Toxic shock associated with Clostridium sordellii and Clostridium perfringens after medical and spontaneous abortion

OBJECTIVE

To better understand the risk of fatal toxic shock caused by Clostridium sordellii in women who had a recent medical abortion with mifepristone and misoprostol.

METHODS

We performed active and passive surveillance for cases of toxic shock associated with medical or spontaneous abortion. To identify the cause of toxic shock, immunohistochemical assays for multiple bacteria were performed on formalin-fixed surgical and autopsy tissues. We extracted DNA from tissues, performed Clostridium species-specific polymerase chain reaction assays, and sequenced amplified products for confirmation of Clostridium species.

RESULTS

We report four patients with toxic shock associated with Clostridium species infection after medical or spontaneous abortion. Two women had fatal Clostridium perfringens infections after medically induced abortions: one with laminaria and misoprostol and one with the regimen of mifepristone and misoprostol. One woman had a nonfatal Clostridium sordellii infection after spontaneous abortion. Another woman had a fatal C sordellii infection after abortion with mifepristone and misoprostol. All four patients had a rapidly progressive illness with necrotizing endomyometritis.

CONCLUSION

Toxic shock after abortion can be caused by C perfringens as well as C sordellii, can be nonfatal, and can occur after spontaneous abortion and abortion induced by medical regimens other than mifepristone and misoprostol.

LEVEL OF EVIDENCE

III.

The relationship between uterine pathogen growth density and ovarian function in the postpartum dairy cow

In cattle, the first postpartum dominant follicle grows slower and produces less oestradiol in animals with high numbers of bacteria contaminating the uterine lumen. However, only bacteria that are uterine pathogens are correlated with severe clinical disease and an increased inflammatory response. It is unknown whether the effect on the ovary in relation to uterine bacterial contamination is associated with the presence of recognised uterine pathogens. Therefore, the present study examined the relationship between pathogenic bacteria in the postpartum uterine lumen, follicle growth and function and the formation of a competent corpus luteum. In addition, peripheral plasma concentrations of immune mediators were quantified. Swabs were collected from the uterine lumen of cattle on day 7 postpartum. Bacteria were cultured and identified and bacterial growth was scored semi-quantitatively. Animals were categorized into high or low recognized uterine pathogen contamination groups based on the number of colonies. Ovarian structures were monitored by daily transrectal ultrasonography and blood samples were collected. In animals with high numbers of uterine pathogens on day 7 postpartum, the diameter of the first postpartum dominant follicle was smaller and plasma oestradiol concentrations were lower. In addition, these animals had smaller corpora lutea, which produced less progesterone. Furthermore, animals with a high day 7 uterine pathogen growth density had higher peripheral concentrations of acute phase proteins. Thus, contamination of the uterus with recognized uterine pathogens is associated with ovarian dysfunction during the postpartum period. Furthermore, infection results in an increase in the production of inflammatory mediators.

Detection of the genome of Chlamydophila abortus in samples taken from the uteri of 304 sheep at an abattoir

A PCR was used to detect the genome of Chlamydophila abortus in samples of uterine tissue collected from 304 sheep by a sterile technique at an abattoir. The stage of pregnancy of the sheep was determined by measuring the dimensions of the embryo/fetus, and its morphology was recorded. Only samples from non-pregnant sheep and sheep up to 100 days of gestation were retained; the clinical history of the animals was unknown. The total prevalence of the chlamydial genome was 30.9 per cent, with a significantly higher prevalence in the pregnant animals (46.9 per cent). Higher detection rates were recorded during early gestation than during mid-gestation.

