palestra infecaouterina interveting-alexei

São Paulo - SP

07/04/2009

Carlos Antônio de Carvalho Fernandes

Med. Vet. PhD.

[email protected]

A major cause for reduced fertility in cattle (4-60%)

Average losses of $75.00/affected animal

� Delay in conception

� Increased cost of semen

� Decreased milk production

� Cost of medication

� Cost of labor (treatment)

Uterine Infections

Uterine Infections

In cattle classified as:

� Puerperal uterine infections (Metritis puerperalis)

� Affect the uterus before the involution is completed

� Normally before 21d post partum

� Post-puerperal uterine infections (Endometritis)

� Occurs after completion of uterine involution

� Normally starting from 4 weeks post calving

Animals between 3rd and 4th week: evaluate through rectal palpation???

Uterine infections in cattle

Uterine infections in cattle

Volume of uterine cavity in cattle

1 days post calving=6 liters-9kg

30 days post calving=0.2 liters – 0.5kg

Practical aspects:

1

� Define the type of infection

� puerperal or post-puerperal

� degree of uterine involution

� time elapsed from calving

Practical aspects: 2

� Define characteristics of microorganisms

present in the uterus

� type of infection

� mixed microorganisms or specific (possibility

of environmental resistance)

� establish the most adequate choice of

antibiotic


� Define the intensity of infection

� Degree of uterine lesions

� Average time of recovery

� Treatment frequency

� Associations (additional factors)

� Selection of antibiotic (persistence in uterus)


� Define treatment scheme/program

� Verify the infection type

� Local or parenteral

� Adequate labor availability

� Cost

� Withdrawal time for milk

Puerperal uterine infections

Metritis Puerperalis

� Occur during the involution phase

� Acute character – require rapid intervention

� Mixed bacterial flora (opportunistic)

� Incidence varies from 6 to 40%

� Predisposing factors:

- Placental retention

- Calving assistance

- Distocia

- Poor body condition at parturition

� Symptoms:- Vaginal discharge: purulent, sanguinolent, fetid

- Dried discharge contaminating perineal region and

base of tail

- Visible abdominal contractions when expulsing uterine

contents

- Hyperthermia, prostrate position, anorexia

- Digestive disorders (tympanus)

- Mortality (generally due to toxemia or bacteriaemia)



Main signs

- Enlarged uterus localized in

abdominal cavity

- Liquid, fetid contents of the

uterine cavity

- Thinned and fragile uterine wall

- In general, ovarian inactivity

- Leucocytosis



Treatment

� Must be rapid and efficacious- Number of bacteria is duplicating every 8 minutes

- Life threatening condition

- acute process

- high absorption capacity of the uterus

- absorption of both bacteria and toxins

Treatment

PUERPERAL

INFECTION

Excessive

Contamination Delayed

involution

Antibiotics Prostaglandins

Treatment

� Characteristics of antibiotics to be used

� Broad spectrum of activity

� Low possibility for bacterial resistance

� Practicality of the treatment

� Cost

* Significativo pelo teste de ‘t’ a 5% de probabilidade

Efficacy of the treatment of placental retention

with oxytetracycline HCl with or without

simultaneous administration of cloprostenol (Fernandes, 1999)

Variable Oxytetracycline

HCl

Oxyt+

Cloprostenol

Number of animals 90 90

Infection at 30d post partum (%) 44.4 42.2

Degree of uterine involution* (%) 1.92 2.43

Interval calving-to-conception (d)* 78.4 54.1

Breeding period (d)* 131.3 111.7

Services/conception 2.41 2.03

� Treatment- Parenteral antibiotics

- Broad spectrum

- Low level of resistance

- Stimulation of uterine involution

- Sustain physiological parameters

- Re-evaluate after 15-30 days

� Contraindications for infusions at this phase

- Large uterine volume

- Increased risk for a transfer of the uterine contents through oviducts

- Hyperaemia

- High capacity for re-absorption through endometrium




Eduardo Ramos de Oliveira

Bruno Fernandes Ludgero AlvesAna Cristina Silva de Figueiredo

Marilu Martins Gioso

Group Treatment NAt 20 h

pp

48 h post

1st application

1 Nuflor IM2x 26 20mg de Florfenicol IM/kg PV 20mg de Florfenicol IM/kg PV

2Nuflor IM2x

+Ciosin28

20mg de Florfenicol IM/kg PV

+ 0,530mg de Cloprostenol

20mg de Florfenicol IM/kg PV

+ 0,530mg de Cloprostenol

3 Nuflor SC1x 27 40mg de Florfenicol SC/kg PV -

4Nuflor SC1x

+Ciosin27

40mg de Florfenicol SC/kg PV

+ 0,530mg de Cloprostenol0,530mg de Cloprostenol

5 Oxitetra IM1x 29 20mg de Oxitetraciclina IM/kg PV

6Oxitetra IM1x

+ Ciosin28

20mg de Oxitetraciclina IM/kg PV

+ 0,530mg de Cloprostenol0,530mg de Cloprostenol

TOTAL 165

Treatment scheme in animals after detection of

calving problems

Classification of uterine involution in cows treated with

antibiotics with or without cloprostenol (Fernandes et al., 2008)

