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PubMed1997

Postpartum endometritis caused by herpes simplex virus.

BACKGROUND: Herpes simplex virus (HSV) is rarely the causative agent of endometritis and is usually found in association with pelvic inflammatory disease. Only one case of postpartum HSV endometritis has been reported. CASES: We describe two cases of herpes simplex postpartum endometritis. Neither patient had genital HSV lesions noted at the time of delivery. The first case developed after a preterm cesarean delivery in an 18-year-old primipara. She had persistent puerperal fever despite broad-spectrum anti-microbial treatment. The second case was a 16-year-old primipara whose vaginal delivery was complicated by severe postpartum endometritis. Vulvar and endometrial cultures were positive for HSV alone in both patients. Both infants died from disseminated HSV infection. CONCLUSION: Herpes simplex virus can cause clinical postpartum endometritis.

Adolescent↗

PubMed1996

Analysis of chronic endometritis for Chlamydia trachomatis by polymerase chain reaction.

Chronic endometritis is characterized histologically by plasma cells infiltrating endometrial stroma. Although it has been speculated that many instances of chronic endometritis are infectious, the origin of most cases is not apparent by routine histopathologic evaluation. Chlamydia trachomatis, an obligate intracellular bacterium, is known to cause chronic endometritis in the setting of pelvic inflammatory disease. The authors analyzed 43 specimens of histopathologically diagnosed chronic endometritis from 38 patients for C trachomatis by PCR using primers for the single-copy major outer membrane protein (MOMP) gene. C trachomatis was detected in only one such case in which dense plasma cell infiltrates were present and concurrent C trachomatis infection of the cervix was documented. Using serially diluted DNA from formalin-fixed, paraffin-embedded McCoy cells, the sensitivity of this method was shown to be equivalent to a single infected cell in a paraffin section. In conjunction with the results of other studies, these data indicate a limited role, if any, of C trachomatis in the origin of mild or moderate chronic endometritis.

Adolescent↗

PubMed1999

Uterine clearance and resistance to persistent endometritis in the mare.

The objective of this article is to review the role of uterine defense mechanisms in natural resistance to chronic or persistent endometritis. A breakdown of uterine physical clearance mechanisms is currently believed to play a major role in susceptibility to persistent endometritis. Mares with increased susceptibility to persistent endometritis have impaired myometrial contractility in response to an acute inflammation, resulting in an accumulation of fluid and inflammatory products within the uterine lumen. The origin of this defect remains unknown. Recent studies have demonstrated that spermatozoa trigger PMN chemotaxis into the uterine lumen. This observation suggests that a transient endometritis is a normal physiological response to breeding. However, in mares with impaired uterine defense mechanisms, the condition may develop into a persistent endometritis and subsequent subfertility. In contrast to spermatozoa, seminal plasma has a suppressive effect on complement activation and PMN chemotaxis (65). The exact role of seminal components in breeding-induced inflammation needs further investigation.

Animals↗

PubMed2000

Post-breeding endometritis in the mare.

Post-breeding endometritis is a major cause of subfertility in the mare. Endometritis is a normal event in the immediate period after mating, but the presence of ultransonographically visible uterine fluid more than 12 h later is thought to be evidence of uterine pathology. In mares that are free of venerally transmitted endometritis, treatment is aimed at removing the intraluminal fluid. If the endometritis persists past day 5, when the embryo enters the uterine lumen, the cytotoxic environment will not be compatible with pregnancy. Reproductive anatomy, defective myometrial contractility, lowered immune defences, overproduction of mucus, inadequate lymphatic drainage, or a combination of these factors will predispose the mare to post-breeding endometritis.

Animals↗

PubMed2001

Some aspects of immunology of the bovine uterus related to treatments for endometritis.