Relationships between uterine culture, cytology and pregnancy rates in a Thoroughbred practice

Endometrial cytology and culture specimens (n=2123) were collected concurrently with a guarded uterine culture instrument from 970 mares (738 barren, 1230 foaling and 155 maiden mares) during three breeding seasons (2001-2004). Results were compared to the 28-d pregnancy rate for the cycle from which the samples were taken. Cytological smears were evaluated for inflammation at x100 and graded as: not inflammatory (0-2 neutrophils/field), moderate inflammation (2-5 neutrophils/field), severe inflammation (>5 neutrophils/field), or hypocellular (scant epithelial cells and no neutrophils). Uterine culture swabs were plated within 6h, incubated for 72 h and results determined at 24, 48, and 72 h. Approximately, 20% (n=423) cytology samples were positive for inflammation (>2 neutrophils), whereas approximately 11% (n=231) of cultures had microorganisms recovered. A majority (64%) of the positive cultures (147/231) had inflammation on cytology smears. Streptococcus equi subsp. zooepidemicus was associated with more positive cytology results than coliforms (P<0.01). Mares with positive cytology or culture had lower pregnancy rates than mares with normal findings (P<0.01). Lowest pregnancy rates were recorded for mares with severe endometrial inflammation (21%, versus moderate inflammation 48%). Isolation of a microorganism from mares with endometrial inflammation was not associated with a further reduction in pregnancy rates. In barren, foaling and maiden mares, cytology was positive in 28, 17, and 5%, respectively, and culture was positive in 12.2, 11.1, and 3.2%. Foaling and maiden mares had higher pregnancy rates than barren mares (62, 69, and 44%, respectively, P<0.001). In conclusion, a positive cytology was twice as common as a positive culture, and isolation of microorganisms was associated with reduced pregnancy rates, even in the apparent absence of inflammation.

Use of a low-volume uterine flush for diagnosing endometritis in chronically infertile mares

Low-volume uterine flush (n=401) was performed in 308 infertile mares to diagnose endometritis. Mares evaluated were either barren after three or more breedings or had two or more unsuccessful embryo recovery attempts during consecutive cycles. Culture results were compared with cytological and histological findings, efflux clarity and pH to substantiate that the micro-organisms recovered were truly pathogens. Cytological specimens were evaluated for presence of epithelial and inflammatory cells, bacteria, yeast and debris. Endometrial biopsies (n=110) were examined for the presence of neutrophils in the stratum compactum. Micro-organisms were recovered in 282/401 (70%) of low-volume flushes; E. coli was most frequently isolated (42.2%), followed by beta hemolytic Streptococcus (37.6%). Efflux clarity of 318 flushes was clear (n=109), cloudy (n=149), or mucoid (n=60). Isolation of micro-organisms was highly associated with cloudy and mucoid effluxes (P<0.001), debris on cytological specimens (P<0.001), increased efflux pH (P<0.003), and neutrophils on endometrial biopsy (P<0.01). E. coli was associated with debris on cytological smear (P<0.002), whereas beta hemolytic Streptococcus was associated with increased efflux pH (P<0.002). Using the presence of neutrophils in a tissue specimen as the "best standard" for diagnosing endometritis, the sensitivity of flush culture was 0.71 and for flush cytology was 0.8, whereas the specificity was 0.86 and 0.67, respectively. Neutrophils in uterine flushes under-reported inflammation; only 86/282 positive cultures were positive on cytology. The clinical estimate of a contaminated (false positive) flush culture was 11%, if a false positive was defined as positive culture with clear efflux and no debris or neutrophils on cytology (26/228). In conclusion, a low-volume uterine flush was a rapid, accurate method for identifying mares with chronic endometritis. When micro-organisms were recovered, endometritis was confirmed by efflux clarity, pH and cytological findings of debris, bacteria, or neutrophils. E. coli was most commonly isolated and it appeared to differ in pathogenicity from beta hemolytic Streptococcus.

Chronic endometritis: correlation among hysteroscopic, histologic, and bacteriologic findings in a prospective trial with 2190 consecutive office hysteroscopies

OBJECTIVE

To evaluate the type and etiopathogenic role of infectious agents detected in endometrial cultures obtained from women with chronic endometritis (CE).

DESIGN

Prospective controlled study.

