Cytological endometritis in dairy cows: diagnostic threshold, risk factors, and impact on reproductive performance

Lessons learned from bovine subclinical endometritis: A systematic review exploring its potential relevance to chronic endometritis in women

Chronic endometritis (CE) in humans is asymptomatic inflammation of the endometrium, associated with poor reproductive outcomes. Similarly asymptomatic endometrial inflammation in cows, termed subclinical endometritis (SCE), is associated with adverse reproductive outcomes. While the pathophysiology and treatment options for CE in humans remains poorly defined, the financial implications of SCE in dairy cows mean it has been intensively researched. We performed a systematic review with an emergent theme thematic analysis of studies of SCE in cows, to determine potential areas of interest in human CE research. A literature search for studies of subclinical endometritis in cows published between 1990 and November 2021 was performed across Embase, Medline, Scopus and CINAHL. Studies of symptomatic or clinical endometritis were excluded. Thematic analysis across two broad themes were explored: diagnostic methods and pathophysiology of SCE. In total, 44 bovine studies were included. 12 studies reported on diagnostic methodology. The primary emergent theme was the use of cytology for the diagnosis of SCE. This method has a lower sensitivity than histopathology but is less invasive and more specific than alternative techniques of ultrasound, vaginoscopy, or metabolic markers. The subthemes related to pathophysiology were identified as type of endometritis, metabolic stress, artificial insemination, infective causes, and altered cellular pathways. Despite the lack of symptoms, cellular pathways of inflammation including NFkB, MAPK, and inflammasomes were found to be activated. The key themes related to the diagnosis and pathophysiology of SCE in cows identified in this systematic review highlight potential areas for future research into human CE.

Allogenic adipose derived mesenchymal stem cells are effective than antibiotics in treating endometritis

Endometritis is a uterine inflammatory disease that causes reduced livestock fertility, milk production and lifespan leading to significant economic losses to the dairy industry. Mesenchymal stem cells (MSC) may act as an alternative for inefficacy of antibiotics and rising antibiotic resistance in endometritis. The present study aimed to cure the chronic endometritic buffaloes using allogenic adipose-derived MSCs (AD-MSC). AD-MSCs were isolated from buffalo adipose tissue and characterized by multilineage differentiation as well as MSC-specific markers. The in vivo safety and efficacy were assessed after infusion of AD-MSCs. In safety trial, cells were administered in healthy buffaloes via different routes (IV and IC) followed by examination of clinical and hematological parameters. In efficacy study, AD-MSCs treatments (IV and IC) and antibiotic therapy (ABT) in endometritic buffaloes were comparatively evaluated. AD-MSCs did not induced any immunological reaction in treated buffaloes. PMN count, CRP levels and VDS were significantly (p ≤ 0.05) reduced after AD-MSCs infusions in IV and IC groups and no significant difference was observed in antibiotic group. The IV group was marked with 50% absolute risk reduction in endometritis and 50% live calf births after artificial insemination in comparison with ABT group. Anti-inflammatory cytokines (IL4 and IL10) and anti-microbial peptides (PI3, CATHL4, LCN2 and CST3) expressions were significantly (p ≤ 0.05) upregulated in IV group. The calf delivery rate after the treatments in IV group was higher (50%, 3 calves) than the other groups (IC: 33.3%, 2 calves; ABT: 16.6%, 1 calf). In conclusion, the administration of AD-MSCs through IV route was found to be safe and efficacious for alleviating chronic endometritis in dairy buffaloes.

Individual and Combined Effects of Diseases and Cytological Endometritis on Reproductive Performance and Culling of Dairy Cows: Preliminary Results

The objective of this study was to evaluate the effect of calving-related disorders/clinical diseases (DIS) and cytological endometritis (CYTO) on the reproductive performance and culling of dairy cows. In a total of 119 multiparous Holstein cows, DIS were recorded and CYTO was diagnosed at 40 ± 2 d in milk. Onset of luteal activity was defined as the first postpartum measurement of milk progesterone >5 ng/mL. A dummy variable containing all four possible permutations between DIS and CYTO statuses was created. The pregnancy rates after first artificial insemination were 57.7, 42.9, 23.0 and 15.8% for the DIS−/CYTO−, DIS+/CYTO−, DIS−/CYTO+ and DIS+/CYTO+ groups, respectively. The hazard of pregnancy was affected by DIS−/CYTO+ and DIS+/CYTO+ health statuses (hazard ratio (HR) = 0.43 and 0.29, respectively), whereas DIS+/CYTO− and DIS−/CYTO− cows had a similar hazard to pregnancy. The hazard of onset of luteal activity was affected by DIS+/CYTO+ health status (HR = 0.45), but not by DIS+/CYTO− and DIS−/CYTO+ health statuses. Compared with DIS−/CYTO− cows, DIS−/CYTO+ and DIS+/CYTO+ cows had 4.24 and 5.57 times the odds of being culled, respectively. Culling was not affected by DIS+/CYTO− health status. In conclusion, CYTO+ status, irrespective of DIS status, decreased the pregnancy rate. When DIS+ and CYTO+ were combined, they had an additive negative effect. Our preliminary findings suggest that the far-reaching consequences of clinical diseases on fertility and culling can be mediated through the development of CYTO. Further investigations including a larger number of cows are required to confirm these results.

