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
Practical aspects: 3
� Define the intensity of infection
� Degree of uterine lesions
� Average time of recovery
� Treatment frequency
� Associations (additional factors)
� Selection of antibiotic (persistence in uterus)
Practical aspects: 4
� 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)
Puerperal uterine infections
Metritis Puerperalis
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
Puerperal uterine infections
Metritis Puerperalis
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
Puerperal uterine infections
Metritis Puerperalis
Carlos Antônio de Carvalho Fernandes
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.).
Post-puerperal uterine infections
Endometritis
Post-puerperal uterine infections
Endometritis
Post-puerperal uterine infections
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
Post-puerperal uterine infections
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
Post-puerperal uterine infections
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)
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
Carlos Antônio de Carvalho Fernandes
Med. Vet. D.Sc.