SETTING

University hospital.

PATIENT(S)

2190 women undergoing hysteroscopy for different indications.

INTERVENTION(S)

Vaginal and endometrial samples were collected from 438 women with a CE diagnosis at hysteroscopy and 100 women with no signs of CE (controls).

MAIN OUTCOME MEASURE(S)

Histology and cultures for common bacteria, Neisseria gonorrhoeae and Mycoplasma, and molecular biology testing for Chlamydia were performed.

RESULT(S)

We compared results of vaginal and intrauterine cultures obtained from women with and without CE. Histologic results were positive in 388 of these cases (88.6%), and at least one microorganism was found in 320 endometrial samples (73.1%). In the control group, histologic results and endometrial culture were positive in only 6% and 5% of cases, respectively. The most frequent infectious agents detected at the endometrial level were common bacteria (58% of cases). Ureaplasma urealyticum was detected in 10% and Chlamydia in only 2.7% of positive endometrial cultures. In only 143 (32.6%) cases were the same infectious agent isolated in endometrial and vaginal cultures.

CONCLUSION(S)

More than 70% of CE cases resulted from nongonococcal, nonchlamydial infections. Common bacteria and Mycoplasma were the most frequent etiologic agents. Vaginal cultures have low concordance with endometrial cultures.

Bacterial complications of postpartum uterine involution in cattle

The bacterial contamination of the postpartum uterus is a frequent finding which by itself does not disturb the anatomical and histological restoration of tubular genital tract. The improper balance between uterine infection and the intrauterine antimicrobial self-defence mechanisms, however, often results in complications, such as puerperal metritis, clinical endometritis, pyometra and subclinical endometritis. After reviewing the bacteriology of uterine involution, and the predisposing factors for its bacterial complications, this paper defines the different clinical forms, and summarizes their pathology, furthermore, the recent progress in diagnostic considerations and principles of current treatments for these diseases of bovine genitals.

Lethal outcome in xanthogranulomatous endometritis

Xanthogranulomatous inflammation is rare, mainly involving the kidneys, while primary xanthogranulomatous endometritis (XE) is a very unusual finding, histologically characterized by partial or complete replacement of the mucosa by granulation tissue with an abundance of foamy histiocytes, siderophages and multinucleated giant cells. We present the case of a 69-year-old woman with a short history of abdominal pain and a palpable mass in the pouch of Douglas. Dilatation of the cervix drained a pyometra. Histological examination of the curettage rendered the diagnosis of XE. Microbiological studies revealed enterococcus spp. and Peptostreptococcus magnus. Despite antibiotic treatment the patient died of heart failure due to systemic inflammation. Autopsy confirmed the diagnosis of XE with transmural extension into the peritoneal cavity. Such a lethal course of XE is extraordinary. Proposed causes of XE include obstruction, infection and hemorrhage. Demonstration of enterococcus spp. and P. magnus supports the probable significance of bacteria in the development of XE. Because this condition may mimic malignant disease macroscopically and histologically, knowledge of XE is of major importance for both pathologists and gynecologists.

Effect of treatment with two intravaginal inserts on the uterine and vaginal microflora of early postpartum beef cows

OBJECTIVE

To describe the bacterial species found within the uterus and vagina of early postpartum (10 to 20 d) beef cows treated for 14 d with (i) two intravaginal (CIDR-B) progesterone releasing inserts (C-P4; n=31); (ii) two identical but blank inserts (C-BL; n=15); (iii) untreated controls (CON; n=15). It was hypothesised that due to the locally immunosuppressive effects of progesterone on the uterus, the bacterial microflora of C-P4 would be altered by this treatment in contrast to CON and C-BL.

PROCEDURE

Cows were enrolled at two intervals 7 d apart. Blood samples were collected at 0, 7 and 14 d after beginning treatments for subsequent progesterone assay. A triple guarded swabbing technique was used to collect bacteriological samples from the uterus of every cow on days 0, 7 and 14 following CIDR insertion. Swabs were also collected from the inserts and vagina of every cow on day 14. Due to the small sample sizes, only descriptive statistics were generated.

