CLINICO-DIAGNOSTIC STUDIES AND EVALUATION OF CERTAIN BIOMARKERS IN CANINE PYOMETRA
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Date
2021-01
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SRI VENKATESWARA VETERINARY UNIVERSITY TIRUPATI - 517 502. (A.P.) INDIA
Abstract
The aim of the present study was to identify the frequency of SIRS in
pyometra affected bitches and to study the role of certain biomarkers of diagnostic
and prognostic importance, along with evaluation of blood flow velocities and
hemodynamic indices in uterine artery and to study the hemato-biochemical,
histopatholgical and immunohistochemical changes in canine pyometra. Out of 716
bitches presented for various gynaecological ailments, 122 bitches were diagnosed
with pyometra with an overall occurrence of 17.04 per cent. Bitches in the age group
of 6 to 9 years (29.51%) had high occurrence of pyometra followed by 3 to 6 years
(28.69%), 9 to12 years (27.05%), 12 to 15 years (9.83%) and least in bitches upto 3
years of age (4.92%). The mean age of occurrence of pyometra was 8.03±0.26 years
with a range of 2 to 15 years. The present study revealed high occurrence of pyometra
in Spitz (43.44%) followed by Labrador (22.95%), Mongrel (9.83%), German
Shepard (7.38%), Pug (5.74%), Pomeranian (4.10%), Great Dane (2.46%), Doberman
(1.64%), Dachshund, Bull Mastiff and Saint Bernard (0.82% each). Occurrence of
pyometra was highest in nulliparous (62.30%) bitches followed by primiparous
(22.13%) and pluriparous (15.57%) bitches. The occurrence of open cervix (85.25%)
pyometra was higher than closed cervix (14.75%) pyometra. The most predominant
symptom reported by the owners was presence of vaginal discharge (80.00%)
followed by inappetence (72.00%), polydipsia (74.60%), vomiting (68.00%), polyuria
(57.30%) and diarrhoea (12.00%). The altered physiological findings on clinical
examination were increased (28.00%) and decreased (1.33%) temperature, pale
(28.00%) and hyperemic (6.67%) mucous membranes, mild (32.00%) to moderate
(6.67%) dehydration, moderate (50.67%) to severe depression (34.67%) in pyometra
affected bitches. On palpation of abdomen 24.00 per cent bitches expressed pain and
enlarged uterus was clearly felt in 32.00 per cent bitches and unclear in 68.00 per cent
bitches. The temperature and respiratory rate were significantly elevated in pyometra
affected bitches compared to healthy controls.
Hematological studies revealed decreased hemoglobin, packed cell volume
and total erythrocyte count, while leukogram showed significant neutrophilia and
leukocytosis with left shift. None of the hematological parameters differed
significantly between open and closed pyometra except for TLC and percentage of
band neutrophils being higher in closed cervix pyometra. Serum biochemical profile
showed elevated levels of total protein, globulin, ALT, AST, ALP, BUN and
creatinine and reduced albumin and A/G in pyometra affected bitches compared to
healthy controls. None of the biochemical parameters differed significantly between
open and closed cervix pyometra except for elevated globulin and reduced A/G in
closed cervix pyometra. Estimation of CRP and SAA revealed significant elevation of
these acute phase proteins in pyometra affected bitches (71.12±6.19 mg/L and
60.68±2.27 mg/L) compared to healthy controls and also, the concentrations were
significantly higher in closed cervix pyometra than open cervix pyometra.
In the present study 70.67 per cent bitches affected with pyometra had positive
SIRS status. Positive SIRS status was noticed in 80.00 per cent of bitches with closed
cervix pyometra and 68.33 per cent of bitches with open pyometra. Among the
clinical criteria to assess SIRS status temperature, heart rate, TLC, percentage of band
neutrophils and SAA were significantly higher in SIRS positive than SIRS negative
bitches. No significant difference was noticed in respiratory rate, albumin and CRP
between SIRS positive and SIRS negative bitches.
Radiographic examination revealed a space occupying radiographic opacity
between colon and urinary bladder in moderately affected cases, while in severely
affected bitches distended uterus was easily identified beyond caudo-ventral abdomen
displacing the intestines cranially.
On ultrasonographic examination the distended uterine horns appeared as
round or oval anechoic to hypoechoic fluid filled structures dorsal to anechoic urinary
bladder. The pyometra affected bitches were categorized basing on the sonographic
appearance of uterus and uterine contents into groups B, C, DH and DA. The
diameter of uterine horns was highest in group DA and thickness of uterine wall was
highest in group DH. In pyometra, the blood flow was continuous with high velocity,
low resistance and low pulsatility. In pyometra affected bitches, higher blood flow
velocities (PSV and EDV) and lower hemodynamic indices (RI, PI and S/D) were
recorded in group DA.
The histopathological findings showed that Type II CEH-pyometra complex
(51.52%) was the common pathology observed in pyometra affected bitches followed
by Type III (36.36%) and Type IV (12.12%). Histopathological picture of Type II
uterus was characterized by cystic endometrial hyperplasia with diffuse infiltration of
the stroma by plasma cells. Type III pyometra was characterized by cystic
endometrial hyperplasia with acute inflammatory reaction. Type IV pyometra was
characterized by marked atrophy of endometrium with very few glands and stroma
was infiltrated with plasma cells, macrophages and few neutrophils. All the
histopathological types of pyometra showed cytoplasmic staining for VEGF. A
variation in quick sore was noticed in luminal and glandular epithelium between
different histological types of pyometra. Type II and Type IV had higher quick score
in luminal epithelium whereas, the quick score in glandular epithelium was higher in
Type III. The nuclear staining for Ki-67 did not yield consistent results in the present
study. However cytoplasmic staining of Ki-67 was observed in stroma cells of few
cases of Type II pyometra.
In the present study, the mortality rate in pyometra affected bitches was 18.67
per cent of which 6.67 per cent succumbed to death after surgery and 12.00 per cent
before surgery. The mean temperature, heart rate, percentage of band neutrophils,
total protein, globulin, ALP, BUN, creatinine and SAA were significantly higher
while hemoglobin and TEC were significantly lower in non-survivors than survivors.
A significant association with mortality was noticed with the presence of SIRS
(P<0.0072), closed pyometra (P<0.0279), elevated ALP (P<0.0109), elevated
creatinine (P<0.0002) and elevated serum amyloid A (P<0.0001) in the pyometra
affected bitches and these parameters could be used as prognostic indicators in canine
pyometra.
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