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EQUINE VETERINARY EDUCATION / AE / AUGUST 2020
Fig 4: Candida spp. cultured on Sabouraud’s dextrose agar. Focal fungal infections may remain unidentified by
standard diagnostic methods, in which case hysteroscopy may be useful to identify a nidus of infection. Underlying endocrine disorders such as pituitary pars
Fig 2: Effluent from a uterine lavage of a mare diagnosed with fungal endometritis (Aspergillus spp.).
intermedia dysfunction and insulin resistance should be ruled out as potentiating causes of immune suppression, as altered neutrophil function and an inadequate cellular immune response may result in an increased incidence of secondary infections (McFarlane 2014; McFarlane et al. 2015).
Particular attention should be paid to the conformation of
the vulva, perineum and anus. A recessed anus, deviation of the long axis of the vulva from vertical and compromise to the vulvar, vestibulovaginal or cervical seals will predispose to pneumovagina/pneumouterus, urine pooling and faecal contamination of the reproductive tract. These anatomical defects are known risk factors for the development of fungal endometritis and must be addressed.
Treatment
Fig 3: Endometrial cytology of Mucor spp. stained with Romanovsky stain.
elements, whereas PAS will stain the polysaccharide-laden walls of mycotic elements magenta (Fig 6). Fungal organisms are usually located either within the uterine lumen or within the superficial layers of the stratum compactum, however more invasive forms may be found embedded deep within the glandular lumina. In addition to the location of the fungal organisms, an endometrial biopsy will also determine the severity of inflammation and the extent of endometrial damage, and can be used to assess the response to treatment (Coutinho da Silva et al. 2000).
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Treatment of mares with fungal endometritis is multifaceted and includes correction of any anatomical defects, uterine lavage and systemic and/or intrauterine infusion of antifungals. Topical antifungal treatment of the vagina and clitoris is also advisable since fungal colonisation of the vagina and clitoral fossa and sinuses is a potential reservoir of infection. Uterine lavages should be performed to aid uterine
clearance, decrease fungal load and to remove excessive mucus and potential biofilms. Suggested uterine lavage therapies include 20% N-Acetylcysteine solution, 20% DMSO (Pottz et al. 1967), 3% hydrogen peroxide, Tris-EDTA, 2% acetic acid in combination with 0.9% sterile saline/lactated Ringer’s solution. Due to the risk of fibrosis and adhesion formation, dilute povidine-iodine should be used with great care. Anecdotally, nonspecific uterine lavage therapies have been shown to be very effective in treating cases of fungal endometritis in the mare and should be considered as a first- line treatment option whilst awaiting culture and sensitivity results (Table 1).
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