Palestra infecaouterina interveting-alexei
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  • 1. São Paulo - SP 07/04/2009 Carlos Antônio de Carvalho Fernandes Med. Vet. PhD. [email_address]
  • 2.
    • 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
  • 3. 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 3 rd and 4 th week: evaluate through rectal palpation???
  • 4. Uterine infections in cattle
  • 5. 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
  • 6. Practical aspects: 1
    • Define the type of infection
      • puerperal or post-puerperal
      • degree of uterine involution
      • time elapsed from calving
  • 7. 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
  • 8. 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)
  • 9. Practical aspects: 4
    • Define treatment scheme/program
      • Verify the infection type
      • Local or parenteral
      • Adequate labor availability
      • Cost
      • Withdrawal time for milk
  • 10.  
  • 11. 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
  • 12.
    • 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
  • 13.
    • 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
  • 14. 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
  • 15. Treatment PUERPERAL INFECTION Excessive Contamination Delayed involution Antibiotics Prostaglandins
  • 16. Treatment
    • Characteristics of antibiotics to be used
      • Broad spectrum of activity
      • Low possibility for bacterial resistance
      • Practicality of the treatment
      • Cost
  • 17. Efficacy of the treatment of placental retention with oxytetracycline HCl with or without simultaneous administration of cloprostenol (Fernandes, 1999) * Significativo pelo teste de ‘t’ a 5% de probabilidade 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
  • 18.
    • 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
  • 19. Carlos Antônio de Carvalho Fernandes Eduardo Ramos de Oliveira Bruno Fernandes Ludgero Alves Ana Cristina Silva de Figueiredo Marilu Martins Gioso
  • 20. Treatment scheme in animals after detection of calving problems Group Treatment N At 20 h pp 48 h post 1st application 1 Nuflor IM2x 26 20mg de Florfenicol IM/kg PV 20mg de Florfenicol IM/kg PV 2 Nuflor IM2x +Ciosin 28 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 - 4 Nuflor SC1x +Ciosin 27 40mg de Florfenicol SC/kg PV + 0,530mg de Cloprostenol 0,530mg de Cloprostenol 5 Oxitetra IM1x 29 20mg de Oxitetraciclina IM/kg PV 6 Oxitetra IM1x + Ciosin 28 20mg de Oxitetraciclina IM/kg PV + 0,530mg de Cloprostenol 0,530mg de Cloprostenol TOTAL 165
  • 21.
    • 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
    Classification of uterine involution in cows treated with antibiotics with or without cloprostenol (Fernandes et al., 2008)
  • 22. 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 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
  • 23. 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 Group Treatment type No Calving-to-1 st 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
  • 24.  
  • 25. 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
  • 26. Sequence of events associated with uterine infections
  • 27. 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
  • 28.
    • 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
  • 29. Post-puerperal uterine infections Endometritis
  • 30. Post-puerperal uterine infections Endometritis
  • 31. Mucosal discharge
  • 32. Comparative efficacy of tow methods for diagnosis of uterine infections in cattle: rectal palpation and vaginoscopy Method Number of animals Efficacy (%) Vaginoscopy 738 100 Rectal palpation 260 35,2
  • 33.
    • Treatment:
    • - Antibiotic therapy
    • - Local x parenteral
    • - Additional treatments:
    • - prostaglandins
    • - Estrogens
    Post-puerperal uterine infections Endometritis
  • 34.
    • Treatment:
    • - Antibiotic therapy
    • - Local x parenteral
    • - For whom infusions are not suitable!!!
    Post-puerperal uterine infections Endometritis
    • Local:
    • Lower Cost
    • Less risk of WTD
    • Parenteral:
    • Practicality of administration
    • Does not interfere with uterine defenses???
    ADVANTAGES
  • 35. “ 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
  • 36. 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
  • 37. Bruno Fernandes Ludgero Alves 1 ; Eduardo Ramos e Oliveira 1 , Carlos Antônio de Carvalho Fernandes 2 ; Marilu Martins Gioso 2
  • 38. Efficacy of cloprostenol (Ciosin®) in the treatment of uterine infections in cattle Treatment scheme and number of animals in accordance with the classification of the uterine infection and presence of ovarian activity (CL) 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
  • 39. 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)
  • 40. 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)
  • 41. Eficiência m é dia geral (Número e Percentual) dos tratamentos de infec ç ão uterina em animais com presen ç a ou não de Corpo L ú teo (Alves et al 2008). CL (+) CL (-) 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%) 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%)
  • 42. 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)
  • 43. Carlos Antônio de Carvalho Fernandes 2 ; Marilu Martins Gioso 2 ;Bruno Fernandes Ludgero Alves 1 ; Eduardo Ramos e Oliveira 1
  • 44. Average efficacy (numeric and percentage) of the treatments independently from the presence of CL Group Development of the condition (treatment) N Improvement Cure Improvement and Cure 1: Control 30 3 a 3 a 6 ( 20,00% ) a 2: Preloban 64 9 b 17 b 26 ( 40,62% ) b 3: Metricure 64 11 b 30 c 41 ( 64,06% ) c 4: Preloban + Metricure 64 14 b 36 c 50 ( 78,12% ) c Total 222 37 86 123
  • 45. Average efficacy of evaluated treatment approaches in cows with or without the presence of CL
  • 46. Average interval treatment-to-conception in different treatment groups in cows with or without the presence of CL
  • 47. “ 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”. José de Alencar Carlos Antônio de Carvalho Fernandes Med. Vet. D.Sc. [email_address]