RESULTS

Plasma progesterone levels were maintained at mid-luteal phase concentrations by the intravaginal progesterone releasing inserts (C-P4: 4.2 +/- 0.4 ng/mL at 7 d; 3.6 +/- 0.2 ng/mL at 14 d), although increased progesterone concentrations were found in 4/15 CON and 9/15 C-BL cows on day 14. Bacteria were isolated from 32/61 (52%) of all uterine samples collected at the time of insertion. Uterine and vaginal swabs from CON cows showed a marked reduction in isolates over time such that 14 d after insertion only 1/15 uterine swabs grew bacteria. In contrast, C-BL and C-P4 treated cows failed to show reductions in the number of uterine or vaginal isolates at 14 d after device insertion. Heavy growths of Pseudomonas aeruginosa and Actinomyces pyogenes were found on the intravaginal inserts from C-BL and C-P4 cows. Cows enrolled in the second week of the study that received intravaginal inserts (C-P4 + C-BL) were more likely to have Pseudomonas isolated from the uterus than those enrolled in week 1 (1/18 versus 14/28).

CONCLUSIONS

The presence of two intravaginal inserts, regardless of hormone content, substantially altered the profile of uterine and vaginal bacteria in early postpartum beef cows. It was suspected that because of the early stage at insert application, the cervix had not involuted sufficiently to provide an adequate microbial barrier to the uterus. Pseudomonas aeruginosa was the predominant species isolated from both uterine and insert cultures after 14 d of treatment but may have been a contaminant, due to the greater proportion of cows infected with it that had been enrolled in the second week of the study.

Collection of tissue and culture samples from the canine reproductive tract

Definitive diagnosis of reproductive tract infection or other disease often requires sampling of tissue, either for culture or histopathology. Indications, sample collection technique, possible side-effects and interpretation of results are reviewed. Pertinent facts include: (1) collection of uterine biopsy specimens via laparotomy was associated with higher yield of diagnostic samples and fewer side-effects than other less invasive techniques; (2) vaginal culture samples should be collected from the anterior vagina to minimize number of contaminants in the sample; (3) collection of culture samples from the anterior vagina during proestrus or estrus, in the presence of discharge originating in the uterus, was a non-invasive technique for assessment for uterine infection; (4) samples for bacterial culture from mucosal surfaces, including the vagina and penis, must be quantitated to allow interpretation, with moderate to heavy growth of any single aerobic bacterial organism relevant; (5) mycoplasma and ureaplasma are part of the normal flora of the genitourinary tract in dogs and bitches and, because most laboratories cannot give reliable quantitative results, interpretation of positive results often is difficult; (6) collection of prostatic tissue samples for cytology or culture was more likely to yield a correct diagnosis than submission of ejaculated prostatic fluid.

Chlamydiae in oviducts and uteri of repeat breeder pigs

Chlamydial infections of the genital organs cause reproductive failure in female pigs, and the uterus is recognized a target tissue for an infection. In contrast, information on the effect of chlamydiae on the porcine oviduct is patchily and inconclusive, although the bacteria are known to cause severe tubal defects in humans and laboratory animals. The aim of this study was to examine the segments ampulla (A), isthmus (I) and utero-tubal junction of the left (n=20) or both (n=22) oviducts, and uteri (U) from 42 culled repeat breeder pigs for chlamydiae using ompA-PCR, partial ompA gene sequencing, immunohistochemistry (IHC) and microscopy of tissue specimens for histopathology. As revealed by PCR, among a total of 26 chlamydia-positive females, 19 were tested positive in one or more segments of one or both oviducts, 14 were found positive in the uterus, and concomitant infections of both organs were observed in 7 of them. Sequencing of 33 PCR products revealed the following chlamydial species: Chlamydophila (Cp.) psittaci (n=18), Cp. abortus (n=2), Chlamydia (C.) suis (n=10), and C. trachomatis (n=3). Immunopositive staining was observed within the surface epithelium (in A, I, U), stromal tissue (in I, U) and muscular layer (in A, I, U). A total of 24 females had inflamed oviductal segments (in A and/or I) and 36 inflamed uteri. However, there was no relationship between histopathology and results of PCR or IHC. In conclusion, chlamydiae were found to infect oviducts and uteri of pigs. Further studies are required to clarify whether chlamydial infection causes specific histopathology and alters tubal function.

