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Clinico-Pathological Alterations in Canine Pyometra.

Introduction

Canine pyometra is defined as hormone mediated diestrual disorder and abnormal accumulation of purulent material within the uterus of intact bitches, typically occurring during or immediately following period of progesterone dominance or diestrual phase of estrous cycle. Pyometra typically affects mature to old age bitches that have undergone repeated estrous cycles, with reported mean age of 7.25 years or more (Johnston et al., 2001). There appears to be an increased incidence of pyometra in non-bred or nulliparous bitches and appears that gestation or pregnancy has protective action on canine endometrium from diestrual disorders. Pyometra is mostly recorded in intact and sexually mature bitches. Approximately one third of bitches are diagnosed to have open type pyometra. Closed cervix pyometra is more life threatening, as septicaemia and toxaemia occur due to production of toxic components by rapidly multiplying bacteria and if left untreated can result in death (Smith, 2006). Pyometra is known to culminate to systemic inflammation potentially affecting multiple vital organs specifically kidney, liver and heart. Mortality rate was assessed to be four percent even though the patient was subjected to modern treatments, which could be due to impairment of liver and kidney functions (Prasad et al., 2017). The systemic effects of pyometra are reflected by changes in hematological and serum biochemical parameters. Therefore the present study was undertaken to study the variations in hemato-biochemical parameters.

Materials and Methods

Animal Selection: The investigation included a total of ten female dogs aged between 4-14 years with clinical signs being exhibited for past 10-15 days before being presented. These cases were tentatively diagnosed for pyometra based on clinical signs exhibited viz. lethargy, polydipsia, polyuria, distended abdomen, inappetence, vomition, serosangunious to foul smelling chocolate brown coloured pus discharges with bitch frequently licking her vulva. Abdominal palpation followed by vaginal exfoliative cytology (VEC) was carried out in all bitches. The vital parameters were recorded and were within the normal range, except for mild elevation of body temperature and pale conjunctival mucous membrane. Three out of ten bitches were presented in lateral recumbency. All bitches were subjected for hemato-biochemical estimations, ultrasonography/ radiography or both for confirmative diagnosis.

Vaginal Exfoliative Cytology: The smears revealed predominant numbers of intermediate cells and neutrophils suggestive of diestrus stage of estrous cycle and uterine infection.

Ultrasonographic and Radiographic Findings: Sonogram revealed that uterus was distended and appeared as anechoic/ hypoechoic circular convoluted tube with speckles in lumen (Fig. 1). Radiograph revealed that uterus was larger in diameter than small intestinal loops located in ventral caudal abdomen while displacing loops of intestine dorsally and cranially (Fig. 2).

Gross Specimen Examination: The uterus, uterine horn and ovary were collected after ovario-hysterectomy to record gross pathological changes.

Results and Discussion

The hematological parameters recorded in pyometra affected bitches showed alterations from normal values are presented in Table 1. At the time of presentation, leukocytosis (85.58[+ or -]2.23), neutrophilia (93.9[+ or -]0.45) and lymphopenia (6.1[+ or -]0.45) were recorded in most bitches, which was more pronounced in bitches affected with closed type of pyometra and in delayed cases. The results were in agreement with the recent studies of Singh et al. (2010) and Sahoo et al. (2012). Marked neutrophilic leukocytosis with shift to left of reticulocytes (immature/band cells) was indicative of severe bacterial infection to uterus, which might be due to stimulation of bone marrow to release more number of immature or band cells into peripheral circulation in an attempt to overcome infection (Mojzisova et al., (2000) (Fig. 3). Moderate to severe anaemia was observed in open pyometra and is more pronounced in closed pyometra, that was assessed based on hemoglobin (5.65 [+ or -] 0.63), PCV (27.9 [+ or -] 2.03) and RBC (4.34 [+ or -] 0.41) which might be due to loss of red blood cells into uterine lumen (Nath et al., 2009).

The values of serum biochemical parameters in pyometra affected bitches showed alteration from normal values is presented in Table 2. Blood urea nitrogen (BUN) and creatinine values were used for prediction of prognosis of pyometra. The BUN (mg/dL) and creatinine (mg/dL) values were 69.68[+ or -]8.72 and 2.93[+ or -]0.28, respectively. High level of BUN and creatinine values were pronounced in closed type of pyometra. These findings are consistent with the observations of Colombo et al. (1988). Increased values of BUN and creatinine in pyometra affected bitches might be due to decreased efficiency of kidney to remove nitrogen containing waste from body fluids (Gayakwad et al., 1999). Hypoalbuminaemia (2.77[+ or -]0.09) recorded in present study might be due to renal impairment that might culminate to renal loss of albumin. No significant alterations of ALT (47.46[+ or -]3.20) values were recorded in our study. Moderate to severe elevation of ALP levels (138.93[+ or -]6.63) were recorded which could be due to effects of hepatic impairment (Verstegen et al., 2008).

