Review

Authors: Ragnvi Hagman

Pyometra is a common disease in intact bitches and queens and occurs, although less frequently,in most other female pets. The illness is generally diagnosed within 4 months after estrus, in middle-aged to older bitches and queens. Hormonal and bacterial factors are important for the disease development, and progesterone plays a key role. The diagnosis is based on case history, clinical signs, and findings on physical examination, laboratory analyses and diagnostic imaging. Pyometra is potentially life-threatening and considered a medical emergency. Surgical ovariohysterectomy is the safest and most efficient treatment, but purely pharmacologic options are possible in less severe cases.

Topics: Animals; Dog Diseases; Dogs; Endometrial Hyperplasia; Female; Hysterectomy; Progesterone; Pyometra

PubMed: 35465903
DOI: 10.1016/j.cvsm.2022.01.004

Review

Authors: Rafael Gariglio Clark Xavier, Clarissa Helena Santana, Yasmin Gonçalves de Castro...

Pyometra, characterized by the accumulation of purulent exudate in the uterus, is the most prevalent reproductive disease in canines. While the disease often begins with mild local symptoms, it can escalate into peritonitis, sepsis, and multi-organ dysfunction, thereby posing a significant threat to life. Despite the high incidence and recognized significance of canine pyometra, gaps persist in our understanding of its epidemiology, etiology, and pathogenesis. Recent studies have, however, broadened our comprehension of this disease, shedding light on potential new infection sources, etiologies, and the application of clinical predictive biomarkers and new therapeutic protocols. This study aimed to review the current understanding of canine pyometra, with particular emphasis on the latest research concerning its etiology and epidemiology. Furthermore, it addressed key research questions and proposed directions for future investigations into various facets of canine pyometra.

PubMed: 37958065
DOI: 10.3390/ani13213310

Review

Authors: Ragnvi Hagman

Pyometra is a common disease in dogs and cats. Hormones and opportunistic bacteria are fundamental in the development, with progesterone playing a key role. The disease should be suspected in intact bitches and queens presenting with illness, and particularly if within 4 months after estrus. Early diagnosis and treatment are vital to increase chances of survival as endotoxemia and sepsis often are induced. Typical clinical signs include vaginal discharge, depression, anorexia, polyuria and polydipsia, fever and gastrointestinal disturbances. Surgical ovariohysterectomy is the safest and most effective treatment. For breeding animals with less severe illness, purely medical treatments alternatives are possible.

Topics: Animals; Cat Diseases; Cats; Dog Diseases; Dogs; Female; Hysterectomy; Ovariectomy; Pyometra

PubMed: 29933767
DOI: 10.1016/j.cvsm.2018.03.001

Review

Authors: Silvan R Urfer, Matt Kaeberlein

: Desexing dogs is promoted for population control, preventative healthcare, and behavior modification. Common methods are orchiectomy and ovariectomy/ovariohysterectomy. GnRH superagonist implants are available in some areas. Alternative methods like vasectomy and salpingectomy/hysterectomy are uncommon. The terminology used to describe desexing is inconsistent and contradictory, showing a need for the adaption of standardized terminology. : Surprisingly, empirical studies show no effects of desexing on population control in companion and shelter dogs despite desexing being consistently recommended in the literature. There is evidence for a population control effect in free-roaming dogs, where desexing also has benefits on zoonotic disease and bite risk. Population control in free-roaming dogs is mostly correlated with female, not male desexing. : Desexing affects numerous disease risks, but studies commonly neglect age at diagnosis and overall lifespan, age being by far the most important risk factor for most diseases. We argue that lifespan is a more important outcome than ultimate cause of death. A beneficial effect of desexing on lifespan is consistently demonstrated in females, while evidence for a beneficial effect in males is inconsistent. Studies are likely biased in desexing being a proxy for better care and desexed dogs having already lived to the age of desexing. Desexing reduces or eliminates common life-limiting diseases of the female reproductive system such as pyometra and mammary tumors, while no analogous effect exists in males. Disease risks increases across sexes and breeds include cruciate ligament rupture, various cancers, and obesity. Urinary incontinence risk is increased in females only. Various other disease risk changes show considerable variability between breeds and sexes. : Desexed males show reduced libido, roaming, conspecific mounting, and urinary marking frequency, as well as reduced male dog-directed aggression in a majority of males desexed for behavioral reasons. There is a detrimental effect on the risk and progression of age-related cognitive dysfunction. Desexed dogs may be less likely to cause bite injuries across sexes. The evidence for other effects such as human-directed aggression, human or object mounting, resource guarding, or shyness and anxiety is inconsistent and contradictory. There are few studies specific to females or individual breeds. : The evidence for a beneficial effect of desexing is stronger in female than in male dogs; however, there is significant variation between breeds and sexes, and more research is needed to further elucidate these differences and to arrive at individualized evidence-based recommendations for clinical practice.