[Sequential analysis of detection Mycoplasma in different positions of female genital tract]

OBJECTIVE

To discuss the main parasitic position of Ureaplasma urealyticum (Uu) and Mycoplasma hominis (Mh) in female genital tract.

METHODS

Using the standard aseptic cotton swab to collect secretion in vaginal fornix and orificium internum uteri, to culture Uu and Mh in Mycoplasma ID medium of France Bio-Merieux Co. According to double-direction quality reaction sequential test design, detection results of different position were analyzed.

RESULTS

Total positive and > or = 10(4) ccu/ml positive of Uu in vaginal fornix were significantly higher than that in orificium internum uteri. Total positive of Mh in vaginal fornix was significantly higher than that in orificium internum uteri as well.

CONCLUSION

In order to raise the detectable rate of Mycoplasma, we suggested that the secretion in vaginal fornix position be collected.

Bacteriological findings and hormonal profiles in the postpartum Balady goats

Twenty-six Balady goats categorized according to parity into primiparous and pluriparous goats were used to investigate bacterial flora of the genital tract and hormonal profiles during the postpartum (PP) period. Escherichia coli and Staphylococcus aureus were isolated in pure or mixed culture from the uterus. Arcanobacterium pyogenes was isolated from swabs obtained from the vagina and cervix of one primiparous goat. Uteri and cervices but not vaginas were free of bacterial contamination by day 10 PP except for one pluriparous goat with scanty E. coli contamination on day 25 PP. Fluctuating oestradiol 17beta (E2) levels demonstrated resumption of follicular activity as early as day 13 PP in both parity groups. Progesterone (P4) levels remained low at basal levels throughout the study period. Higher concentrations of 15-keto-13,14-dihydroprostaglandin F2alpha (PGFM) were observed during the first week PP compared with the rest of the PP period. PGFM concentrations dropped to low basal level by day 10 PP and remained constantly low throughout the study period. P4, E2 and PGFM profiles were not different between the different parity groups. In conclusion, intrauterine infection is not common in goats with normal kidding. E. coli was the most common intrauterine bacterial isolate. E2 and P4 profiles were consistent with resumption of follicular growth but not ovulation. High PGFM concentrations coincided with the fast regression phase of uterine involution. Hormonal profile and bacterial contamination and clearance were similar to those reported in other related species and not related to parity.

Reduction of mucin-1 gene expression associated with increased Escherichia coli adherence in the canine uterus in the early stage of dioestrus

The relation between adherence of Escherichia coli and expression of mucin-1 (Muc1: an integral membrane mucin) mRNA in the endometrium was studied in beagle bitches at different stages of the oestrous cycle and in those with cystic endometrial hyperplasia/pyometra complex (pyometra). The number of E. coli adhering to the endometrium was low at pro-oestrus and oestrus and increased at the early stage (day 10) of dioestrus, corresponding to the implantation period; it declined thereafter. Adhesion of the organisms to endometrial epithelial cells collected at day 10 of dioestrus was inhibited by the addition of D-mannose. When endometrial epithelial cells collected at pro-oestrus were treated with hyaluronidase, an enzyme that digests mucins, the numbers of E. coli adhering to the cells tended to increase. With polymerase chain reaction analysis it was possible to detect Muc1 gene transcripts in the endometrium at all stages of the oestrous cycle, although the level of Muc1 mRNA decreased by day 10 of dioestrus. The levels of Muc1 mRNA in bitches with a clinical stage of pyometra were low and comparable to those at day 10 of dioestrus. The number of E. coli adhering to the endometrium and Muc1 mRNA levels in the endometrium were inversely correlated (r=-0.77, P<0.01). Immunohistochemical analysis showed little staining for Muc1 in the endometrial epithelia at day 10 of dioestrus and in bitches with pyometra. These results suggest that reduction of Muc1 expression is associated with increased E. coli adherence in the canine uterus at the early stage of dioestrus, possibly facilitating the development of pyometra.

