Emphysematous pyometra secondary to Enterococcus avium infection in a dog

Summary

A 5-year-old female intact Mastiff dog was presented with a history of vaginal discharge for 1 day. Physical examination revealed a sanguineo- purulent vaginal discharge and systemic inflammatory response syndrome. Abdominal radiographs showed several dilated and gasfilled tubular loops. The differential diagnoses included emphysematous pyometra or small intestinal mechanical ileus. Surgical exploration of the abdomen demonstrated a severely dilated and gas-filled uterus, and emphysematous pyometra was confirmed. The patient’s clinical signs resolved after ovariohysterectomy. Histopathology revealed mild endometrial cystic hyperplasia with infiltration of inflammatory cells in the superficial endometrial epithelia. Enterococcus avium, an α-hemolytic gram-positive coccus, was isolated from the uterus. This paper highlights the radiographic features of emphysematous pyometra and a pathogen that has never been reported to be associated with canine pyometra previously.

Zusammenfassung

Eine 5-jährige weiblich-intakte Mastiff-Hündin wurde mit seit einem Tag bestehenden Vaginalausfluss vorgestellt. Die Allgemeinuntersu - chung ergab blutig-eitrigen Vaginalausfluss und ein systemisches inflammatorisches Response-Syndrom. Auf Röntgenaufnahmen des Abdomens waren mehrere dilatierte, gasgefüllte tubuläre Schleifen zu erkennen. Differenzialdiagnostisch wurden eine emphysematöse Pyometra oder ein mechanischer Ileus der Dünndärme erwogen. Bei der Laparotomie konnte aufgrund eines stark dilatierten, gasgefüllten Uterus eine emphysematöse Pyometra bestätigt werden. Klinische Symptome waren nach der Ovariohysterektomie nicht mehr vorhanden. Histopathologisch wurde eine geringgradige zystische Hyperplasie des Endometriums mit Infiltration entzündlicher Zellen im superfiziellen endometrialen Epithel nachgewiesen. Aus dem Uterus ließ sich Enterococcus avium, ein grampositives, α-hämolytisches Kokkenbakterium, isolieren. Der Fallbericht stellt die röntgenologischen Merkmale der emphysematösen Pyometra dar und beschreibt die Infektion mit einem Krankheitserreger, der im Zusammenhang mit der Pyometra des Hundes bisher nicht beschrieben wurde.