PubMed: 31817504
DOI: 10.3390/ani9121086

Review

Authors: Katarzyna Malin, Olga Witkowska-Piłaszewicz

Acute phase response is a nonspecific reaction to disturbances in homeostasis during which the production of some Acute Phase Proteins (APPs) is stimulated; they are sensitive but nonspecific markers of systemic inflammatory processes. The major positive APP in dogs is the C-reactive protein (CRP). The dynamic of its concentration changes fast, rising and decreasing rapidly with the onset and removal of the inflammatory stimulus. It increases within the first 4-24 h after the stimulus and reaches up to a 50-100-fold increase of the baseline level. It has been documented that this APP's concentration is elevated during several diseases, such as pyometra, panniculitis, acute pancreatitis, polyarthritis, sepsis, immune-mediated hemolytic anemia, and neoplasia in dogs. In clinical practice, canine CRP is mostly measured to detect and monitor systemic inflammatory activity and the efficacy of treatments, because it is a more sensitive marker than shifts in leukocyte counts. Blood serum CRP concentration is becoming a part of routine biochemistry panels in many countries. In this article, changes in CRP concentration and its clinical application in healthy and diseased dogs are discussed.

PubMed: 36290272
DOI: 10.3390/ani12202888

Authors: A Morales Vicente, Y García Sánchez, N Santonja López...

Xanthogranulomatous endometritis (XGE) is an uncommon inflammatory benign condition that can mimic endometrial cancer. The majority of the reported cases of XGE have been observed in postmenopausal women, often presenting clinically as haematometra or benign senile pyometra. We report a case of XGE in a 73-year-old woman who presented with pyometra. Diagnostic hysteroscopy is an important tool when accompanied by endometrial samples for histology in suspected cases. Knowledge of this uncommon disease is crucial for accurate diagnosis. XGE is a benign condition, however, there have been reported cases of chronic active XGE and bacterial infection in which hysterectomy was required due to complications.

PubMed: 38128093
DOI: 10.52054/FVVO.15.4.106

Authors: Xin Wang, Guohua Yu

Canine pyometra, which is accompanied by bacterial contamination of the dog uterus, is defined as a complex disease associated with the activation of several systems, including the immune system. This study uses text mining and microarray data analysis methods to discover some existing targeted gene drugs and expand potential new drug indications. Text mining ("canine pyometra") and microarray data analysis (GSE99877) were used to obtain a common set of genes. These genes and protein-protein interaction (PPI) networks were analyzed using Gene Ontology and the Kyoto Encyclopedia of Genes and Genomes. Then, the important genes clustered in the PPI network were selected for gene-drug interaction analysis to provide evidence for potential drug discovery. Through text mining and data analysis, we obtained 17,544 text mining genes (TMGs) and 399 differentially expressed genes (DEGs), respectively. There were 256 repeat genes between TMGs and DEGs, including 70 upregulated genes and 186 downregulated genes. Thirty-seven genes clustered in three significant gene modules. Eight of the 37 genes can target 23 existing drugs. In conclusion, the discovery of 8 immune response-related genes (, , , , , , , and ) targeting 23 existing drugs may expand the drug indications for pyometra-related diseases in dogs.

Topics: Humans; Female; Animals; Dogs; Gene Expression Profiling; Pyometra; Microarray Analysis; Gene Regulatory Networks; Protein Interaction Maps; Data Mining; Computational Biology; Gene Ontology

PubMed: 37101686
DOI: 10.1155/2023/7839568

Authors: Madhav Paudel, Sujan Kafle, Tulsi Ram Gompo...

