Comparison of Cervical and Uterine Cytology Between Different Classification of Postpartum Endometritis and Bacterial Isolates in Holstein Dairy Cows

Quantitative and functional dynamics of circulating and endometrial polymorphonuclear leukocytes in healthy peripartum dairy cows

The aim of the present study was to assess the counts, viability, and functionality of circulating and endometrial polymorphonuclear leukocytes (PMN) isolated from fourteen clinically and metabolically healthy multiparous dairy cows in the peripartum period. For this, blood samples were collected at -5, +9, +21 and + 37 days (d) relative to calving. Cytology samples were collected from the vagina, cervix, and uterus at +9, +21 and + 37 d, using the cytobrush technique. Additional vaginal samples were collected at -5 d. Cytology smears were prepared and the PMN-to-all nucleated cell proportions (PMN%) were calculated. The endometrial cytobrush samples were also used for flow cytometric assessment of endometrial PMN (ePMN) viability and functionality. Functionality tests for circulating PMN (cPMN) included phagocytosis (PC), oxidative burst, and intracellular proteolytic degradation. For ePMN, we evaluated PC only. The effect of day relative to calving on PMN viability and functionality were fitted in linear regression models, accounting for repeated measures. The endometrial PMN% were higher at +9 d (23.5 ± 0.4%; least-squares means ± standard error) and +21 d (8.5 ± 0.3%) than at +37 d (1.4 ± 0.3%). No changes in PMN% were found on either vaginal or cervical cytology along the peripartum period. The cPMN counts were higher pre- (6.2 ± 0.4 x 10⁶/mL) than postpartum (4.9 ± 0.4 x 10⁶/mL). Upon viability analysis, only the percentage of viable cPMN tended to be lower at -5 d (90.1 ± 1.5%) than at +37 d (94.1 ± 1.4%), and no other changes in the percentage of apoptotic and necrotic cPMN, nor in their functionality were found during the peripartum period. Analysis of ePMN viability showed that the percentage of viable ePMN did not change over time. In marked contrast, the percentage of apoptotic ePMN was higher at +9 d (37.8 ± 5.1%) than at +21 d (20.9 ± 5.1%) and +37 d (11.9 ± 5.3%), while the percentage of necrotic ePMN was lower at +9 d (27.0 ± 6.3%) than at +37 d (54.9 ± 6.6%). The percentage of ePMN PC was higher at +9 d (27.5 ± 3.4%) than at +37 d (13.3 ± 4.9%). In conclusion, during the peripartum period ePMN in the healthy postpartum uterus are highly dynamic in terms of counts, viability, and functionality compared to their circulating counterparts.

Destination of corpus luteum in postpartum clinical endometritis cows and factors affecting self-recovery

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The most cyclic clinical endometritis cows revealed new CL two weeks after clean test.

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The uterus of most of cyclic clinical endometritis cows was clean 14 days after 30 ± 3 days postpartum.

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About two third of clinical endometritis cows with persistent CL remained infected after second examination and considered as pyometric cows.

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Concentration of some metabolic or steroid hormones and production and reproduction factors influenced self-recovery of cows from clinical endometritis.

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Size and position of reproductive tract influenced self-healing from clinical endometritis.

In this study, the fate of corpus luteum was investigated in cows affected by severe clinical endometritis. Also, concentration of IL-1β, IL-6, COX-2, adiponectin, leptin, progesterone (P4), PGFM, insulin, and IGF-1 were studied in severe clinical endometritis cows at day 30 ± 3 postpartum. Eighty-seven dairy cows affected by severe clinical endometritis were selected and their reproductive tract was examined by ultrasonography at day 30 ± 3 postpartum (first examination) and 14 days later (second examination). The majority of the cows with CL and affected by clinical endometritis at first examination had new CL 14 days later, and most of these cows were clean without any treatment (self-healing). The CL of about 28.7% of all cows with clinical endometritis at first examination persisted two weeks later and the uterus of most of them remained infected as pyometric cows. Most of the anestrous cows (83.3%) were pregnant, but only 51% of cows with new CL were pregnant at the end of next six month period. There was a significant difference in the means of lactation number, uterine lumen diameter, cervical diameter, and size of uterine horn, milk production at first examination, concentrations of insulin, COX-2, P4, IL-1β, and IL-6 among persistent CL, new CL, and anestrous cows. The pregnancy rate and the discharge score were different among persistent CL, new CL, and anestrous cows. In conclusion, CL on ovary of cows and its fate could affect recovery from severe clinical endometritis. The concentration of some metabolic hormones influenced the self-recovery of cows from clinical endometritis.

