight SC) on 3 consecutive days and amoxicillin (20 mg/kg body weight IM) on 7 consecutive days. Transient post-injection reactions caused by cloprostenol administration included diarrhea, vomiting and vocalizations. Reactions began as quickly as 10 mins after cloprostenol administration and lasted as long as 30 mins. All queens improved clinically after cloprostenol treatment and remained healthy until the end of the study, 1 year after treatment. All queens resumed normal estrous cycles without further treatment and two (40%) delivered a normal litter. In conclusion, use of cloprostenol is an acceptable treatment for open-cervix pyometra in queens.

Spontaneous perforation of pyometra: a report of seven cases and review of the literature.

BACKGROUND/AIMS: The spontaneous perforation of pyometra is very rare and is associated with a poor prognosis. The present study aimed to evaluate the clinical characteristics and prognostic factors for patient survival. PATIENTS AND METHODS: We reported on 7 patients with spontaneous rupture of pyometra. We also reviewed 47 additional published cases. Thus, all 54 patients were analyzed for mortality. RESULTS: We investigated the prognosis in 44 of 54 patients, excluding 8 patients with undocumented outcome and 2 who died of other diseases. The mortality rate was 25% (11 of 44). In univariate analysis, variables such as age, correct preoperative diagnosis, comorbidities, the presence of malignancy, and hysterectomy were not significant between surviving and deceased patients. In bacterial cultures from the peritoneal cavity, the most common etiological organisms were Escherichia coli and anaerobes such as Bacteroides and Peptococcus species. The rate of isolation of anaerobic bacteria was significantly increased in patients who died (odds ratio, 6.33; 95% confidence interval, 1.28-31.02; p = 0.04). CONCLUSION: Antibiotic therapy for E. coli and anaerobes should be considered in patients with spontaneous perforation of pyometra.