Effects of Intrauterine Infusion of Micronised Purified Flavonoid Fraction (MPFF) in Metritis-Diagnosed Dairy Cows Naturally Infected by E. coli during the Early Postpartum

The occurrence of metritis during the postpartum period causes serious economic losses in dairy cattle. The Micronised Purified Flavonoid Fraction (MPFF) is a polyphenolic flavonoid compound which is considered to have many health-related properties such as antibiotic, anti-inflammatory, phlebotonic, and several vascular-protecting activities. The aim was to evaluate the effects of a new strategic therapy for metritis based on MPFF intrauterine infusions during the early postpartum in dairy cows naturally infected by Escherichia coli. The clinical effects on reproductive anatomical structures and chronological involution dynamics were monitored until day 24 postpartum by ultrasonography. Moreover, uterine bacteriological and cytological (polymorphonuclear neutrophils; PMNs) profiles were analysed before and after MPFF infusion. The results showed that the success rate (% cure) at day 24 postpartum was improved significantly when using higher MPFF doses (p < 0.05). Moreover, MPFF treatment acutely diminished the size of the cervix and uterus and improved the involution process during the first 24 days (p < 0.05). The prevalence of pathogenic bacteria found in in vitro cultures was significantly variable (p < 0.01), as were the antibiotic sensitivity patterns. Pathogenic bacteria isolates decreased after MPFF applications in a dose−response fashion (p < 0.01), while isolates obtained from controls and low-dose-MPFF-treated animals were stable and similar (p > 0.05). The sensitivity patterns of pathogenic bacteria isolated in in vitro cultures from MPFF-treated animals were variable, although resistance to E. coli, Staphylococcus aureus, Bacillus spp., and coliforms was shown irrespective of the MPFF doses used. However, MPFF-treated cows showed a dose−response effect regarding PMN rates (p < 0.05). The calving-first service, calving−conception interval, and conception rate improved significantly from using higher MPFF doses (p < 0.05). In conclusion, this study shows that MPFF treatment differentially affects uterine involution, bacteriological profiles, cytological traits, and reproductive performance in metritis-positive dairy cows naturally infected by E. coli.

Cytological endometritis diagnosis in primiparous versus multiparous dairy cows

Endometritis is a uterine disease of dairy cows causing substantial negative effects on reproductive performance and inflicting considerable economic losses. It is typically diagnosed by endometrial cytology evaluation and commonly named cytological endometritis (CEM). In most previous studies, cows were defined as CEM positive if the proportion of polymorphonuclear cells (%PMN) in their endometrial cytology was above a pre-set threshold. Thresholds were established based on CEM diagnosis in association with reproductive performance, typically analyzed by a single reproductive parameter and calculated for all cows together. Our objective was to examine whether primiparous and multiparous cows should optimally be diagnosed for CEM by different %PMN thresholds and sampling timings, using a combination of several reproductive performance parameters. Two endometrial cytobrush cytology samples were collected from Holstein-Friesian dairy cows (n = 415; 269 multiparous; 146 primiparous), at 30-40 d in milk (DIM) and 60-70 DIM, and %PMN were evaluated microscopically (blindly; Diff-Quick stain, Medi-Market). The %PMN thresholds were set at ≥1% to ≥10%, ≥15%, and ≥20%, and accordingly, for each of the thresholds, several reproductive performance parameters were compared between CEM-positive versus CEM-negative cows. Upon application of several analytic approaches, our results indicated that optimal CEM diagnosis should be performed by different criteria in primiparous and multiparous cows: in primiparous cows at 30-40 DIM, using a threshold of ≥7%PMN, and in multiparous cows at 60-70 DIM, using a threshold of ≥4%PMN. Such a diagnostic approach provides a comprehensive view of the reproductive prognosis of CEM-positive primiparous and multiparous cows, which is pertinent information for researchers, veterinarians, and farmers.