Mononuclear phagocyte system in mice with intrauterine Candida albicans infection and postnatal experimental tuberculosis

Intrauterine Candida albicans infection in mouse fetuses affected the type of granulomatous inflammation induced by BCG vaccine during the postnatal period. It manifested in increased formation of granulomas and variations in their cellular composition.

[Serologic and genetic analysis of group B streptococci isolated from adult patients]

Serologic and genetic typing with RAPD (Random Amplified Polymorphic DNA) method was used for epidemiologic analysis of GBS. 125 strains isolated from various clinical samples from adult patients were tested. In serologic typing seven serotypes have been found. Serotypes III and R were the most often encountered, containing 37,6% and 20,8% of samples. There was no dependence between serologic type and disease process. Optimalisation of RAPD reaction parameters was based on the standard strains of GBS. In the group of strains tested with the use of RAPD method, eleven genetic profiles were found, with prevalence of profile B (25,8%). Five other profiles occured with similar frequency (8,8% - 12,8%). Among streptococci isolated from patients with the infection of genitourinary tract, great differentiation in the genetic profiles of the strains has been found. Each serologic type contained various genetic profiles. Genetic variety showed by RAPD method indicates the raised ability of this technique to find differences among isolates of GBS.

Routes of intraspecies transmission of Mycobacterium avium subsp. paratuberculosis in rabbits (Oryctolagus cuniculus): a field study

Rabbits have been increasingly linked to the persistence of paratuberculosis (Johne's disease) in domestic ruminants in the United Kingdom. The aims of this study were to determine the routes of intraspecies transmission of Mycobacterium avium subspecies paratuberculosis (MAP) in rabbits and to estimate the probability of transmission via each route, in order to gain understanding of the dynamics of MAP in this host. Rabbits were sampled from two sites where MAP had previously been isolated from the livestock and rabbit populations. No pathology was noted in any animals, but the overall prevalence of MAP in rabbits was high at both sites studied, 39.7% and 23.0%, respectively. MAP was isolated from the testes, uterus, placenta, fetuses, and milk. This is the first time that the bacterium has been isolated from any of these tissues in a nonruminant wildlife species. These results suggest that transmission may occur vertically, pseudovertically, and horizontally. Vertical, i.e., transplacental, and/or pseudo-vertical, i.e., through the ingestion of contaminated milk and/or feces, transmission occurred in 14% of offspring entering the population at 1 month of age. As infection via these routes is only possible from infected adult females, this equates to a probability of infection via this route of 0.326. Probability of infection via horizontal transmission (including interspecies transmission) occurred at up to 0.037 per month. The presence of these routes of transmission within natural rabbit populations will contribute to the maintenance of MAP infections within such populations and, therefore, the environment.

Cystic endometrial hyperplasia-pyometra complex in cats. A review

Presentation of complex cystic endometrial hyperplasia-pyometra is not very common in cats. As in bitches, hormonal influences result in environmental and histological changes in the uterus leading to predisposition to bacterial growth. Its influence on the organism provokes certain clinical signs. Diagnosis and treatment must be fast and aggressive. Depending on the clinical status and queen purpose, it can be both surgical or medical. Both of them offer a high rate of success if the detailed protocols are followed.

