Sheldon IM, Lewis GS, LeBlanc S, Gilbert RO
Theriogenology 2006 May;65(8):1516-30
PMID: 16226305
Abstract
Uterine function is often compromised in cattle by bacterial contamination of the uterine lumen after parturition, and pathogenic bacteria often persist, causing uterine disease, a key cause of infertility in cattle. However, the definition or characterization of uterine disease frequently lacks precision or varies among research groups. The aim of the present paper was to provide clear clinical definitions of uterine disease that researchers could adopt. Puerperal metritis should be defined as an animal with an abnormally enlarged uterus and a fetid watery red-brown uterine discharge, associated with signs of systemic illness (decreased milk yield, dullness or other signs of toxemia) and fever > 39.5 degrees C, within 21 days after parturition. Animals that are not systemically ill, but have an abnormally enlarged uterus and a purulent uterine discharge detectable in the vagina, within 21 days post partum, may be classified as having clinical metritis. Clinical endometritis is characterised by the presence of purulent (> 50% pus) uterine discharge detectable in the vagina 21 days or more after parturition, or mucuopurulent (approximately 50% pus, 50% mucus) discharge detectable in the vagina after 26 days post partum. In the absence of clinical endometritis, a cow with subclinical endometritis is defined by > 18% neutrophils in uterine cytology samples collected 21-33 days post partum, or > 10% neutrophils at 34-47 days. Pyometra is defined as the accumulation of purulent material within the uterine lumen in the presence of a persistent corpus luteum and a closed cervix. In conclusion, we have suggested definitions for common postpartum uterine diseases, which can be readily adopted by researchers and veterinarians.
In summary, bacteria from the surface of the animal and the environment contaminate
the uterine lumen of most postpartumcows. Elimination of this contamination is dependent on uterine involution, regeneration of the endometrium, and uterine defence mechanisms. The influx of polymorphonuclear neutrophils (PMN), attracted by chemokines such as interlukin-8 (IL-8), plays a key role in the uterine immune response. However, ovarian activity and luteal progesterone modulate many of the processes that make a cow resistant or susceptible to uterine infections, and exogenous PGF2a or intrauterine antimicrobials are effective treatments.
研究で病気を分類するなら、ちゃんと診断するべし、という論文。とはいえ、臨床現場向きの内容。Puerperal metritis, Clinical endometritis, Pyometraは現場レベルの機材や検査でほぼ診断できる。Subclinical endometritisは組織学的、細胞学的診断が入るので、迅速性に欠ける、コストもかかるので現場向きじゃないので、難しいよねって話。