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Canine Pyometra: Current Perspectives on Causes and Management – A

Review

Article · August 2018

DOI: 10.21887/ijvsbt.v14i1.12998

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The Indian Journal of Veterinary Sciences & Biotechnology (2018) Volume 14, Issue 1, 52-56
ISSN (Print) : 2394-0247 : ISSN (Print and online) : 2395-1176, abbreviated as IJVSBT
10.21887/ijvsbt.v14i1.12998

Canine Pyometra: Current Perspectives on Causes and Management – A Review

Alok Kumar* and Atul Saxena
Institute of Paraveterinary Sciences, (DUVASU), Mathura, UP, India
Department of Veterinary Gynaecology and Obstetrics,
College of Veterinary Science, DUVASU Mathura, U.P., India.

Publication Info Abstract

Article history: Canine pyometra is a pathological condition of endometrium
Received : 02-06-2018 which results in accumulation of purulent semisolid substance in
Accepted : 11-06-2018 uterus. Canine pyometra is a sequlae of cystic endometrial
Published : 20-07-2018 hyperplacia (CEH) which results from hormonal imbalance.
Despite of enormous veterinary medical research and
Key Words:
development, still its main aspect of etio-pathology is not fully
Canine pyometra, Uterus, Cystic
known. Canine pyometra is mostly associated with other similar
endometrial hyperplacia (CEH),
Hormones. uterine pathological conditions, i.e., hydrometra, mucometra and
chronic endomertitis.
*Corresponding author:
dr.alokshukla.vet@gmail.com

This work is licensed under the

Creative Commons Attribution
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by/4.0/P), which permits
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reproduction in any medium,
provided the original work is
properly cited.

Copyright @: 2018 by authors

and SVSBT.

Introduction cervix as open-cervix or closed-cervix; however

closed type is more serious condition, which
Canine pyometra is a common reproductive
needs surgical intervention so as to prevent
syndrome of intact, sexually mature bitches
concomitant sepsis and fatality (Smith, 2006).
during met/diestrous stage with various clinical
as well as pathological signs specific to Pyometra can be defined as pathological
reproductive system along with systemic signs condition of uterus in which there is accumulation
(Fransson, 2003). Other terms to describe canine of purulent semisolid-liquid substance inside the
pyometra in relation to pathogenesis like chronic uterus of intact bitches, generally during post-
endometritis, chronic purulent metritis, cystic progesterone dominant phase of estrous cycle.
endometrial hyperplasia (CEH) or cystic Several authors suggested that pyometra should
endometrial hyperplasia - pyometra complex etc. be classified as CEH- pyometra complex because
also coined (Sandholm et al., 1975). Canine of the fact that subacute endometritis later
Pyometra can be categorized based on status of

Indian J. Vet Sci. Biotech (2018) Vol. 14 No. 1 52

develops as CEH is most important predisposing decrease risk of disease (Jitpean et al., 2012).
factor of pyometra (Sandholm et al., 1975).
Pathogenesis
However, others classified both condition
separately based on histopathology and clinical During luteal phase of estrous cycle blood
reports which profess pyometra without CEH (De progesterone level increases which in turn leads
Bosschere et al., 2002). to increased secretions from endometrial glands,
increase proliferation of endometrium, reduced
Etiology
myometrial contraction and closure of cervix
Several researches indicated predominant (Hardie, 1995) that favours occurrence of disease.
role of reproductive hormones, i.e., progesterone Factors associated with bacteria as well as their
and estrogen as predisposing factors for pyometra receptor expression may lead to enhance bacterial
in which former being most dominant one. It is attachment to endometrium (Gabriel et al., 2016).
well established that progesterone stimulates Wijewardana et al. (2015) described negative
endometrial glands secretions as well as correlation between progesterone on maturation
suppresses myometrial contraction which is of antigen presenting dendritic cells which may
favorable for bacterial growth and colonization lead to reduction of cell mediated immunity
(Cox, 1970). Estrogen has indirect role as it (CMI). Gultiken et al. (2016) reported increased
enhances endometrial response to progesterone. expression of 3β-hydroxysteroid dehydrogenase
Etiology of bacterial origin can be traced by most on endometrial tissue in bitches suffering from
common presence of E. coli along with endotoxins pyometra which further indicates influence of
(Hageman, 2004; Bondade et al., 2010) Virulence local production of progesterone on disease
factor of E. coli, i.e., K antigen and cytotoxin occurrence even at its normal range. Therefore
necrotizing factor are associated with pathological reduced CMI due to progesterone dominance in
conditions; however several other pathogenic luteal phase (Sugiura et al., 2004), along with
bacteria are also identified as causative agent, suppressed local immunity is favorable uterine
i.e., Klebsiella Spp., Streptococci, Staphylococci, environment for pathogens leading to their
anaerobic bacteria, Pseudomonads (Dhaliwal et enhanced growth and colonization.
al ., 1998). Several workers narrated that
Clinical Signs and Diagnosis
susceptibility of host and pathogenic bacteria
along with progesterone appears to be an Clinical signs of pyometra include
important components leading to disease endotoxaemia, septic shock, peritonitis and multi-
condition (Krekeler et al., 2012a; 2012b). organ failure. Jitpean et al. (2014) described
peritonitis as most common finding in pyometra
Prevalence, History and Clinical Findings
which ranges 10% of total cases. Cytological
Canine pyometra is commonly reported from examination of vaginal discharge generally shows
mature bithches ranging from 4 to 16 years, but neutrophilia with more number of degenerative
most common at the age of 7.5 years with neutrophils. Bacteria may be seen in vaginal
regular and repeated estrous cycle (Johnston et discharge.
al., 2001). Recently disease occurrence was
Biochemical analysis shows considerable
reported as 19% in bitches below 10 years of
increase in serum urea nitrogen, creatinine, ALT,
age and 20% in older female dogs (Jitpean et al.,
AST, ALP, globulin; however albumin level
2014). Breed susceptibility is also observed in
decreases highly significantly thus causing
this condition with high risk include Rottweiler,
enhanced ratio of globulin:albumin in pyometra
Saint Bernard, Chow chow, Golden Retriever,
cases (Jitpean et al., 2014). Destruction of tissue
Miniature Schnauzer, Irish Terrier, Airedale Terrier,
due to effect of endotoxin can be attributed to
Cavalier King Charles Spaniel, Rough Collie, and
elevated levels of serum urea nitrogen and
Bernese Mountain dog (Smith, 2006). Moreover,
creatinine. Hypoalbuminaemia and
a few breeds possess low risk like German
hyperglobulinaemia can be a result of acute
Shepherd, Daschunds, and Swedish hounds.
phase reaction and dehydration respectively
Breed susceptability strongly indicates the
(Patil et al., 2013; Shah et al., 2017).
contribution of genotype towards increase or

