The Diagnosis of Endometritis in the Mare by...
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Virginia-Maryland Regional College of Veterinary Medicine William B. Ley, DVM, MS, Dipl., A.C.T. The Diagnosis of Endometritis The Diagnosis of Endometritis in the Mare by in the Mare by Endometrial Cytology Endometrial Cytology William B. Ley, D.V.M., M.S., Diplomate A.C.T. Professor of Theriogenology & Equine Production Management Medicine Department of Large Animal Clinical Sciences
Transcript of The Diagnosis of Endometritis in the Mare by...
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
The Diagnosis of EndometritisThe Diagnosis of Endometritis in the Mare by in the Mare by
Endometrial CytologyEndometrial Cytology
William B. Ley, D.V.M., M.S., Diplomate A.C.T.Professor of Theriogenology &
Equine Production Management MedicineDepartment of Large Animal Clinical Sciences
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Anatomy of the Caudal Anatomy of the Caudal Reproductive TractReproductive Tract
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Cellular Defense MechanismsCellular Defense Mechanisms
Stimulus
Uterine PMN response
ClearanceNormal Mare
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Cellular Defense MechanismsCellular Defense Mechanisms
Stimulus
Uterine PMN response
ClearanceAbnormal Mare
MacrophagesEosinophils
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Effect of the Estrous CycleEffect of the Estrous Cycle
Myometrial contractions
Endometrial secretions
Cervicalrelaxation
Physical clearance
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Physical ClearancePhysical Clearance
"The physical ability of the uterus to clear infectious agents and inflammatory products
may be a critical factor as a first line ofdefense against uterine infections."
From: Troedssen and Liu, J. Reprod. Fert. Suppl 44 (1991), 283.
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Age vs. Physical ClearanceAge vs. Physical Clearance
Uterine contractility and uterine tone were reduced in old mares (≥ 15 years) in comparison to young mares (5 to 7 years).
Ultrasonically detected intrauterine fluid collections were more extensive in old vs. young mares.
From: Carnevale and Ginther, Therio, 37 (1992), 1101.
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Bacterial Causes of EndometritisBacterial Causes of Endometritis
• ß-hemolytic Streptococci
• E. coli
• Stapylococci
• Klebsiella
• Pseudomonas
• Corynebacteria
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Venereal Disease OrganismsVenereal Disease Organisms
Klebsiella pneumoniae
Capsule types: 1,2 & 5 are venereal
Urease positive isolates are suspect
Mucoid colony characteristics
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Venereal Disease OrganismsVenereal Disease Organisms
Pseudomonas aeruginosa
No laboratory test exists to distinguish venereal from opportunistic infections.
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Venereal Disease OrganismsVenereal Disease Organisms
Taylorella equigenitalis
Amies Charcoal Transport Medium
Chocolate blood agar with 5-10% carbon dioxide enrichment.
Mares can be chronic asymptomatic carriers.
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Fungal Causes of EndometritisFungal Causes of Endometritis
A history of repeated antibiotic usage may be present, but not always!
Active or chronic-active inflammatory pattern seen on endometrial cytology.
Repeat cytology and culture to confirm initial diagnosis prior to treatment.
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Yeasts and Fungi Isolated Yeasts and Fungi Isolated From the Equine UterusFrom the Equine Uterus
• Candida spp.• Mucor spp.• Aspergillus spp.• Scedosporium
(Monosporium) • and others…
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Diagnosis of Acute EndometritisDiagnosis of Acute Endometritis
Recognition of signs of inflammation:
• external inspection• palpation and ultrasonography• vaginosocopy• hysteroscopy
Invasiveness
Least
Most
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Obtaining the Endometrial SampleObtaining the Endometrial Sample
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Endometrial CytologyEndometrial Cytology
Simple but definitive test !!!
Greater than 1-2 PMN's per 5 high power microscope (400x) fields.
Or an epithelial to leukocyte ratio of 10 to 1, or less.
Active inflammation:
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Diff-Quik™ Stain SetDiff-Quik™ Stain Set
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Normal Normal Endometrial Endometrial
CytologyCytology1.1.
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
NormalNormalEndometrialEndometrial
CytologyCytology2.2.
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
EndometrialEndometrialCytology Cytology with Cellwith Cell
ExtrusionExtrusion
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Vaginal Epithelial CellsVaginal Epithelial Cells
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Cervical Epithelial CellsCervical Epithelial Cells
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
ErythrocytesErythrocytesonon
Endometrial Endometrial CytologyCytology
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
EosinophilsEosinophilsonon
EndometrialEndometrialCytologyCytology
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Polymorphonuclear LeukocytesPolymorphonuclear Leukocytes
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Acute Inflammatory CytologyAcute Inflammatory Cytology
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
PyometraPyometra
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
SmallSmallMononuclearMononuclear
CellsCells
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
ChronicChronicActiveActive
withwithPlasmacytesPlasmacytes
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Yeast on Yeast on CytologyCytology
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Gram StainGram StainEndometrialEndometrial
CytologyCytology
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Endometrial CultureEndometrial Culture
"Because recovery of bacteria from a uterine swab is subject to a variety of errors, the diagnosis of endometritis should never be made on culture results alone."
--A. C. Asbury, Uni. of Florida
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Endometrial BiopsyEndometrial Biopsy
An adjunct to diagnosis…
Neutrophils migrating through superficial layers is indicative of active inflammation, but lympho- cytic infiltrates are less reliable.
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Cytology-Culture-BiopsyCytology-Culture-Biopsy
The correlation between cytological and histological diagnosis and positive bacteriological results suggests that endometrial cytology can replace biopsy samples for the specific diagnosis of acute endometritis.
From : Brum Medici, et al J. Reprod. fert., Suppl. 44(1991), 700.
Virginia-Maryland Regional College of Veterinary MedicineWilliam B. Ley, DVM, MS, Dipl., A.C.T.
Cytology-Culture-BiopsyCytology-Culture-Biopsy
Chronic infiltrative and / or degenerative endometritis CANNOT be diagnosed accurately using endometrial cytological examinations.
From : Brum Medici, et al J. Reprod. fert., Suppl. 44(1991), 700.