Risk factors associated with endometritis in zero-grazed dairy cows on smallholder farms in Rwanda

Clinical endometritis (CLE) and subclinical endometritis (SCLE) manifesting at the cow- and herd-levels has been associated with multiple risk factors (RFs), but hardly are RFs with direct influences separated from those with mediated indirect influences. This study identified and quantified the direct and indirect associations of cow- and herd-levels RFs with CLE and SCLE cases observed among 466 zero-grazed dairy cows that were in their 21-60 days postpartum (dpp). The cases were observed in a cross-sectional survey of smallholder farms (n = 370) in Rwanda. The direct and indirect associations were constructed with odds ratio (OR) derived from multiple logistic regression modelling. The cow-level RFs that had direct positive association with CLE and SCLE were the season of calving (OR: 5.0, 2.1), dystocia (OR: 1.9, 2.2), poor body condition score (OR: 4.1, 2.2), stillbirth (OR: 3.5, 3.3), and retained placenta (OR: 1.4, 1.8) while mastitis (OR: 2.5) and parity (OR: 1.5) had a direct positive association with SCLE. Breed and parity of cow, sex of calf, and twin births had indirect positive association with both CLE and SCLE cases. At the herd-level, unhygienic cowshed (OR: 25.1, 8.9) had direct positive association with both CLE and SCLE cases. In contrast, earthen floor cowshed (OR: 6.6) and large herd size (OR: 3.1) had direct positive association with CLE and not using bedding materials (OR: 1.5) had direct positive association with SCLE. Herd-level RFs that showed indirect positive association with both CLE and SCLE cases were farm size (OR: 2.9) and farmer's experience in dairying (OR: 1.7) while housing cows within the first 30 dpp (OR: 0.1) showed indirect negative association. These results show which RFs have strong direct and indirect influences on CLE and SCLE cases at the cow- and herd-levels. Effective management of those RFs should be a priority in extension education and services to enable smallholder farmers effectively manage them to prevent and control endometritis among their zero-grazed dairy cows.

Influence of endometritis on milk yield of zero-grazed dairy cows on smallholder farms in Rwanda

Endometritis being a post-partum uterine infection in dairy cows is likely with substantial production loss through reduction in milk yield (MY), discarded milk during treatment and withdrawal period, and increased cost of veterinary treatment. This study quantified the influence of endometritis on MY of zero-grazed dairy cows managed on smallholder farms in Rwanda. The study enrolled a total of 461 cows within their 21 to 60 days in milk to examine for clinical endometritis (CLE) and subclinical endometritis (SCLE). A cow was considered having endometritis if it was positive for at least one test (CLE or SCLE), otherwise was negative. The MY data were collected prospectively from endometritis positive and negative cows for 30-day post-endometritis diagnosis. Compared to cows negative for endometritis, the positive endometritis cows were 2.4 times more (29.7 vs. 70.3%) with daily MY 15.3% lower (7.5 ± 0.2 vs. 8.9 ± 0.3 litres; p<0.05), representing a reduction of 1.4 ± 0.2 litres of milk/cow/day. Of the CLE positive cows, 33.4% (104/311) were treated using different veterinary drugs, which resulted in 23.5% more discarded milk compared (p<0.05) to untreated positive cows. Discarded milk was higher (p<0.05) among cows treated with oxytetracycline (65.9 ± 4.4 litres) compared to cows treated with procaine penicillin G and dihydrostreptomycin (35.5 ± 2.7 litres). The percentage of total milk loss was much higher (45.6%) among CLE positive cows that received treatment compared to the untreated cows (16.3%). These results demonstrate a strong association between MY loss and endometritis. A timely diagnosis and treatment of the disease is recommended using conventional veterinary drugs that have zero withholding time for milk to reduce the MY loss and associated economic loss, estimated at 154 US$ in a lactation.