All affected bitches were subjected to ovariohysterectomy after stabilization with parentral fluids (Ringers lactate 10 ml/kg and Intalyte (a) 5ml/kg i.v) and antibiotic therapy (Taxim (b) 500 mg i.v). The gross examination of genital tract revealed that uterine horns were flabby with thickened endometrial wall and accumulated with sanguinopurulent discharge in uterine horn which might be due to inflammation of myometrium and endometrium wall. The endometrial layer was corrugated and small cyst like structures with some portions of endometrial wall being exposed (Fig. 4 and 5). Ovaries showed presence of persistent corpus lutem. In present study, histopathological examination of affected uterus revealed multifocal erosions in superficial epithelial layers of endometrium, which was infiltrated with large number of viable and degenerated neutrophils, tissue debris and extravascular erythrocytes. The endometrial glands were disorderly arranged with diffuse cellular infiltration with neutrophils and extravasated erythrocytes in endometrial stroma in accordance with the findings of Biswas et al. (2012) (Fig. 6). Out of ten bitches, two bitches succumbed two days after surgery while another two recovered slowly after initial events of severe vomition for five days post surgery. Other six bitches had uneventful recovery without any complications. Mortality recorded in two bitches of present study might be due to delayed presentation with elevated levels of BUN and creatinine suggestive of renal impairment. Evaluation of hemato-biochemical parameters facilitates inprediction of prognosis for pyometra in small animal practice. It is concluded from our study that early diagnosis and presentation along with prompt institution of fluid, antibiotic therapy and postoperative management could result in good prognosis and hemato-biochemical parameters helped the clinician in therapeutic plan.

References

Biswas, D., Das, S., Das, B.C. and Saifuddin, A.K.M. (2012). Pyometra in a German Shepherd Dog: A Clinical Case Report. Asian J. Anim. Vet. Adv. 7: 446-51.

Colombo, G., Oselin, D.A., Battocchio, M. and Ragione, I.L.A. (1988). The cystic endometrial hyperplasia - pyometra complex in bitches. Further studies on Blood Chemistry. Bulletino Associazioeltaliana Vetrerinari Per Piccoli Animali. 25: 221-37.

Gayakwad, S.G., Ranganath, B.N., Jayadevappa, S.M., Srinivas, C.L. and Krishnaswamy, S. (1999). Observations on biochemical changes in canine pyometra. Indian Vet. J. 76: 289-90.

Johnston, S.D., Kustritz, M.V.R. and Olson, P.N.S. (2001). Disorders of canine uterus and uterine tubes. In: Canine and Feline Theriogenology. Philadelphia, USA: W.B Saunders. p. 206-24.

Mojzisova, J., Valocky, I., and Maracek, I. (2000). Monitoring of selected immunological parameters in bitches with glandular cystic hyperplasia pyometra complex before and after ovariohysterectomy. Polish. Vet. Sci. 3: 23-27.

Nath, K., Tiwari, S.K. and Kalim, O. (2009). Physiological and haematological changes in bitches with pyometra. Indian Vet. J. 86: 734-36.

Prasad, V.D., Kumar, P.R. and Sreenu, M. (2017).

Pyometra in Bitches: A Review of Literature. Res. Rev. J. Vet. Sci. Technol 6: 12-20.

Sahoo, M., Panda, S.K., Sahoo, N.R., Mohapatra, H.K. and Nath, I. (2012). A clinico-pathological investigation on canine pyometra. Indian Vet. J. 89: 21-22.

Singh, K.P., Singh, B., Singh, J.P., Singh, S.V., Singh, P. and Singh, H.N. (2010). Diagnostic and therapeutic management of pyometra in bitches. Intas Polivet. 11: 86-87.

Smith, F.O. (2006). Canine pyometra.Theriogenol. 66: 610-12.

Verstegen, J., Dhaliwal, G. and Onclin, K.V. (2008). Mucometra, cystic endometrial hyperplasia, and pyometra in the bitch: Advances in treatment and assessment of future reproductive success. Theriogenol. 70: 364-74.