Indian J. Vet Sci. Biotech (2018) Vol. 14 No. 1 53

 Haematological evaluation shows efficacious over conventional open method with
erythrocytopenia, reduced level of haemoglobin careful case selection in order to improve success
(Hb), decreased packed cell volume (PCV), rate (Adamovich Rippe et al., 2013; Wallace et
azotemia and leucocytosis with neutrophilia as al., 2015; Becher-Deichsel et al., 2016).
consistent findings associated with disease (Patil
Medical Approach
et al., 2013). Gupta and Dhami. (2013) explained
that reduced level of Hb, PCV, total erythrocyte Medical approach mainly aims at systemic
count (TEC) and platelets along with elevated and intrauterine application of medicines.
level of erythrocyte sedimentation rate (ESR), Subcutaneous administration of prostaglandin
total leucocytes count (TLC) and (PGF2α) at the dose rate of 150-200 µg/kg/day
polymorphonuclear (PMN) cells indicates for more than 10 days showed 100% results
toxaemia whereas raised level of leucocytes, (Myhre, 2016), which may be due the fact that
PMN cells and declining lymphocytes point out PGF 2 α causes luteolysis which leads to
recovery from toxemia. Therefore these altered progesterone block (Renton et al., 1993). Another
hematological values can be used as aid to protocol with combination of cabergoline (@ 5
diagnosis as well as prognosis of canine pyometra Pg/kg PO once daily) and cloprostenol (@ 1 Pg/
(Mohan et al., 2015). Most common finding in kg once daily) for seven days was found
bitches affected with closed cervix pyometra enthusiastic. However, in recent times use of
shows leucocytosis with shift to left. (Nath et al., progesterone blockers such as mifepristone
2009). Anaemia in bitches can be sequelae of (Hoffman and Schuler, 2000) or aglepristone
erythrocyte diapedesis into uterine lumen along (Wehrend and Traschbostedt, 2003; Arnold et al.,
with depression of erythropoiesis in the bone 2006) has proved better protocol of choice.
marrow associated with toxaemia (Nath et al., Further Contri et al. (2015) successfully used a
2009). The azotaemia follows glomerulonephritis protocol in which aglepristone combined with a
which occurs due to deposition of antigen- short duration (6 days) antibiotic cover proved
antibody complex on basement membrane of efficacious. Another recent protocol used for the
glomerulus; moreover this condition is further treatment of pyometra is administration of third
aggravated by pre-renal azotaemia (Pretzer, generation GnRH antagonist acyline @ 330 μg/
2008). kg orally (single dose) with amoxicillin- clavulanate
Advanced diagnostic techniques like @ 12.5 mg/kg twice a day, orally for seven days
ultrasonographic imaging is one of the best provided promising results (Batista et al., 2016),
diagnostic tool in which uterus is observed as Conclusion
enlarged and hypoechoic tubular organ containing
In spite of greater pace of veterinary
echogenic fluid (Gupta et al., 2013), however
pharmacological and pathological advancement
sometimes pus shows slow, whirlpool like pattern
in research and innovation, satisfactory treatment
(Bigliardi et al., 2004).
for canine pyometra is still not formulized. One
X ray can be another mode of diagnosis, but of the several reasons for this condition can be
with some limitation as observation is sometime narrated as lack of complete and detailed
misdiagnosed with pregnancy especially of pre- information regarding etio-pathology of canine
mineralization stage (less than 45 days) (Pretzer, pyometra due to very complex nature of disease.
2008). It is need of the hour to find well established
Treatment medical treatment with maximum recovery rate
which can be used as alternative to stressful,
Surgical Approach costly and laborious surgical approach.
Spaying remains the choice of treatment for Acknowledgment
majority of obstetrician, however recently
Laparoscopic Assisted Ovariohysterectomy Authors are thankful to the Professor & Head
(LAOVH) is advocated for treatment of select and staff of Depar tment of Veterinar y
cases of canine pyometra, which is proved to be Gynaecology and Obstetrics, College of Veterinary
Science, Mathura.

Indian J. Vet Sci. Biotech (2018) Vol. 14 No. 1 54

Conflict of interest: of scavenger receptor SR-B1 in canine
endometrial and placental epithelial cells and its
All authors declare no conflict of interest. potential involvement in pathogenesis of pyometra.
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