It is a fatal disease of bitches and early intervention is required to save the life of animal.

1. Canine PyometraCanine Pyometra
Vivek Joshi
Ph.D Scholar
Division of Medicine

2. OverviewOverview
1. Introduction
2. Types
3. Predisposing Factors
4. Aetio-pathogenesis
5. Clinical signs
6. Diagnosis
7. Differential diagnosis
8. Treatment
9. Control
10. Conclusion

3. IntroductionIntroduction
 Canine pyometra → intact bitches → uterine bacterial
infection → systemic illness
 Etiology: Escherichia coli clones from normal flora
 Early diagnosis & intervention to avoid disastrous
consequences
 Closed-cervix pyometra : medical emergency

4. PyometraPyometra
 Greek: pyo = pus, metra = uterus
 Accumulation of pus in uterus
 Infection overlying CEH → intrauterine purlent fluid
 Diestrual disorder of intact adult bitches (Dow,
1959)
 Chronic purulent endometritis post estrum, with/ without
multisystemic effects (Hardy & Osborne, 1974)

5. CEH-Pyometra-ComplexCEH-Pyometra-Complex
Cystic
endometrial
hyperplasia
Endometritis Pyometra
cysts 1 mm-1
or more cm
uterine
intraluminal
diameter of
< 1 cm
uterine
intraluminal
diameter of
> 1 cm

6. CEH-Pyometra-ComplexCEH-Pyometra-Complex
 CEH precedes pyometra
 CEH & pyometra → two separate entities → clinical
manifestations & morphohistological differences
(De Bosschere et al, 2001)
 Four gradations of CEH-Pyometra complex
(Dow, 1959)

7. Type I Type II Type III Type IV
thickened
endometrium
with
translucent
cysts
diffuse
plasma cell
infiltration
acute
endometritis
metritis or
pyometra
Chronic
endometritis,
squamous
metaplasia

8. ““Open” or “Closed” cervixOpen” or “Closed” cervix
1. Closed pyometra
2. Open pyometra
3. Stump pyometra
 inflammation/ bacterial infection→uterine body
remnant
 Severity of signs : cervix patency

9. INCIDENCEINCIDENCE
Pyometra : 23-24% before 10 yrs
(Egenvall et al, 1999)

10. (Tamilnadu J. Veterinary & Animal Sciences 7 (5) 252-253, September-
October, 2011)

11. Predisposing FactorsPredisposing Factors
Age
 middle-aged or old bitches (> 4 years)
 8.2 years (Dow, 1959)
 2.4 years (Kersey, 2004)
Parity
 nulliparous, intact bitches
Oestrous characteristics
 long diestrus

12. Breed
 wire-haired Dachshund/ Mongrels: ↓ risk
 Rottweiler, rough-haired Collie,Cavalier King
Charles Spaniel/ Golden Retriever: ↑ risk
(Susi Arnold, 2006)
 No breed influence on pyometra development
(Niskanen & Thrusfield, 1998)

13. PathogenesisPathogenesis
1) Hormonal influence on uterus
2) Virulence of infecting bacteria
3) Ability of bitch to combat infection
4) Individual sensitivity
 Growth factors & their receptors (growth factors
receptors, GFs)
(Gama et al. 2009)

14. Hormonal influence on uterusHormonal influence on uterus
 Progesterone in aetiology of canine pyometra & its
potentiation by estrogen
Teunissen (1952)
 Prolonged stimulation of uterus by progesterone from cystic
corpora lutea
Hardy & Osborne (1974)
 Steroid hormones influence conc. & distribution of steriod
receptors in uterus & cause pyometra
Dhaliwal et al (1999)

16. Virulence of infecting bacteriaVirulence of infecting bacteria
 Bacterial infection- not primary cause
 Predominant bacteria (in 82–100% of clinical cases):
Escherichia coli
 E. coli isolates → O serogroups (O4, O6)
(Wadas et al, 1996)
 Uropathogenic virulence factors (UVFs) for extra-intestinal
infection
(Yuri et al, 1999)

17. Genes Products
pap P fimbriae
fim Type1 fimbriae
sfa S fimbriae
hlyA α-haemolysin
cnf1 cytotoxic necrotising factor 1
iuc aerobactin
afa afimbrial adhesin 1 or Afa1

18.  P fimbriae
 PapGIII adhesin binds to Galα1–4Gal glycolipids &
Forssman Ag
 bacterial adhesion & colonization
 α-haemolysin/ CNF1 : tissue damage
 E. coli isolates : 5, 3 or more UVF genes
 genetic linkage- UVF genes & pathogenicity associated
islands (PAIs) : cnf1, hlyA; hlyA, pap; cnf1, hlyA, papGIII

