EAGLE’S VIEW ON PYOMETRA IN DOGS
(Syn: Chronic Purulent Endometritis)
Dr. N. Bhumapati Devi, Dr. Laltlankimi*, Dr. M.G.Jayathangaraj, Dr. Keneisezo Kuotsu and Dr. Sashitola Ozukum
Department of Veterinary Clinical Complex, CoVSc and AH, CAU(i) Jalukie, Nagaland
*corresponding author: meemieltki@gmail.com
Abstract
Among the reproductive diseases, one of the commonest encountered by pet owners rearing female dogs of multiple species is pyometra. The causes of pyometra in dogs, the types and incidences of pyometra, in addition to the different types of clinical symptomatology, are to be understood by pet owners. In this aspect, technical information has been delivered in this article, in addition to the various management-related measures to be followed by the pet animal owners.
Key words: dog; oestrus cycle; pyometra, symptoms; management measures
Introduction: Pyometra, from the Latin “pyo” for pus and “metra” for uterus, is essentially an infected uterus. Pyometra can be defined as a pathological condition of the uterus in which there is accumulation of purulent discharge inside the uterus of dogs and it occurs as a syndrome.
Incidence of pyometra
- Pyometra is a common disease mainly affecting bitches over 7-8 years of age. The disease generally occurs following oestrus and generally during the luteal phase.
- It may occur in any sexually intact young to middle-aged dog; however, it is most common in older dogs.
- Pyometra occurs at any age after the first estrus and is typically a condition of the middle-aged to older unspayed bitch. The majority of spontaneous diseases affect heifers over the age of 6 years. However, it also affects younger animals with a mean of 2 years of age approximately.
- Usually, two to eight weeks following the last estrus, pyometra develops.
Etiological factors of Pyometra
- Estrous cycle stages: Most bitches present to pyometra within 8 weeks of their last estrous cycle. It can, however, occur at any stage of the estrous cycle or during pregnancy.
- Parity: There is a modest relationship between nulliparity and pyometra, but no association between pseudopregnancy and an abnormal estrous cycle.
- Hormonal imbalances.
- Breed: Breeds predisposed to pyometra are: rough-coated collies, rottweilers, miniature schnauzers, Cavalier King Charles spaniels, and golden retrievers.
Oestrus cycle of dogs in a nutshell (vaginal discharge-cytology helps diagnosis of stages).
The canine estrous (reproductive) cycle is made up of 4 different stages (proestrus, estrus, diestrus, and anestrus).
- Proestrus: When we say “the dog is in heat,” we are referring to the stage in which most owners begin to notice changes. This stage lasts an average of 9 days but can last up to 27 days. Male dogs will be attracted to the female, but she will be unresponsive. Estrogen levels will be at their highest, and follicles will form. The vulva is usually swollen and discharged with a blood-tinged discharge.
- Estrus is the stage when the female is receptive to the male (it ranges from 4 to 24 days), and when mating occurs now, it may often result in conception. The vulva is enlarged, but softens a little, and there is a decrease in the blood in the vulvar discharge; estrogen levels drop, and progesterone levels start to increase.
- Diestrusis is the stage that occurs after estrus, when the female is no longer receptive to the male. This stage lasts for about 2 months. Estrogen levels are low, while progesterone levels peak three to four weeks after the start of diestrus and then fall to baseline by the end of diestrus. This increase and then decrease in progesterone will occur whether or not the dog is pregnant.
- Anestrus: The period between diestrus and the next proestrus is known as anestrus. This stage usually lasts four months, though some breeds can last much longer. The vulva is no longer puffy, and there is no vaginal discharge. The body makes use of this period to get the uterus ready for the next possible pregnancy.
Types of pyometra: There are two types of pyometra: open and closed.
- Open pyometra: The classic sign is the foul-smelling purulent discharge from the vulva.
- Closed pyometra: No such discharge is visible, but the abdomen may appear bulged.