Endometritis in breeding cattle occurs during the postpartum period, and is associated primarily with contamination of the reproductive tract involving Arcanobacter pyogenes (formerly Actinomyces pyogenes) together with Gram-negative anaerobes. Polymorphonuclear inflammatory cells (PMNs) contribute partly to the defense mechanisms against micro-organisms contaminating the vagina and uterine lumen, whose phagocytic activity depends on bacterial opsonisation by humoral antibodies; significant numbers of lymphocytes are also present. Whilst leukocyte numbers in the uterine lumen are relatively high during metoestrus and dioestrus compared to other phases of the oestrous cycle, their functional activity is unaffected. Humoral antibody concentrations in the reproductive tract are stimulated following exposure to local antigen, and the response is site dependent; of the several different classes of immunoglobulins, IgG predominates in the uterus and IgA the vagina. Only a portion of the total IgG1 found on the uterine lumen is synthesised locally in the endometrium, the remainder and all of the IgG2 is derived from the local uterine blood supply. Generally, concentrations of immunosuppressant proteins present in the uterine lumen increase under progesterone dominance, and these inhibit lymphocyte proliferation, making the uterus more susceptible to infection. The relationship between uterine susceptibility to micro-organism contamination and the luteal phase of the oestrous cycle is still unclear. Intrauterine infusion of immunomodulators such as E. coli lipopolysaccharides (LPS) or oyster glycogen, in healthy cows and those with endometritis, stimulates leukocytes to migrate into the uterine lumen. At a dosage rate of 100 microg, lipopolysaccharides are not absorbed by the healthy endometrium and do not alter the oestrous cycle length. It is unknown, whether a similar dose can be absorbed through an inflamed endometrium in naturally occurring cases of endometritis to cause systemic illness. Currently, prostaglandin F2alpha is recommended for treating endometritis in both cycling and non-cycling cows, but its mode of action in non-cycling cows is not fully understood. The efficacy of endometritis treatment using an intrauterine infusion of an immunomodulator in cases occurring naturally has not been determined on a large scale.

Animals↗

PubMed1985

The efficacy of antibiotic prophylaxis in the prevention of post-cesarean section endometritis.

Endometritis is an infectious complication in 9% to 65% of patients delivered by cesarean section. The risk of developing endometritis is greater in the high-risk emergent patient as compared to routine repeat abdominal deliveries. This study describes the incidence of endometritis following cesarean section delivery in different patient groups at the University of Virginia Hospital during a 1-year period and reviews the literature on the efficacy and risks of prophylactic antibiotics in this setting. Of patients not receiving antibiotic prophylaxis, 11 (less than 1%) of 1,461 normal spontaneous vaginal delivery patients, 7 (16.7%) of 42 repeat and 39 (29.8%) of 131 emergent cesarean section patients developed endometritis. This contrasts to none of the 24 emergent patients who received antibiotic prophylaxis. The literature review shows multiple prospective well-designed and executed studies that demonstrate reliable decreases in the incidence of endometritis with short course antibiotic prophylaxis. Our conclusion is that short course antibiotic prophylaxis is a safe, reproducible, cost-effective and indicated method of reducing the incidence of this costly and serious postoperative infection.

Anti-Bacterial Agents↗

PubMed1999

Plasma cell endometritis is associated with Chlamydia trachomatis infection.

The presence of plasma cells in endometrial tissue has been linked to Chlamydia trachomatis infection. The aim of our work was to determine the strength of the association between C trachomatis infection and plasma cell endometritis. C trachomatis infection was detected by polymerase chain reaction (PCR) or immunohistochemistry in 5 (24%) of 21 endometrial tissue samples with plasma cell endometritis and in 1 (4%) of 28 tissue samples with no evidence of plasma cell endometritis (P < .02). Patients with plasma cell endometritis were also more likely to have symptoms and signs consistent with upper genital tract chlamydial infection; thus there is an association between endometrial C trachomatis infection and the presence of plasma cells in the endometrium. The histopathologic finding of plasma cell endometritis should encourage further examination of the tissue sample for simultaneous chlamydial infection. Plasmid-based polymerase chain reaction and immunohistochemical staining of paraffin-embedded samples are useful methods for detecting C trachomatis in endometrial tissue.

Adult↗

PubMed2005

Endometrial micropolyps at fluid hysteroscopy suggest the existence of chronic endometritis.

BACKGROUND: At fluid hysteroscopy the presence of endometrial micropolyps (less than 1 mm of size) is a frequent finding. Although their origin is still unknown, in our experience they are associated with stromal edema, endometrial thickening and periglandular hyperhaemia that suggest the existence of chronic endometritis. This study will aim to describe these lesions and evaluate their inflammatory significance by comparing hysteroscopic and histological findings. METHODS: 820 women underwent hysteroscopy and endometrial biopsy. Sensitivity, specificity, positive and negative predictive values and accuracy of the micropolyps presence for the diagnosis of chronic endometritis were calculated. RESULTS: Micropolyps were found in 96 cases (11.7% of all hysteroscopies); in 90 (93.7%) of these cases histology confirmed the presence of chronic endometritis. In women without micropolyps, chronic endometritis was significantly less frequent (78 cases, 10.8%) (P < 0.000001). The likelihood of chronic endometritis for women with micropolyps was very high (odds ratio 124.2, confidence interval 50.3-205.4). The sensitivity, specificity, positive and negative predictive values were 54%, 99%, 94% and 89%, respectively; the diagnostic accuracy was 90%. CONCLUSIONS: The presence of endometrial micropolyps at fluid hysteroscopy is significantly associated with endometrial inflammation and can be considered a reliable diagnostic sign for this pathology.