19. Clinical signs Open-cervix Close-cervix
Vaginal discharge Watery- creamy;
light brown, green or
yellow
rare
Temperature normal/ slightly
elevated
elevated/ sub-normal
(toxemic bitch)
Lethargy/ depression + +
Vomiting + +
Polyuria/ polydipsia + +
 Clinical signs : 4-8 wks following last standing heat

20. Diestrus bitch with purulent vaginal dischargeDiestrus bitch with purulent vaginal discharge

21. Mechanism of PolyuriaMechanism of Polyuria
 Multifactorial
 Reduced permeability for water in DCT of kidney
(Asheim, 1964)
 Deposition of immune complexes in glomeruli causes
membranoproliferative glomerulonephropathy
(Sandholm et al, 1975)
 Renal tubular insensitivity to ADH due to tubular
damage by E.coli endotoxins

23. Abdominal palpationAbdominal palpation
Open-cervix pyometra
 thickened, irregular & slightly turgid uterine horns
Closed-cervix pyometra
 greater degree of uterine distension
 visible abdominal enlargement
 Care taken to avoid rupturing a distended uterus

24. UltrasonographyUltrasonography
 In early diagnosis of canine pyometra
(Bigliardi et al; 2004)
 Most valuable in closed-cervix pyometra
 Uterine wall- increased thickness/ hypoechoic
 Uterine lumen- grossly dilated/ anechoic fluid with
small echogenic particles

25. RadiographyRadiography
Abdominal Radiography
 tubular structures of fluid density/ opacity in caudal
abdomen
 Not specific for pyometra

26. Clinical pathologyClinical pathology
Haematology
 not pathognomic for pyometra
Leukocytosis
 TLC : 15,000- 60,000/mm³
(Bigliardi & Pamigiani, 2004)
 Neutrophilia (degenerative left shift) : PBN >3%
Anemia
 Normocytic, normochromic, non-regenerative

27.  Hyperglobulinemia
 Hypoalbuminemia
 ↑ ALP, BUN
 ↑ PG-metabolite (SIRS); cTnI / CRP (myocardial
injury→ endotoxemia, septicemia, DIC, secondary uremia)
(Hagman et al, 2007)
Urinalysis
 Hyposthenuria (sp. gravity < 1.030)

28. TreatmentTreatment
Surgical
 Ovariohysterectomy is treatment of choice
 severely ill bitches : aggressive fluid therapy & broad
spectrum antibiotics
Transcervical Endoscopic Catheterisation (TECT)
(Verstegen et al., 2008)

29. MedicalMedical
Indications:
 further breeding
 O.H. not possible : intercurrent disease (CHF)
 owner refuses surgery

31. 1. Antibiotics1. Antibiotics
 in every case
 G(-) and G(+) efficacy
 according resistogram as soon as possible
 Quinolones (Enrofloxacin/Marbofloxacin)
 Gentamicin
 Cefalosporins

32. Natural PGF₂α Synthetic PGF₂α0.02 mg/kg SC bid 7-10 days 0.001– 0.002 mg/kg SC OD
7-10 days
Day 1 : 0.1 mg/kg
Day 2 : 0.2 mg/kg
Day 3-7 : 0.25 mg/kg OD
Longer duration of action
Dinoprost
(Lutalyse®)
Cloprostenol
(Cyclix®)
2. Prostaglandin F₂α/ PGE

33.  Aglepristone
10 mg/kg SC
 day 1, day 2, day 7
 once a week
3. Antiprogestins

34. 4. Antiprolactins4. Antiprolactins
Cabergoline (Cabgolin®)
 0.005 mg/kg PO OD 7-10 days

35. 5. Supportive therapy5. Supportive therapy
 IV fluids (Lactated Ringer’s sol. /Glucose 5%)
 H₂ blocker : Metoclopramide
(vomiting / nausea)
 NSAIDs
 Antihistaminics
 Anticholinergics (excess salivation)

36. Prostaglandins
Results
Open-Cervix
Pyometra
Closed-Cervix
Pyometra
Complete
resolution
94 % 31 %
Whelped litter 88 % -
Recurrence 26- 40 % within 1 year
(Feldman & Nelson: Canine and Feline Endocrinology and
Reproduction, 2004)

37. ControlControl
1. O.H.
 at 6 months of age or before
 after breeding years
2. Post-partum reproductive system checking
3. Very rarely use contraceptive drugs

38. ConclusionConclusion
 Canine pyometra : infectious cause of infertility
 Occurrence : any bitch → clinical signs → after diestrus
regardless of age
 Confirmatory diagnosis : combination of diagnostics
 OH : therapy of choice
 PGF₂α therapy : ↑ success rates in open-cervix pyometra