M. Srinivas (1), K. Anusha (2), B. Chandra Prasad (3) and A. Thangamani (4)

Department of Veterinary Gyanecology and Obstetrics N.T.R. College of Veterinary Science Sri Venkateswara Veterinary University (SVVU) Gannavaram - 521101 (Andhra Pradesh)

(1.) Professor and Corresponding author. E-mail: mandasrinivas2001@gmail.com

(2.) Assistant Professor

(3.) Assistant Professor, Veterinary Clinical Complex

(4.) Post Graduate Scholar

(a) - Brand of Intas Animal Health, Ahmedabad

(b) - Brand of Alchem Laboratories Limited, Mumbai

Dr. Inderjeet Singh resumes as Director (Animal Husbandry), Punjab

Dr. Inderjeet Singh, a renowned Veterinary Gynaecologist, Researcher and Academician resumed charge on 5th November' 2018 as Director, Department of Animal Husbandry, Punjab. Dr. Singh was born on 23rd November 1960, completed his schooling and college education from the town of Hisar. Hisar is famous for Hisar breed of sturdy and tall bullocks and is a hub of animal husbandry activities esp. buffalo rearing and breeding.

Dr. Singh graduated from Haryana Agricultural University (HAU), followed by Masters in Animal Reproduction and served the university as Assistant Professor/Associate Professor for nearly 16 years (Sept'1985-April' 2001). In the meanwhile, he completed his Ph.D. from University of Liverpool as a Commonwealth Scholar. In May' 2001, he joined Indian Council of Agricultural Research (ICAR) at Central Institute for Research on Buffaloes (CIRB), Hisar as Principal Scientist. He served as Head of the Division of Animal Reproduction and Physiology for over ten years before resuming as Institute Director in May' 2013. During his tenure as Director, the institute witnessed transformation in all spheres of activities (research projects, publications, animal herds' performance, farm production, revenue generation as well as overall infrastructure and outlook). The institute is well recognised as a centre of attraction for livestock farming communities across the country due to farmer-centric approaches viz. trainings, buffalo fairs and shows, milking competitions and other activities organized befitting of livestock farmers. During his tenure, he handled several research projects on bovine infertility, reproductive biotechnology, proteomics and coordinated a pan-India Network Project on Buffalo Improvement addressing seven important buffalo breeds. Dr. Singh laid the foundation of Murrah Buffalo Breeders Welfare Association in 2013 and more recently in July' 2018 for the Nili Ravi Breeders' Association. He has provided his inputs and has been instrumental in several important national and international policy making. In February' 2018, Dr. Singh successfully organized IX Asian Buffalo Congress at CIRB, Hisar as President of the Asian Buffalo Association. Dr. Inderjeet Singh has been honoured as Fellow of the prestigious National Academy of Veterinary Sciences (2001), National Academy of Dairy Science (India, 2016) and Indian Society for Study of Animal Reproduction (ISSAR, 2012). He also served as General Secretary of ISSAR and as Editor of the scientific journal 'Haryana Veterinarian', besides being in the executive committee and Editorial boards of various other societies and scientific journals of national and international repute.

Dr. Singh has well promoted buffalo rearing and farming as the 'Black Gold' of the country. He strongly believes that economy of Indian farmer can be well supported with rearing of these native animals with higher milk fat. We wish him the best for all his scientific endeavours and look forward for his achievements in yet another state focussed on buffalo rearing. We hope that his potential will be well explored befitting the animal farming community of Punjab state.
Table 1: Hematological parameters in bitches affected with pyometra

Parameters                         Pyometra        Reference
                               affected bitches      range

Hemoglobin (gm/dl)              5.65[+ or -]0.63    12-18
RBC (X [10.sup.6]/[micro]L)     4.34[+ or -]0.41     5.5 8.8
PVC (%)                        27.9[+ or -]2.03     37-55
WBC (X [10.sup.3] /[micro]L)   85.58[+ or -]2.23     6-17
Reticulocyte/                   2.75[+ or -]0.30     0-1.5
Band cells (%)
Neutrophils (%)                93.9[+ or -]0.45     60-70
Lymphocytes (%)                 6.1[+ or -]0.45     30-40

Table 2: Biochemical parameters in bitches affected with pyometra

Parameters               Pyometra         Reference
                      affected bitches     range

BUN (mg/dL)           69.68[+ or -]8.72    7-32
Creatinine (mg/dL)     2.93[+ or -]0.28    0.5-1.4
Albumin (gm/dL)        2.77[+ or -]0.09    3.2-4.2
ALT (U/L)             47.46[+ or -]3.20   10-94
ALP (U/L)            138.93[+ or -]6.63    0-90
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Title Annotation:Clinical Article
Author:Srinivas, M.; Anusha, K.; Prasad, B. Chandra; Thangamani, A.
Publication:Intas Polivet
Geographic Code:9INDI
Date:Jul 1, 2018
Words:2085
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