Adult↗

PubMed1994

Randomized comparison of ampicillin-sulbactam to cefoxitin and doxycycline or clindamycin and gentamicin in the treatment of pelvic inflammatory disease or endometritis.

OBJECTIVE: To evaluate the efficacy and safety of ampicillin-sulbactam (3 g every 6 hours) in patients with pelvic inflammatory disease or postpartum endometritis using a randomized, comparative, multicenter study of parallel design. METHODS: Eligible patients with pelvic inflammatory disease were randomized to receive either ampicillin-sulbactam or cefoxitin (2 g every 6 hours) plus doxycycline (100 mg every 12 hours). Those with endometritis were randomized to ampicillin-sulbactam or clindamycin (900 mg every 8 hours) plus gentamicin (1.5 mg/kg every 8 hours). In the ampicillin-sulbactam group, chlamydia-positive patients also received oral doxycycline. RESULTS: For pelvic inflammatory disease, the clinical response rates (cure or improvement) were 85.5% (47 of 55) and 89.6% (43 of 48) in the ampicillin-sulbactam and cefoxitin and doxycycline groups, respectively (chi 2 = 0.10, P = .76). For endometritis, the clinical response rates were 88.7% (141 of 159) and 90.8% (139 of 153) in the ampicillin-sulbactam and clindamycin and gentamicin groups, respectively (chi 2 = 0.15, P = .70). The percentages of patients with pelvic inflammatory disease who had adverse experiences were not significantly different in the cefoxitin and doxycycline group (47% [29 of 62]) than in those receiving ampicillin-sulbactam (33% [22 of 66]) (P = .12). These adverse effects were mostly mild or moderate. In the endometritis subjects, the incidence of adverse experiences in the ampicillin-sulbactam group (11% [20 of 179]) was comparable to that during treatment with clindamycin and gentamicin (12% [22 of 180]). These adverse experiences were also mostly mild to moderate. CONCLUSION: Ampicillin-sulbactam is as effective and well tolerated as combination regimens using cefoxitin plus doxycycline and clindamycin plus-gentamicin for the treatment of pelvic inflammatory disease or endometritis, respectively.

Adult↗

PubMed2000

Effect of three programmes for the treatment of endometritis on the reproductive performance of a dairy herd.

Three management programmes to improve the reproductive performance of a dairy herd were compared in a prospective controlled field study on one commercial farm. A total of 542 cows were examined for endometritis 22 to 28 days postpartum and assigned to one of three treatment groups: in group 1 the cows with signs of endometritis were treated with an intrauterine infusion of 100 ml of a 2 per cent polycondensated m-cresolsulphuric acid formaldehyde solution; in group 2 the cows with signs of endometritis were treated with an intrauterine infusion of 125 ml of a 20 per cent eucalyptus compositum solution; and in group 3 all the cows were injected intramuscularly with 0.75 mg of tiaprost, an analogue of prostaglandin F2alpha (PGF2alpha) at two-week intervals, starting on day 43, until they were inseminated. Thirty-four per cent of the cows showed signs of endometritis. In group 3, oestrus detection efficiency was significantly higher than in groups 1 and 2 (P<0.05), the interval to first service was shorter, and the cows had fewer days open than the cows in groups 1 and 2 (P<0.05). The results indicate that management programmes based on the strategic use of PGF2alpha are an effective alternative to traditional programmes based on rectal palpations and intrauterine infusions to control endometritis at a herd level.

Animal Husbandry↗

PubMed1980

Studies on natural and experimental endometritis in ewes.