Fatal toxic shock syndrome associated with Clostridium sordellii after medical abortion

Endometritis and toxic shock syndrome associated with Clostridium sordellii have previously been reported after childbirth and, in one case, after medical abortion. We describe four deaths due to endometritis and toxic shock syndrome associated with C. sordellii that occurred within one week after medically induced abortions. Clinical findings included tachycardia, hypotension, edema, hemoconcentration, profound leukocytosis, and absence of fever. These cases indicate the need for physician awareness of this syndrome and for further study of its association with medical abortion.

Increased intrauterine frequency of Ureaplasma urealyticum in women with preterm labor and preterm premature rupture of the membranes and subsequent cesarean delivery

OBJECTIVE

The purpose of this study was to evaluate the prevalence of microbial invasion of the amniotic cavity at the time of preterm cesarean delivery for therapy-resistant preterm labor or preterm premature rupture of membranes, which are events that commonly are induced by infection, and to compare this group of patients with a group of patients who underwent preterm cesarean delivery for indications other than preterm labor or preterm premature rupture of membranes.

STUDY DESIGN

We studied 207 consecutive women between 23 and 34 weeks of gestation who underwent cesarean delivery. These patients were divided into 3 groups according to the indication for cesarean delivery: patients with preterm labor (group 1), patients with preterm premature rupture of membranes (group 2), and patients with other indications (group 3). In the course of the surgical procedure, amniotic fluid, amniotic membrane, and placental tissue specimens were collected for the detection of pathogens.

RESULTS

Ureaplasma urealyticum was detected in 43.9% (58/132) of the patients of groups 1 and 2, with no significant difference between these 2 subgroups. In group 3, which served as the comparison group, Ureaplasma urealyticum was isolated in only 2.7% (2/75) of the patients. Ureaplasma urealyticum as a single pathogen was more frequent than all obligate pathogens together (43.9% vs 39.3%).

CONCLUSION

Our results provide evidence for an association between intrauterine colonization with Ureaplasma urealyticum and both therapy-resistant preterm labor and preterm premature rupture of membranes.

Association of uterine and salpingeal fibrosis with chlamydial hsp60 and hsp10 antigen-specific antibodies in Chlamydia-infected koalas

Infection by Chlamydia pneumoniae or Chlamydia pecorum commonly causes chronic, fibrotic disease of the urogenital tracts of female koalas. Studies of humans have associated titers of serum immunoglobulin G (IgG) against chlamydial hsp60 and hsp10 antigens with chronic infection, salpingeal fibrosis, and tubal infertility. To determine whether a similar relationship exists in Chlamydia-infected koalas, samples were collected opportunistically from 34 wild female koalas and examined by gross pathology and histopathology, PCR, and immunohistochemistry for Chlamydia spp. and enzyme-linked immunosorbent assay for serological responses to chlamydial hsp10 and hsp60 antigens. Greater anti-hsp titers occurred in Chlamydia-infected koalas with fibrous occlusion of the uterus or uterine tube than in other Chlamydia-infected koalas (for hsp10 IgG, P = 0.005; for hsp60 IgG, P = 0.001; for hsp10 IgA, P = 0.04; for hsp60 IgA, P = 0.09). However, as in humans, some koalas with tubal occlusion had low titers. Among Chlamydia-infected koalas with tubal occlusion, those with low titers were more likely to have an active component to their ongoing uterine or salpingeal inflammation (P = 0.007), such that the assay predicted, with 79% sensitivity and 92% specificity, tubal occlusion where an active component of inflammation was absent. Findings of this study permit advancement of clinical and epidemiological studies of host-pathogen-environment interactions and pose intriguing questions regarding the significance of the Th1/Th2 paradigm and antigen-presenting and inflammation-regulating capabilities of uterine epithelial cells and the roles of latency and reactivation of chlamydial infections in pathogenesis of upper reproductive tract disease of koalas.

Gross abnormalities, bacteriology and histological lesions of uteri of dairy cows failing to conceive or maintain pregnancy

AIM

To describe the gross pathology, bacteriology and histopathology of the reproductive tracts of dairy cows that failed to conceive or maintain pregnancy.

