Palestra infecaouterina interveting-alexei

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Palestra infecaouterina interveting-alexei

  1. 1. Carlos Antônio de Carvalho Fernandes Med. Vet. PhD. cacf@biotran.com.brSão Paulo - SP07/04/2009
  2. 2. Uterine Infections 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)
  3. 3. Uterine Infections In cattle classified as: Puerperal uterine infections (Metritis puerperalis) Affect the uterus before the involution is completed Normally before 21d post partumAnimals between 3rd and 4th week: evaluate through rectal palpation??? Post-puerperal uterine infections (Endometritis) Occurs after completion of uterine involution Normally starting from 4 weeks post calving
  4. 4. Uterine infections in cattle
  5. 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. 6. Practical aspects:1 Define the type of infection puerperal or post-puerperal degree of uterine involution time elapsed from calving
  7. 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. 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. 9. Practical aspects: 4 Define treatment scheme/program Verify the infection type Local or parenteral Adequate labor availability Cost Withdrawal time for milk
  10. 10. Puerperal uterine infectionsMetritis 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
  11. 11. Puerperal uterine infectionsMetritis PuerperalisSymptoms:- 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)
  12. 12. Puerperal uterine infectionsMetritis PuerperalisMain signs- Enlarged uterus localized in abdominal cavity- Liquid, fetid contents of the uterine cavity- Thinned and fragile uterine wall- In general, ovarian inactivity- Leucocytosis
  13. 13. 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
  14. 14. Treatment PUERPERAL INFECTION Excessive DelayedContamination involution Antibiotics Prostaglandins
  15. 15. Treatment Characteristics of antibiotics to be used Broad spectrum of activity Low possibility for bacterial resistance Practicality of the treatment Cost
  16. 16. Efficacy of the treatment of placental retentionwith oxytetracycline HCl with or withoutsimultaneous administration of cloprostenol(Fernandes, 1999)Variable Oxytetracycline Oxyt+ HCl CloprostenolNumber of animals 90 90Infection at 30d post partum (%) 44.4 42.2Degree of uterine involution* (%) 1.92 2.43Interval calving-to-conception (d)* 78.4 54.1Breeding period (d)* 131.3 111.7Services/conception 2.41 2.03* Significativo pelo teste de ‘t’ a 5% de probabilidade
  17. 17. Puerperal uterine infectionsMetritis Puerperalis 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
  18. 18. Carlos Antônio de Carvalho FernandesEduardo Ramos de OliveiraBruno Fernandes Ludgero AlvesAna Cristina Silva de FigueiredoMarilu Martins Gioso
  19. 19. Treatment scheme in animals after detection of calving problems At 20 h 48 h postGroup Treatment N pp 1st application 1 Nuflor IM2x 26 20mg de Florfenicol IM/kg PV 20mg de Florfenicol IM/kg PV Nuflor IM2x 20mg de Florfenicol IM/kg PV 20mg de Florfenicol IM/kg PV 2 28 + 0,530mg de Cloprostenol + 0,530mg de Cloprostenol +Ciosin 3 Nuflor SC1x 27 40mg de Florfenicol SC/kg PV - Nuflor SC1x 40mg de Florfenicol SC/kg PV 4 27 + 0,530mg de Cloprostenol 0,530mg de Cloprostenol +Ciosin 5 Oxitetra IM1x 29 20mg de Oxitetraciclina IM/kg PV Oxitetra IM1x 20mg de Oxitetraciclina IM/kg PV 6 28 + 0,530mg de Cloprostenol 0,530mg de Cloprostenol + CiosinTOTAL 165
  20. 20. Classification of uterine involution in cows treated withantibiotics 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
  21. 21. 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) N and % of animals with Grade 1 Grade 2 Grade 3Group Treatment Type N uterine No and % No and % No and % infection 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 – 7,14TOTAL 165 35,15 15,76 12,73 6,66 P> 0,05
  22. 22. Days post partum at first service, number of services per conception and breeding period in animals in different treatment groups (Fernandes et al., 2008) Calving-to-1st Services/ BreedingGroup Treatment type No service interval conception period (days) (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 + 44,60TOTAL 165 65,08 + 17,47 2,96 + 0,98 154,56 + 42,01 P> 0,05