Of 100 uteri of ewes collected from a slaughterhouse, 44 had endometritis. These cases were classified as acute endometritis (18%), acute lymphocytic endometritis (59%), chronic non-suppurative endometritis (16%) and suppurative endometritis (6.8%). Aerobic bacteria were isolated from 26 uteri. The most commonly isolated bacteria were Escherichia coli, Corynebacterium pyogenes, and Staphylococcus aureus. These organisms then were inoculated into the uteri of normal ewes. None of the inoculated bacteria consistently produced any particular type of endometrial lesion.

Animals↗

PubMed2002

Association between endometritis and urocystitis in culled sows.

Slaughterhouse sampling and examination of urogenital tracts of 499 sows and gilts culled for reproductive reasons from 21 Hungarian herds were performed over a 6-year period. The aim was to estimate the prevalence of different urogenital tract lesions, and to provide sensitivity and specificity estimates for macroscopic and bacteriological examinations in the diagnosis of urocystitis and endometritis. Furthermore, the association between endometritis and urocystitis was assessed. The prevalence of main lesions of the urogenital tract was similar to that reported in other studies. The 'sensitivity' of macroscopic and bacteriological methods was determined statistically by taking histopathology as the 'Gold Standard'. As a result, the 'sensitivity' of macroscopic methods for the diagnosis of endometritis and urocystitis was < or = 18.1% and 47.9%, respectively, while the 'sensitivity' of bacteriology for the diagnosis of the same conditions was < or = 31.8% and 63.0%, respectively. The presumed positive association between urocystitis and endometritis was confirmed; it was not confounded by parity. Animals affected by urocystitis had a 3.5 times higher odds to simultaneously have endometritis than animals without urocystitis.

Animals↗

PubMed1991

[Current diagnostic methods and therapeutic principles in various forms of puerperal endometritis].

A total of 55 puerperants+ with endometritis followed by spontaneous labours (26 females) and cesarean operation (29 females) were studied. A comprehensive study involved echography, hysteroscopy, bacteriological analysis of the uterine content, and histological examination of mucosal curettage of the corpus uteri. Three types of the clinical course of endometritis were identified: 1) in the presence of placental tissue residues; 2) with necrosis of delayed decidual tissue and lochia- or hematometra; and 3) a "pure" type of endometritis without abnormal tissues in the uterus. Uterine curettage was performed in the first type of endometritis, vacuum aspiration of its content was carried out in Type 2. The patients from Group 3 who had the most severe inflammatory process of the uterus underwent its cavity washing with large volumes of cold antiseptic solutions, took detoxifying, ++rheo-vasoactive and protein agents, received immunomodulating and uterotonic therapy. The algorithm developed for management of puerperants+ with postpartum endometritis substantially enhanced the efficiency of therapy and prevented severe septic events in time.

Adult↗

PubMed1991

Clinical and pathologic features of endometrial hyperplasia, pyometra, and endometritis in cats: 79 cases (1980-1985).

Records of 79 cats determined to have endometrial hyperplasia (EH) with or without pyometra or endometritis were studied. Forty-eight cats (61%) were spayed or died because of complications relating to reproductive tract disease. All other cats were free of clinical signs of disease, and lesions were found incidentally during routine ovariohysterectomy or at necropsy. Prevalence of uterine lesions was greater in cats greater than or equal to 5 years old. Breeding, age at first breeding, and queening could not be correlated with clinical or pathologic signs of disease. Seventy-one percent (34/48) of cats with clinical signs referable to the reproductive tract had histologic evidence of pyometra or endometritis, whereas only 19% (6/31) of cats without clinical signs had histologic evidence of either disease. Only 23% (9/39) of cats without pyometra or endometritis had corpora lutea (CL) in at least one ovary, whereas 40% (16/40) of cats with either pyometra or endometritis had CL. We concluded that the prevalence of EH in cats increases with age in sexually intact female cats, and that most cases of pyometra or endometritis, but not EH, in cats are associated with retained CL.

Age Factors↗

PubMed1990

Xanthogranulomatous endometritis. Report of six cases and a proposed mechanism of development.