Effects of endometritis on reproductive performance of zero-grazed dairy cows on smallholder farms in Rwanda

Endometritis is a prevalent post-partum uterine infection in dairy cows resulting in suboptimal reproductive performance. The hypothesis was that endometritis status is associated with suboptimal reproductive performance of postpartum dairy cows managed under zero-grazing feeding practice on smallholder farms. In this study, there was evaluation of effects of endometritis diagnosed at 38.5 ± 14.7 days postpartum (dpp) on subsequent reproductive performance. Reproductive performance of 436 cows from 345 farms was recorded for 210 dpp. Values for reproductive performance indicators were less (P < 0.05) in cows determined to be positive compared to negative for endometritis. Cows that tested positive, as compared to negative, for endometritis had longer periods after parturition until initiation of oestrous cycles (median, interquartile range; 85.0, 57.5-127.0 and 62.6, 49.0-90.0 days, respectively), longer durations before being detected pregnant (95.5, 61.8-145.5 and 63.0, 50.0-83.0 days, respectively), lesser pregnancy rates as a result of the first breeding postpartum (16.5% and 32.7%, respectively), more natural-mating or artificial inseminations per pregnancy (1.3 ± 0.1 and 1.1 ± 0.0, respectively) and more occurrences of anoestrus postpartum (48.4% and 11.7%, respectively). These results provide evidence of a strong association between endometritis and suboptimal fertility performance in zero-grazed cows on smallholder farms in Rwanda. Considering there were 70.2% of cows in the present study were diagnosed with endometritis, this is indicative of a widespread herd health issue, warranting that field veterinary practitioners prioritise endometritis in their herd health service delivery to smallholder dairy farmers for effective disease management and herd sustainability.

Nutritional condition in the dry period is related to the incidence of postpartum subclinical endometritis in dairy cattle

Objective

Endometritis is a major disease, that causes infertility in cattle, and is usually categorized as clinical or subclinical endometritis (SCE). The nutritional condition during the dry period is important for recovery after the last stage of the lactation period, and for postpartum production and reproduction. This study aimed to clarify the relationship between nutritional and metabolic characteristics in the dry period, and the risk of postpartum SCE.

Methods

Multiparous Holstein dairy cows (n = 25, raised in a tied stall) were used. Endometrial cytological analysis was performed around 30 days post-partum, with 5% to 14% polymorphonuclear (PMN) as a cut-off point to define SCE. Serum levels of glucose, non-esterified fatty acids, β-hydroxybutyric acid (BHBA), blood urea nitrogen, total cholesterol, aspartate aminotransferase, γ-glutamyl transpeptidase, calcium, phosphorus, and magnesium were measured in the cows at the dry period to evaluate energy status, protein metabolism, and mineral metabolism.

Results

The incidence of SCE in the cows was 60.0% (n = 15/25) and the mean PMN% in postpartum cows diagnosed as SCE was 8.05%±2.6%. Overall, 17 and 8 samples were collected from the cows in the far-off and close-up periods, respectively. The serum concentration of BHBA in the far-off period and serum glucose concentration in the close-up period were correlated with postpartum PMN% (r = 0.62, p<0.01; r = −0.74, p<0.05, respectively). Serum levels of calcium and magnesium in the dry period were associated with the incidence of postpartum SCE (healthy vs SCE cows, p<0.05).

Conclusion

Blood levels of glucose, BHBA, calcium, and magnesium in dry periods could be useful parameters for predicting the risk of postpartum SCE. The present study also suggests that management in the close-up period is essential for promoting recovery from calving fatigue.

Diagnostic evaluation of subclinical endometritis in dromedary camels

The objective of the present study was to evaluate the efficacy of various diagnostic methods and to estimate the prevalence of bacterial pathogens associated with subclinical endometritis (SCE) in dromedary camels. During two consecutive breeding seasons, a total of 2122 infertile female dromedaries were assigned to this study and suspected cases of SCE were identified using the established criteria which included failure to conceive after three or more consecutive matings with a fertile male, a clinically healthy genital system, no observable vaginal discharge, and normal sexual behavior. Manual vaginal examination, Metricheck, bacteriological examination using endometrial swabbing, and hemogram assessments were conducted and there were comparisons of results to when there was cytological examination using the Cytobrush technique as the gold standard. The threshold value for positive cases of SCE was set at ≥ 5% polymorphnuclear cells in the cytological samples. Subclinical endometritis was diagnosed in 211 9.94 %) of the total infertility cases. Endometrial swabbing was a more sensitive and specific technique for diagnoses compared with the other methods. Bacillus sp., Staphylococcus sp., and Candida albicans were the most commonly isolated microorganisms. Hemogram testing and rectal and ultrasonographic examinations were not effective for the diagnosis of SCE. It was concluded that, compared with other diagnostic tests, bacteriological examination is more sensitive and specific for the detection of SCE in dromedaries.