Clinical Signs of Pyometra
Common clinical signs include mucopurulent discharge, lethargy, depression, inappetence, polyurea, polydipsia, vomiting (which are the pathognomonic symptoms in pyometra cases), and diarrhea. Fever may or may not be present in cases of open cervix pyometra, but fever is commonly associated with closed cervix pyometra. The symptoms associated with toxaemia may be hypothermic. Multiple organ dysfunctions with changes in haematology and biochemistry often exist in pyometra-affected dogs.
Imaging techniques for diagnosis of pyometra:
The diagnosis of pyometra is best made with the aid of ultrasonography (Fig: 1) and radiology (Fig: 2).
Fig 1: Ultrasography Fig 2: Radiography
Treatment
- Ovariohysterectomy is the choice of treatment for older bitches. Induction of luteolysis (or) prevention of progesterone binding to its receptors for prevention of progesterone effects is generally required.
- Use of PGF2-alpha medicaments: Prostaglandin treatment using PG F2-alpha or a synthetic product like cloprostenol Dose: 10 μg/kg, daily for 5 to 7 days. IM shall be used as treatment for pyometra when reproduction is desired.
- Use of dopamine agonists or prolectin inhibitors: Hence, the dopamine agonists or prolactin inhibitors (in bitch, prolactin is an important luteotropic hormone). such as bromocriptine (20mcg/kg) or cabergoline (5mcg/kg) are used in combination with natural or synthetic prostaglandin to treat pyometra.
- Use of progesterone receptor blocker therapy: Aglepristone (10 mg/kg on days 1, 2, and 8) competitively prevents progesterone from binding to its receptor.
- Use of oxytocin in pyometra cases: When the cervix is closed, as in closed pyometra cases, avoid usage of oxytocin, but in case of an open type of pyometra, one shall use the oxytocin at the dose rate of 5 to 25 IU, as the total dose, in dogs by IM or IV.
- Use of antimicrobial treatment: Antimicrobial therapy is associated with the use of appropriate broad-spectrum antibiotics.
Use of other therapeutic and management measures
- If swelling is noticed in the abdomen by pet animal owners, the dog is to be taken to a veterinarian for therapy because any further delay will cost the dog its life.
- Further, the animal with abdominal swelling should not be made to assume lateral recumbency for a long time to avoid respiratory embarrassment.
- It is to be understood by the animal owner that use of an Elizabethan collar is necessary to prevent the ingestion or licking of the vulvar discharge.
- Antibiotic coverage with non-nephrotoxic agents (e.g., amoxicillin-clavulanic acid, 25 mg/kg/day) to prevent septicaemia for bitch in bad general health
- Fluid therapy by the IV route using a 5% DNS solution shall be given after ruling out anemia, and drugs like ondensetron are to be used against vomiting.
- The use of colloids, i.e., blood volume expanders, shall be carried out.
- Ovariohysterectomy is both curative and preventive of pyometra.
Conclusion
Pyometra is an important disease in female dogs, and the symptomatology and management measures need to be properly understood by pet owners.
References:
- Rubina kumari Baithalu, Biswa Ranjan Maharana, Chinmoy Mishra, Laxminarayan Sarangi and Lipismita Samal. 2010. Canine Pyometra. Veterinary World Vol.3(7): 340-342:
- Martin Llazani, Alketa Qoku, and Luljeta Dhaskali. 2021. .Laboratory Findings, Vaginal Cytology and Histopathology in Bitches with Cystic Endometrial Hyperplasia – Pyometra Complex: European Journal of Biology and Biotechnology.
- Boel A. Fransson, MS Claude and A. Ragle. 2003. Canine Pyometra: An Update on Pathogenesis and Treatment. 25(8).
- Alok Kumar and Atul Saxena. 2018. Canine Pyometra: Current Perspectives on Causes and Management – A Review. The Indian Journal of Veterinary Sciences & Biotechnology. 14(1) 52-56.