  23. 23. Post-puerperal uterine infectionsEndometritisOccur in cows after puerperal period when theuterus completed its involutionRepresent more chronic courseRarely are life threateningPredisposing factors:- puerperal uterine infections- nutritional deficiencies- confinement (microbism)- lack of proper hygiene at mating or AI- presence of sexually transmissible diseases
  24. 24. Sequence of events associated withuterine infections
  25. 25. 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
  26. 26. Post-puerperal uterine infectionsEndometritis 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.).
  27. 27. Post-puerperal uterine infectionsEndometritis
  28. 28. Post-puerperal uterine infectionsEndometritis
  29. 29. Mucosal discharge
  30. 30. Comparative efficacy of tow methods fordiagnosis of uterine infections in cattle:rectal palpation and vaginoscopy Number of Method Efficacy (%) animalsVaginoscopy 738 100Rectal palpation 260 35,2
  31. 31. Post-puerperal uterine infectionsEndometritis Treatment: - Antibiotic therapy - Local x parenteral - Additional treatments: - prostaglandins - Estrogens
  32. 32. Post-puerperal uterine infectionsEndometritis Treatment: - Antibiotic therapy - Local x parenteral - For whom infusions are not suitable!!! ADVANTAGES Local: Parenteral: •Lower Cost •Practicality of administration •Less risk of WTD • Does not interfere with uterine defenses???
  33. 33. “Recent” information Actual conclusions Estradiol does not have immunostimulatory properties Progesterone is immunosuppressiveFactsDuring estrogenic phase (heat) uterus is moreresistant to infections than during the luteal phase ConclusionsEstradiol must have some immunostimulatory properties
  34. 34. Effects of prostaglandinon 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
  35. 35. Bruno Fernandes Ludgero Alves1; Eduardo Ramos e Oliveira1, CarlosAntônio de Carvalho Fernandes2; Marilu Martins Gioso2
  36. 36. Efficacy of cloprostenol (Ciosin®) in thetreatment of uterine infections in cattleTreatment scheme and number of animals in accordance with theclassification of the uterine infection and presence of ovarian activity (CL) Group Ovarian Grade of Uterine Infection Activity (treatment) N Grade 1 Grade 2 Grade 3 (class) 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
  37. 37. Average and percentage occurrence of different types of uterineinfections in animals with or without corpus luteum in accordance with the characteristics of uterine discharge detected with vaginoscopy (Alves et al., 2008)
  38. 38. Average and percentage occurrence of different types of uterineinfections in animals with or without corpus luteum in accordance with the characteristics of uterine discharge detected with vaginoscopy (Alves et al., 2008)
  39. 39. Eficiência média geral (Número e Percentual) dos tratamentos de infecçãouterina em animais com presença ou não de Corpo Lúteo (Alves et al 2008). 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%)CL (-) 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%)
  40. 40. 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)
  41. 41. Carlos Antônio de Carvalho Fernandes2; Marilu Martins Gioso2;BrunoFernandes Ludgero Alves1; Eduardo Ramos e Oliveira1
  42. 42. Average efficacy (numeric and percentage) of the treatmentsindependently from the presence of CL Group Development of the condition Improvement (treatment) N Improvement Cure 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 + 64 14b 36c 50 (78,12%)c Metricure Total 222 37 86 123
  43. 43. Average efficacy of evaluated treatment approachesin cows with or without the presence of CL
  44. 44. Average interval treatment-to-conceptionin different treatment groups in cowswith or without the presence of CL
  45. 45. “O sucesso nasce do querer.Sempre que o homem aplicar adeterminação e a persistênciapara um objetivo, ele vencerá osobstáculos, e, se não atingir oalvo, pelo menos fará coisasadmiráveis”. José José de Alencar Carlos Antônio de Carvalho Fernandes Med. Vet. D.Sc. cacf@biotran.com.br

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