ISSN 2398-2977      

Metritis-laminitis-septicemia complex

pequis

Introduction

  • Cause:
    • Sequelae to retained placenta or any gross contamination of the uterus during foaling.
    • Severe bacterial infection in the myometrium → systemic bacterial +/- toxin absorption, septicemia and systemic inflammatory response syndrome (SIRS) → sepsis-associated laminitis.
    • Parturition abnormality, including retained placenta, especially in draft breeds.
  • Signs: increased vulval discharge, severe systemic illness and endotoxemia, laminitis, occasionally death.
  • Diagnosis: history, clinical examination, vaginal examination, clinical pathology, foot radiographs.
  • Treatment: includes therapy for retained placenta Placenta: retained, uterine lavage, systemic antibiotics, NSAIDs, IV fluid therapy and acute laminitis treatment Foot: laminitis.
  • Prognosis: guarded.

Pathogenesis

Etiology

  • Delayed uterine involution Uterus: delayed involution.
  • Severe bacterial infection including anaerobes, eg Bacteroides fragilis Bacteroides fragilis.
  • Rapid multiplication and/or death of Gram-negative bacteria results in endotoxin release.
  • Bacteria and/or toxins are absorbed through compromised uterine wall into the circulation.
  • Toxins initiate a systemic inflammatory response syndrome (SIRS) Systemic inflammatory response syndrome.
  • Bacteria result in sepsis.
  • The feet are one of the end organs affected by SIRS, resulting in sepsis-associated laminitis.

Predisposing factors

General

Specific

Pathophysiology

  • Sequel to retained placenta or any gross contamination of the uterus during foaling, eg dystocia Reproduction: dystocia.
  • Infection of endometrial, myometrial and occasionally serosal layers → septicemia and SIRS with possible secondary consequences, eg laminitis Foot: laminitis.
  • Gross contamination of the uterus at foaling +/or retained placenta → delayed uterine involution, increased autolysis of the placenta and severe bacterial infection.
  • The uterine wall becomes thin and friable → disruption of the endometrial barrier → allows myometrial +/- serosal infection.
  • The toxic metritis allows absorption of bacteria and bacterial toxins → subsequent septicemia/endotoxemia + SIRS → laminitis.
  • Death can occur in severe cases.

Timecourse

  • 12-24 h onwards.

Epidemiology

  • Adult post-parturient mares.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Belknap J et al (2012) Sepsis-related laminitis. Equine Vet J 44 (6), 738-740 PubMed.
  • Crabtree J (2012) Peripartum problems in mares 2. Postpartum problems. In Pract 34 (8), 462-471 VetMedResource.

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