Keywords

Vaginal discharge - uterine infection - gram-positive cocci - ileus

Schlüsselwörter

Vaginalausfluss - Gebärmutterentzündung - grampositive Kokken - Ileus

• Literatur

• 1 Chang J, Jung J, Jeong Y, Hong K, Kim K, Yoon J, Choi M. What is your diagnosis? Emphysematous pyometra with a large amount of gas. J Small Anim Pract 2007; 48: 717-719.
• 2 Coggan JA, Melville PA, de Oliveira CM, Faustino M, Moreno AM, Benites NR. Microbiological and histopathological aspects of canine pyometra. Braz J Microbiol 2008; 39: 477-483.
• 3 Cottagnoud P, Rossi M. Enterococcus avium osteomyelitis. Clin Microbiol Infect 1998; 4: 290.
• 4 England GCW. Abnormal pregnancy. Dog Breeding, Whelping and Puppy Care.. UK: Blackwell; 2012: 223-231
• 5 Ghosh A, Kukanich K, Brown CE, Zurek L. Resident cats in small animal veterinary hospitals carry multi-drug resistant enterococci and are likely involved in cross-contamination of the hospital environment. Front Microbiol 2012; 3: 62.
• 6 Hagman R, Kindahl H, Lagerstedt AS. Pyometra in bitches induces elevated plasma endotoxin and prostaglandin F2alpha metabolite levels. Acta Vet Scand 2006; 47: 55-67.
• 7 Hernandez JL, Besso JG, Rault DN, Cohen AH, Guionnet A, Begon D, Ruel Y. Emphysematous pyometra in a dog. Vet Radiol Ultrasound 2003; 44: 196-198.
• 8 Hollett RB. Canine brucellosis: outbreaks and compliance. Theriogenology 2006; 66: 575-587.
• 9 Jackson CR, Fedorka-Cray PJ, Davis JA, Barrett JB, Frye JG. Prevalence, species distribution and antimicrobial resistance of enterococci isolated from dogs and cats in the United States. J Appl Microbiol 2009; 107: 1269-1278.
• 10 Jones S, England R, Evans M, Soo SS, Venkatesan P. Microbiologically confirmed meningoencephalitis due to Enterococcus avium: a first report. J Infect 2007; 54: e129-131.
• 11 Jung MY, Chang YH, Kim W. A real-time PCR assay for detection and quantification of Lactococcus garvieae. J Appl Microbiol 2010; 108: 1694-1701.
• 12 Kataoka Y, Umino Y, Ochi H, Harada K, Sawada T. Antimicrobial susceptibility of enterococcal species isolated from antibiotic-treated dogs and cats. J Vet Med Sci 2014; 76: 1399-1402.
• 13 Kempist B, Bukowska D, Wozna M, Piotrowska H, Jackowska M, Zuraw A, Ciesiolka S, Antosik P. Endometritis and pyometra in bitches: a review. Veterinarni Medicina 2013; 58: 289-297.
• 14 Kinns J, Nathan N. The uterus, ovaries, and testes. Textbook of Veterinary Diagnostic Radiology.. Thrall DE. USA: Elsevier; 2012: 757-768
• 15 Lee PP, Ferguson DAJ, Laffan JJ. Vancomycin-resistant Enterococcus avium infection: report of 2 cases and a review of Enterococcus avium infection. Infect Dis Clin Pract 2004; 12: 239-244.
• 16 Mirzoyev Z, Anavekar N, Wilson F, Uslan D, Baddour L, Mookadam F. Enterococcus avium endocarditis. Scand J Infect Dis 2004; 36: 876-878.
• 17 Mohanty S, Dhawan B, Kapil A, Das BK, Pandey P, Gupta A. Brain abscess due to Enterococcus avium. Am J Med Sci 2005; 329: 161-162.
• 18 Noakes DE, Parkinson TJ, England GCW. The caesarean operation and the surgical preparation of teaser males. Arthur’s Veterinary Reproduction and Obstetrics.. USA: Elsevier; 2001: 339-365
• 19 Patel R, Keating MR, Cockerill 3rd FR, Steckelberg JM. Bacteremia due to Enterococcus avium. Clin Infect Dis 1993; 17: 1006-1011.
• 20 Pretzer SD. Clinical presentation of canine pyometra and mucometra: a review. Theriogenology 2008; 70: 359-363.
• 21 Riedesel EA. The small bowel. Textbook of Veterinary Diagnostic Radiology.. Thrall DE. USA: Elsevier; 2012: 789-811
• 22 Schwarz T. The large bowel. Textbook of Veterinary Diagnostic Radiology.. Thrall DE. USA: Elsevier; 2012: 812-824
• 23 Smith FO. Canine pyometra. Theriogenology 2006; 66: 610-612.
• 24 Stager CE, Davis JR. Automated systems for identification of microorganisms. Clin Microbiol Rev 1992; 5: 302-327.
• 25 Thilagar S, Vinita WP, Heng HG, Aisah S, Khairani-Bejo S. What is your diagnosis? Small intestinal and colonic obstruction; emphysematous pyometra. J Small Anim Pract 2006; 47: 687-688
• 26 Tsumagari S, Ishinazaka T, Kamata H, Ohba S, Tanaka S, Ishii M, Memon MA. Induction of canine pyometra by inoculation of Escherichia coli into the uterus and its relationship to reproductive features. Anim Reprod Sci 2005; 87: 301-308.
• 27 Wang CM, Shyu CL, Ho SP, Chiou SH. Characterization of a novel thermophilic, cellulose-degrading bacterium Paenibacillus sp. strain B39. Lett Appl Microbiol 2008; 47: 46-53.