Characterization of inflammatory responses by cervical cytology, cytokine expression and ultrastructure changes in a goat subclinical endometritis model

Endometritis is a common puerperal disease in livestock. Thus, a practical clinical test for the establishment of diagnosis is needed. We developed a goat model for subclinical endometritis diagnosis by examining cytological, ultrastructural features and molecular expression in cervical discharge collected by cervical cytobrush method. A suspension of E. coli was infused into the uterine horn of goats, and cervical discharge, peripheral blood and endomertrial biopsy samples were collected before inoculation and at 3, 6, 12, 24, 72, 120 and 168 hr post-inoculation (pi). In experimental goats, total leukocytes increased at 6-12 hr pi in hematological examinations, abundant neutrophils were observed in cervical discharge smears, and some micro-villi shortened or were lost from the epithelium at 3 hr pi, with some inflammatory cells infiltrated into the uterine glands and lamina propria. The mRNA expression levels of the Toll-like receptor 4 (TLR4), cytokines and β-defensin-2 increased significantly within 12 hr pi and returned to pre-inoculation levels at 7 day pi. The results showed that subclinical endometritis was simulated in this bacterial infusion goat model, and the evaluation of cervical cytology was in good agreement with molecular changes of cytokines in cervical discharge, hematology and histology. We thus conclude that the simple cervical cytobrush technique can effectively obtain cervical discharge samples for cytology examination in the early diagnosis of subclinical endometritis in goats.

Evaluation of endometrial echotexture and cervical cytology in cows during and after treatment of endometritis

OBJECTIVE

The aim of this study was to evaluate changes in the endometrium by using echotexture parameters during and after treatment of endometritis with intrauterine administration of an intrauterine antiseptic solution (Lotagen®, 3% metacresolsulphonic acid and formaldehyde) in cows which became pregnant after treatment.

MATERIAL AND METHODS

According to the severity of endometritis 21 cows were divided into three groups: E1 (slight, n = 7), E2 (moderate, n = 8), E3 (severe, n = 6). The control group (C, n = 11) consisted of cows without endometritis that did not receive an intrauterine medication. A software (Bs200 Pro®) was used to evaluate echotexture parameters Contrast (CON), Gradient (GR), Homogeneity (HOM), Mean Gray Level (MGL) of images taken during the examinations at hours (h) 0, 1 and 6 and days (d) 2, 3, 5 and 10.

RESULTS

At 0 h, GR was significantly lower in group E2 than in groups E1 and C (p < 0.05). There was an increase in GR values between 0 h and 10 d in group E2 and E3, but a decrease during the same time interval in group C (p < 0.05). In contrast, CON values of group E2 were lower (p < 0.05) at 0 h compared to other timepoints of examination and lower than in group C. HOM values were lower (p < 0.05) in groups E1, E2 and E3 than in group C on d 5 and d 10. HOM values were higher at 1 h compared to 6 h, d 2 and d 10 in group E3 (p < 0.05). By contrast to GR values, HOM values were higher in group C at 6 h and d 10 than they were in group E3. MGL values of group E2 were higher (p < 0.05) than in group C until d 10 and higher (p < 0.05) in group E3 than in group C at 6 h after treatment. In group E2 an increase of MGL values until d 2 was followed by a decrease (p < 0.05).

CONCLUSION

Echotexture parameters determined by the evaluation of sonographic B-mode images reflect changes in the endometrium and could be used for the evaluation of the recovery period after treatment of endometritis.

Invited review: Systematic review of diagnostic tests for reproductive-tract infection and inflammation in dairy cows