METHODS

The reproductive tracts of 105 cows that were not pregnant at the end of the seasonal breeding programme were retrieved following slaughter. The tracts were examined grossly, both horns of the uterine lumen were swabbed for bacteriology, and tissue was collected from each horn and the body of the uterus for histopathology. Grossly enlarged uteri and tracts containing purulent vaginal content were excluded. Histopathology was performed on three sections of uterine tissue from each of three cows in which no gross pathological changes were detected and from which no bacteria were isolated, from three cows in which no gross pathology was detected but from which bacteria were isolated, and from three cows in which gross pathological changes were detected but from which no bacteria were isolated.

RESULTS

Thirty-six (34%) cows had one or more gross lesions which involved the ovary, uterine tube, uterus or vagina. Bacteria were isolated from the uteri of 22 (21%) cows. Isolates included Arcanobacterium pyogenes (n = 1), Escherichia coli (n = 1), Fusobacterium spp (n = 1), Haemophilus somnus (n = 5), Streptococcus acidominimus (n = 12), S. bovis (n = 2), S. uberis (n = 1) and S. salivarious (n = 1). In only five cows were both gross pathology and bacteria detected. There was no relationship between the isolation of bacteria and the diagnosis of gross pathology of the uterus. There were no differences in the degree of histopathological changes in the uteri from the three groups of cows examined, and lesions present were minor.

CONCLUSIONS

Gross pathological changes and intra-uterine bacteria were found in 34% and 20% of cows, respectively, but the correlation between the two was poor. Histopathological changes were unremarkable, suggesting the bacteriological findings were coincidental, that causative agents of infertility were not present at the time of examination, or that unrelated causes such as nutritional anoestrus may have been responsible for the failure of some cows to conceive.

Prevalence of aerobic and anaerobic uterine bacteria during peripartum period in normal and dystocia-affected buffaloes

Parturition complications predispose establishment of uterine infections, which in turn affect subsequent fertility. The aim of present study was to characterize and compare the type of bacterial flora prevalent within the uterine lumen of dystocia-affected buffaloes and compare them with the normally calving buffaloes. The study was conducted on 40 buffaloes; of which 10 calved normally (Group I) and 30 were treated for dystocia (Group II). Bacteriological examination was performed using uterine swabs, which were collected before delivery, immediately after delivery and day's 24-60 postpartum. A total of 30 uterine swabs from Group I and 79 swabs from Group II were collected, of which 19 (63.3%) and 71 (89.9%) yielded significant bacterial growth, respectively. A total of 205 isolates belonging to 10 different genera of bacteria were identified, 8 facultative anaerobes and 2 obligate anaerobes. In Group II, 91.6% of the bacteria positive swabs (n = 71) yielded mixed cultures, whereas the remainder being pure cultures. In contrast, 89.5% of the bacteria positive swabs of Group I (n = 19) yielded pure cultures. Mixed infections comprised mostly Arcanobacter (Actinomyces) pyogenes together with obligate anaerobes, Fusobacterium spp. and Bacteroides spp. In Group II, the frequency of incidental and coliform group bacteria was highest at the time of parturition, i.e., before and immediately after delivery, and decreased to nil during the 24-60-day postpartum period. However, in Group I, the incidental and coliform group of bacteria present at the time of parturition apparently persisted beyond the period when uterine involution is complete. The frequency of obligate anaerobes and A. pyogenes at the time of parturition was nil in the Group I while they predominated in dystocia-affected buffaloes (Group II). During the postpartum period of 24-60 days, the frequency of both obligate anaerobes and A. pyogenes increased significantly in Group II, whereas in Group I, only occasional isolates were obtained. To conclude, at the time of calving the prevalence of obligate anaerobes and A. pyogenes occurring in combination was highest in dystocia-affected buffaloes, and further increased in the postpartum period suggesting that these infections act synergistically.