� Degree of involution:

1. Uterus located completely in abdominal cavity

2. Palpation possible apart from the tips of uterine horns

3. Palpation of more than half of the uterine body possible within the abdominal cavity

4. Access to the complete uterus in the abdominal cavity

5. More than half of the uterus located in the pelvic cavity

Group Treatment Type N

N and % of

animals with

uterine

infection

Grade 1

No and %

Grade 2

No and %

Grade 3

No and %

1 Nuflor IM2x 26 11 - 42,31 5 – 19,23 3 – 11,54 3 – 11,54

2 Nuflor IM2x +Ciosin 28 9 - 32,14 4 – 14,29 4 – 14,29 1 – 3,57

3 Nuflor SC1x 27 10 - 37,03 5 – 18,52 3 – 11,11 2 – 7,41

4 Nuflor SC1x +Ciosin 27 8 - 29,63 4 – 14,81 4 – 14,81 0 – 0,00

5 Oxitetra IM1x 29 11 - 37,93 4 – 13,79 4 – 13,79 3 – 10,34

6 Oxitetra IM1x + Ciosin 28 9 - 32,14 4 – 14,29 3 – 10,71 2 – 7,14

TOTAL 165 35,15 15,76 12,73 6,66

Occurrence and average percentage of uterine infections and

characteristics of the infection in different groups of animals

evaluated between 25 and 35 days pp (Fernandes et al., 2008)

P> 0,05

Group Treatment type No

Calving-to-1st

service interval

(days)

Services/

conception

Breeding

period (days)

1 Nuflor IM2x 26 75,32 + 19,87 3,27 + 1,11 169,29 + 45,76

2 Nuflor IM2x +Ciosin 28 62,45 + 19,62 2,91 + 0,99 148,63 + 39,97

3 Nuflor SC1x 27 66,27 + 16,66 2,96 + 0,86 157,33 + 41,18

4 Nuflor SC1x +Ciosin 27 56,19 + 14,09 2,48 + 0,83 135,49 + 35,64

5 Oxitetra IM1x 29 68,17 + 15,98 3,11 + 0,89 161,02 + 43,53

6 Oxitetra IM1x + Ciosin 28 60,83 + 16,37 2,92 + 0,93 149,24 + 44,60

TOTAL 165 65,08 + 17,47 2,96 + 0,98 154,56 + 42,01

Days post partum at first service, number of services

per conception and breeding period in animals in

different treatment groups (Fernandes et al., 2008)

P> 0,05

Post-puerperal uterine infections

Endometritis

� Occur in cows after puerperal period when the

uterus completed its involution

� Represent more chronic course

� Rarely are life threatening

� Predisposing factors:

- puerperal uterine infections

- nutritional deficiencies

- confinement (microbism)

- lack of proper hygiene at mating or AI

- presence of sexually transmissible diseases

Sequence of events associated with

uterine infections

Infecção uterina pós-

puerperal� Classification:

� Grade 1 (catarrhal): opaque vaginal mucus with few strings or flecks of pus

� Grade 2 (muco-purulent): strings of mucus mixed with mucus

� Grade 3 (purulent): discharge predominantly with purulent character

� Grade 4 (pyometra): Grade 3 infection with accumulation of large quantities of purulent material in uterine cavity

Sintomas principais:

� Redução da fertilidade (retorno ao estro após

cobertura ou IA em intervalos regulares ou não);

� Ciclos estrais irregulares (mais longos ou mais curtos)

ou normais

� Anestro (infecções graves com destruição do

endométrio ou piometra com corpo lúteo persistente)

� Contrações abdominais;

� Sintomatologia sistêmica: rara (febre, taquicardia,

anorexia etc.).


Endometritis


Endometritis

Mucosal discharge

Comparative efficacy of tow methods for

diagnosis of uterine infections in cattle:

rectal palpation and vaginoscopy

MethodNumber of

animalsEfficacy (%)

Vaginoscopy 738 100

Rectal palpation 260 35,2

� Treatment:

- Antibiotic therapy

- Local x parenteral

- Additional treatments:

- prostaglandins

- Estrogens


Endometritis

� Treatment:

- Antibiotic therapy

- Local x parenteral

- For whom infusions are not suitable!!!

