EQUINE VETERINARY EDUCATION / AE / AUGUST 2020


445


TABLE 1: Intrauterine antifungal treatment (Brinsko et al. 2010, Hess et al. 2002) Antifungal Polyene


Dose


Amphotericin B Nystatin


Azole


Clotrimazole Fluconazole Miconazole


500–700 mg 100–500 mg


1,200 mg insert


Chitin synthesis inhibitor Lufenuron (Program2) 540 mg


Reconstituted in 50–100 ml sterile water for infusion Q 24 h for 5–7 days Reconstituted in 50–100 ml sterile water for infusion Q 24 h for 5–7 days 1,200 mg insert deposited into the uterus


Once Reconstituted in 50–100 ml sterile saline for infusion Once


in size, with a characteristic clear ‘halo’ around the organism due to the lack of stain uptake. Moulds in contrast are long, branching, filamentous organisms (Fig 3). Endometrial culture requires prolonged incubation (up to


4 weeks) in a specialist medium (e.g. Sabouraud’s dextrose agar) and a level of expertise for accurate identification. Candida spp. will typically grow as white to clear coloured colonies with a smooth appearance (Fig 4) and Aspergillus spp. as blue–green/grey–green colonies with white borders and a velvet-like texture (Fig 5). Beltaire et al. (2012) found 73% of samples positive for fungal growth on Sabouraud’s dextrose agar to be negative on aerobic culture, highlighting the importance of specific fungal media for accurate diagnosis. Concurrent aerobic culture is however recommended as the same study revealed 51% of samples to have additional bacterial growth (Streptococcus zooepidemicus 32% and E. coli 21%). Obtaining an endometrial biopsy using an aseptic technique and subsequently smearing the tissue sample onto an appropriate agar plate has been shown to be more sensitive at detecting bacterial growth than a surface endometrial swab (Nielsen 2005). This method may aid in the diagnosis of fungal endometritis by detecting mycotic elements deeper within the endometrium. Concurrent culture of the vagina and external genitalia is also recommended to determine any reservoirs of infection.


TABLE 2: Systemic antifungals Antifungal


Fluconazole (200 mg tablets)


Being a nonculture dependent test, quantitative PCR has


the benefit of a potentially increased sensitivity and more rapid turn-around than that of standard culture but is not readily available in all areas and cannot provide antimicrobial sensitivity data (Ferris et al. 2013). An endometrial biopsy stained with Gomon’s methamine silver stain will reveal a black/grey colouration to fungal


100–200 mg


Administration


Frequency Reconstituted in 50–100 ml sterile water for infusion Q 24 h for 5–7 days 0.5–2.5 million units or 5 g Reconstituted in 50–100 ml sterile water for infusion Q 24 h for 5–7 days


A


Dose


10 mg/kg loading dose, then 5 mg/kg


Administration Frequency PO


Q 24 h for 2–3 weeks


Fig 1: Intrauterine fluid accumulation on ultrasound examination of a mare with fungal endometritis.


TABLE 3: Nonspecific uterine lavage treatments Compound


Dose


Administration


Acetic acid 2% (white vinegar) 20–100 ml Diluted in 1 L sterile saline for infusion Dimethylsuphoxide 20% (DMSO) 50 ml


Hydrogen peroxide 3%


Lactated Ringers’s Solution (LRS) 1–4 L N-acetylcysteine 20% solution


Sterile saline 0.9% Tris-EDTA


1–4 L


Diluted in 1 L sterile saline for infusion followed by lavage with saline/LRS in 24 h


6 g (30 ml) 30 ml diluted in 150 ml sterile saline for infusion, followed by sterile saline/LRS lavage in 24 h


Lavage 250–500 ml Infusion followed by lavage with LRS


Frequency


Q 24 h for 5–7 days Q24 h


60–120 ml Infusion, followed by sterile saline/LRS lavage in 24 h Q 24 h Lavage


Q 24 h until effluent is clear Q 24 h until effluent is clear


Q 24 h until effluent is clear Q 24 h for 5–7 days


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