Xanthogranulomatous endometritis is a rare pathologic finding with only five cases reported in the literature. On review of our files over the past 12 years, we found six cases of xanthogranulomatous endometritis, all associated with endometrial adenocarcinoma that had been irradiated by external beam and/or intracavitary implants prior to surgery. Histologically, these cases were characterized by foamy histiocytes with variable amounts of associated multinucleated giant cells, other chronic inflammatory cells, necrosis, calcium, cholesterol clefts, and hemosiderin. Xanthogranulomatous features were not present in the pretreatment endometrial biopsy specimens from any of the six patients. Contributory factors to the development of xanthogranulomatous endometritis such as necrosis, hemorrhage, obstruction, tumor bulk, or delay in treatment were identified. The mechanism of development of xanthogranulomatous endometritis may involve a complex interaction of elements common to the development of xanthogranulomatous change in other organs (obstruction, inflammation, and a lipid source) as well as elements unique to irradiated tissue (generation of free radicals and lipid peroxidation). These cases indicate that radiation injury in the setting of endometrial adenocarcinoma is an additional etiopathologic finding ofulomatous endometritis.

Adenocarcinoma↗

PubMed1987

Opsonins of Streptococcus in uterine flushings of mares susceptible and resistant to endometritis: control of secretion and partial characterization.

The release of opsonins into the uterine lumen of mares susceptible or resistant to endometritis was examined after intrauterine inoculation of a filtrate of Streptococcus culture fluid or vehicle. Uterine flushings were collected at 0.5 hour before and 2, 4, 6, 8, and 24 hours after inoculation on day 2 or 3 of estrus and on day 7 or 8 after ovulation. Amounts of opsonins in flushings were quantified as the H2O2 produced by leukocytes incubated with flushings-opsonized bacteria, compared with H2O2 produced by leukocytes incubated with nonopsonized bacteria. Opsonin values in flushings increased (P less than 0.025) in all mares after inoculation of filtrate or vehicle. For mares resistant to endometritis, opsonin values were greater at diestrus than at estrus. The opposite was true for mares susceptible to endometritis, resulting in a status (susceptible vs resistant) X stage of cycle interaction (P less than 0.025). Overall, opsonins were higher (P less than 0.05) in flushings of mares susceptible to endometritis than in flushings of mares resistant to endometritis, but this difference was only apparent at estrus. Preliminary characterization of opsonins in uterine secretions by ammonium sulfate fractionation and gel filtration indicated that opsonins were mainly associated with an ammonium sulfate-soluble fraction of high molecular weight (greater than 4 X 10(6] and an ammonium sulfate-precipitable fraction that was associated with immunoglobulin G.

Animals↗

PubMed1980

The effect of education, marital status and sexual behaviour on the incidence of puerperal endometritis and bacteriuria.

During a one year study period, 5058 patients were delivered in the State Maternity Hospital of Helsinki. Caesarean section was performed on 774 patients (15.3%). The puerperal endometritis rate was 1.8% after vaginal delivery and 9.8% after Caesarean section. After vaginal delivery, the frequency of endometritis in unmarried women (3.9%) was more than twice as high as in married women (1.5%) (p less than 0.001). After Caesarean section, endometritis occurred in 20.7% of unmarried and in 8.9% of married women (p less than 0.001). Patients who had sexual intercourse during the last week of pregnancy had endometritis after vaginal delivery at a rate of 2.4% and in 20.0% after Caesarean section. In patients who had not sexual intercourse the percentages were 1.6 and 8.3 respectively. In vaginal deliveries the difference was small but in Caesarean sections statistically significant (p less than 0.05). Maternal education had no significant effect on the frequency of endometritis. Bacteriuria corresponding to greater than or equal to 10(5) bacteria/ml of urine was found in 179 patients (5.0%). The frequency of bacteriuria did not have a statistically significant correlation with the marital status of the patients, nor with their education or sexual behaviour during the last week of pregnancy.

Adult↗

PubMed1989

Endometritis in the mare: A comparison between reproductive history and uterine biopsy as techniques for predicting susceptibility of mares to uterine infection.

Thirty mares with no clinical signs of endometritis were categorized as being susceptible or resistant to uterine infection depending on whether or not they had a history of recurrent endometritis. The same mares were then independently classified as susceptible or resistant on the basis of their uterine biopsies; those with significant endometrial degeneration were considered to be susceptible to endometritis. The mares then received an intrauterine inoculation of pathogenic Streptococcus zooepidemicus . Those mares which eliminated bacteria by 10 d after inoculation were considered truly resistant to endometritis, whereas those still infected at 10 d were considered susceptible. The original classifications based on history or biopsy were compared to the inoculation results. A history of recurrent endometritis provided a more sensitive (0.90) and specific (0.95) indication of susceptibility to uterine infection than a uterine biopsy with significant endometrial degeneration (sensitivity 0.5, specificity 0.75).

Journal Article↗