Canine Pyometra, also known as cystic endometrial hyperplasia complex, is a common reproductive issue in bitches. This study aimed to identify associated risk factors, hematological variation, bacteria involved, and the most potent anti-bacterial against bacterial isolates of canine pyometra. Forty-five bitches of different habitats, breeds, and ages infected with pyometra were included in the study. The samples were cultured to isolate bacteria associated with the pyometra and antibiotic sensitivity was done for each bacterial isolates to get antibiogram. The study findings showed that potential risk factors such as age group, medroxyprogesterone acetate administration, and changes in the white blood cells parameters were significantly associated (P < 0.05) with the type of pyometra. Closed cervix pyometra in dogs showed significantly higher prevalence of clinical signs including depression, vomiting, abdominal enlargement, and fever compared to the open cervix pyometra. Low levels of red blood cells, pack cell volume, and hemoglobin indicated that the pyometra-infected dogs were more likely to have normocytic, normochromic, and non-regenerative anemia. Pyometra was attributed to an increase in AST (Aspertate aminotransferase), ALT (Alanine transaminase), ALP (Alkaline phosphatase), BUN (Blood Urea Nitrogen), and Creatinine while a decrease in serum albumin. Of the all bacterial isolates, (35.55%) was the most common pathogen isolated from canine pyometra, followed by spp. (26.66%). and spp. were susceptible to Imipenem, Amikacin, and Gentamicin while highly resistant to Ampicillin and Erythromycin. Imipenem, Amikacin, and Gentamicin were the most sensitive antibiotics, while Ampicillin and Erythromycin were the most resistant antibiotics for the bacterial strain isolated from canine pyometra. Multidrug resistant was observed in 26 of the isolated bacteria, indicating acquired resistance due to improper and uncontrolled use. Hence early diagnosis and close monitoring of antimicrobial susceptibility before therapeutic intervention is indispensable in preventing the global threat of antimicrobial resistance.

PubMed: 38076069
DOI: 10.1016/j.heliyon.2023.e22368

Review

Authors: Fiona Hollinshead, Natali Krekeler

PRACTICAL RELEVANCE

Pyometra is a commonly occurring uterine disease in cats that often leads to loss of breeding potential and, in some cases, can be life threatening. An increased incidence of cystic endometrial hyperplasia (CEH) and pyometra is seen with age. Most queens present with uterine lesions after 5-7 years of age (average 7.6 years, range 1-20 years). Clinical signs most commonly occur within 4 weeks of the onset of oestrus in queens that are either mated, spontaneously ovulate or are induced to ovulate (mechanical stimulation or hormone induction). The disease is most often observed in dioestrus.

CLINICAL CHALLENGES

Queens with pyometra often go undiagnosed as there may be few or only very mild clinical signs and laboratory changes. For example, the classic sign of mucopurulent bloody vulvar discharge often goes unnoticed. Abdominal ultrasound is the best tool for diagnosis of pyometra and for monitoring response to therapy.

PATIENT GROUP

Classically, middle-aged/older nulliparous intact queens present with pyometra. However, so-called 'stump pyometra' can occur if ovarian tissue is left behind during ovariectomy or ovariohysterectomy (ovarian remnant syndrome). Queens treated with exogenous steroid hormones such as high doses of megestrol acetate or medroxyprogesterone acetate for oestrus prevention can also develop CEH and pyometra.

EVIDENCE BASE

There has been little published to date on CEH, endometritis and pyometra in the queen and most of the currently available information has been extrapolated from studies carried out in the bitch. The queen and the bitch have very different reproductive physiology; thus, further research and investigation into the precise aetiopathogenesis of these disease processes of the uterus in the queen is warranted.

AUDIENCE

This review is aimed at clinicians working in small animal practice, especially those in countries where surgical sterilisation is not practised as commonly as in the United States, Canada or Australasia, and who will therefore see a greater proportion of intact queens.

Topics: Animals; Cat Diseases; Cats; Endometrial Hyperplasia; Female; Hysterectomy; Ovariectomy; Pyometra

PubMed: 26733546
DOI: 10.1177/1098612X15623114

Authors: D Muram, P Drouin, F E Thompson...

Pyometra is a potentially lethal disease. Eighteen cases, all but one in postmenopausal women, were diagnosed at the Ottawa General and Ottawa Civic hospitals between 1974 and 1978 inclusive. A review of this series and of the literature demonstrates that a large proportion of cases (72% in this series) are associated with or follow radiotherapy for a malignant disease of the uterus and that anaerobic bacteria are frequently isolated from the uterine cavity (in 56% of the patients in this series). Because pyometra is potentially lethal (one patient in our series died) it should be considered as an abscess and treated promptly and vigorously by evacuation and continued drainage of the uterine cavity. Curettage of the cavity and the endocervical canal after dilatation is essential to rule out associated malignant disease as well as to debride the necrotic tissue. Antibiotics effective against aerobic and anaerobic bacteria should be given to all patients with signs of systemic infection. Once the infection is controlled, the underlying problem can be treated.

Topics: Adult; Aged; Female; Humans; Menopause; Middle Aged; Ontario; Retrospective Studies; Suppuration; Uterine Cervical Neoplasms; Uterine Diseases

PubMed: 7284938
DOI: No ID Found