The objective of this study was to conduct a systematic and critical appraisal of the quality of previous publications and describe diagnostic methods, diagnostic criteria and definitions, repeatability, and agreement among methods for diagnosis of vaginitis, cervicitis, endometritis, salpingitis, and oophoritis in dairy cows. Publications (n=1,600) that included the words "dairy," "cows," and at least one disease of interest were located with online search engines. In total, 51 papers were selected for comprehensive review by pairs of the authors. Only 61% (n=31) of the 51 reviewed papers provided a definition or citation for the disease or diagnostic methods studied, and only 49% (n=25) of the papers provided the data or a citation to support the test cut point used for diagnosing disease. Furthermore, a large proportion of the papers did not provide sufficient detail to allow critical assessment of the quality of design or reporting. Of 11 described diagnostic methods, only one complete methodology, i.e., vaginoscopy, was assessed for both within- and between-operator repeatability (κ=0.55-0.60 and 0.44, respectively). In the absence of a gold standard, comparisons between different tests have been undertaken. Agreement between the various diagnostic methods is at a low level. These discrepancies may indicate that these diagnostic methods assess different aspects of reproductive health and underline the importance of tying diagnostic criteria to objective measures of reproductive performance. Those studies that used a reproductive outcome to select cut points and tests have the greatest clinical utility. This approach has demonstrated, for example, that presence of (muco)purulent discharge in the vagina and an increased proportion of leukocytes in cytological preparations following uterine lavage or cytobrush sampling are associated with poorer reproductive outcomes. The lack of validated, consistent definitions and outcome variables makes comparisons of the different tests difficult. The quality of design and reporting in future publications could be improved by using checklists as a guideline. Further high-quality research based on published standards to improve study design and reporting should improve cow-side diagnostic tests. Specifically, more data on intra- and interobserver agreement are needed to evaluate test variability. Also, more studies are necessary to determine optimal cut points and time postpartum of examination.

Comparison of a leukocyte esterase test with endometrial cytology for diagnosis of subclinical endometritis in postpartum dairy cows

The objective was to compare a leukocyte esterase (LE) test with endometrial cytology (EC) for diagnosis of subclinical endometritis in dairy cows. The relationship between subsequent fertility and the uterine (Ut) and cervical (Cx) leukocyte esterase activity was determined by the odds of pregnancy by 90 days in milk (DIM). Holstein cows (N = 218) without clinical endometritis and between 21 and 47 DIM from five commercial dairy herds were sampled for uterine and cervical leukocyte esterase activity and EC by cytobrush. To test the effect of time, cows were grouped into early (21-31 DIM) and late (32-47 DIM) animals. There was a slight agreement between UtLE and CxLE (weighted κ = 0.37). The percentage of neutrophils was correlated with esterase score either from the uterus (UtLE; P = 0.0001) or cervix (CxLE; P = 0.002). The percentage of neutrophils on EC (P < 0.001), the UtLE score (P < 0.0001), and the CxLE (P = 0.0009) diminished as DIM increased. Neither CxLE nor UtLE were statistically associated with pregnancy at 90 DIM. However, between 32 and 47 DIM, the percentage of neutrophils on EC and odds of pregnancy at 90 DIM were associated (P = 0.04). For the same interval, based on receiver/response operating characteristics analysis, the optimal cutoff was >6.7% neutrophils to classify cows with subclinical endometritis. In conclusion, uterine LE activity was correlated with percentage of neutrophils as determined by EC, but not with odds of pregnancy. Subclinical endometritis (>6.70% neutrophils) diagnosed by EC between 32 and 47 DIM was associated with reduced odds of pregnancy.

Association of Pap smear abnormalities with autoimmune disorders

Recently, it is hypothesized that there might be an association between immunological disorders and cervical premalignant and malignant abnormalities. Related studies have been generally focused on some particular autoimmune disease, specially the Systemic Lupus Erythematosus (SLE). This study aimed at comparing the rate of Pap smear abnormalities in female patients with autoimmune diseases and normal counterparts. In a case-control setting, 118 female patients with various autoimmune diseases (the case group) and 118 healthy female counterparts (the control group) were recruited in Tabriz Imam Reza Teaching Centre in a 24 months period of time. The two groups were matched for demographics and known risk factors of cervical malignancy. Frequencies of abnormal Pap smear testing were compared between the two groups. The autoimmune disorders were SLE (74 patients), rheumatoid arthritis or RA (32 patients), systcmic sclerosis or SS (7 patients) and ankylosing spondylitis or AS (5 patients) in the case group. Frequency of abnormal Pap smear testing was significantly higher in the case group comparing with that in the controls (7.6% vs. 1.7%; p = 0.03). Frequency of abnormal Pap smear testing was higher in the patients with SLE (8.1%) and RA (9.3%) comparing with that in the controls; However, these differences were marginally nonsignificant (p = 0.06 and p = 0.07, respectively). Frequency of cases with abnormal Pap smear testing was not statistically different between the autoimmune disorders (p = 0.99). Based on these findings and in conclusion, there might be an association between the autoimmune disorders and occurrence of premalignant or malignant lesions in cervix. Further studies with larger samples sizes are recommended.