Local:

•Lower Cost

•Less risk of WTD

Parenteral:

•Practicality of administration

• Does not interfere with

uterine defenses???

ADVANTAGES


Endometritis

“Recent” information

� Estradiol does not have immunostimulatory properties

� Progesterone is immunosuppressive

During estrogenic phase (heat) uterus is more

resistant to infections than during the luteal phase

Facts

Estradiol must have some immunostimulatory properties

Conclusions

Actual conclusions

Effects of prostaglandin

on uterine immunity

� Prostaglandins have direct effect on the phagocytic activity of endometrial immune cells

� This efect is even stronger if the uterus is under the effect of

progesterone

� Even in the absence of luteal tissue, prostaglandins remain important for the function of uterine defence mechanisms

- Promote activation of the immune cells

- Increase chemotaxis

- Enhance diapedesis

Bruno Fernandes Ludgero Alves1; Eduardo Ramos e Oliveira1, Carlos

Antônio de Carvalho Fernandes2; Marilu Martins Gioso2

Efficacy of cloprostenol (Ciosin®) in the

treatment of uterine infections in cattle

Group Ovarian Grade of Uterine Infection

(treatment)Activity

(class)N Grade 1 Grade 2 Grade 3

Controle CL (+) 15 5 5 5

CL (-) 15 5 5 5

1 dose CL (+) 32 15 10 7

CL (-) 32 15 10 7

2 doses-24Horas Com CL 32 15 10 7

CL (-) 32 15 10 7

2 doses-48Horas CL (+) 32 15 10 7

CL (-) 32 15 10 7

Total 222 100 70 52

Treatment scheme and number of animals in accordance with the

classification of the uterine infection and presence of ovarian activity (CL)

Average and percentage occurrence of different types of uterine

infections in animals with or without corpus luteum in accordance

with the characteristics of uterine discharge detected with

vaginoscopy (Alves et al., 2008)

Group Development of the condition Improvement

(treatment) N Improvement Cure and cure

Control 15 2 (13,33%) a 2 (13,33%) a 4 (26,67%) a

1 dose 32 5 (15,62%) a 10 (31,25%) b 15 (46,88%) b

2 doses-24Horas 32 5 (18,75%) a 20 (65,62%) c 25 (71,88%) c

2 doses-48Horas 32 7 (21,85%) a 15 (46,87%) b 22 (68,75%) c

Total 111 19 (17,12%) 47 (42,34%) 66 (59,46%)

Eficiência média geral (Número e Percentual) dos tratamentos de infecção

uterina em animais com presença ou não de Corpo Lúteo (Alves et al 2008).

Group Development of the condition Improvement

(treatment) N Improvement Cure and cure

Control 15 2 (13,33%) a 1 (6,67%)a 3 (23,33%)a

1 dose 32 5 (15,63%) a 10 (31,25%)b 15 (46,87%)b

2 doses-24Horas 32 5 (15,63%) a 16 (50,00%)b 21 (65,63%)b

2 doses-48Horas 32 8 (25,00%) a 12 (37,50%)b 20 (62,50%)b

Total 111 20 (18,02%) 39 (35,14%) 60 (50,05%)

CL (+)

CL (-)

Average percentage of positive development (improvement and

cure) of the uterine infections in animals with or without CL,

independently from the type of treatment (Alves et al., 2008)

Carlos Antônio de Carvalho Fernandes2; Marilu Martins Gioso2;Bruno

Fernandes Ludgero Alves1; Eduardo Ramos e Oliveira1

Group Development of the condition

(treatment) N Improvement CureImprovement

and Cure

1: Control 30 3a 3a 6 (20,00%)a

2: Preloban 64 9b 17b 26 (40,62%)b

3: Metricure 64 11b 30c 41 (64,06%)c

4: Preloban +

Metricure64 14b 36c 50 (78,12%)c

Total 222 37 86 123

Average efficacy (numeric and percentage) of the treatments

independently from the presence of CL

Average efficacy of evaluated treatment approaches

in cows with or without the presence of CL

Average interval treatment-to-conception

in different treatment groups in cows

with or without the presence of CL

“O sucesso nasce do querer. Sempre que o homem aplicar a determinação e a persistência para um objetivo, ele vencerá os obstáculos, e, se não atingir o alvo, pelo menos fará coisas admiráveis”.

JosJosJosJoséééé de Alencarde Alencarde Alencarde Alencar


Med. Vet. D.Sc.

[email protected]

palestra infecaouterina interveting-alexei

Health & Medicine