Semina: Ciências Agrárias ISSN: 1676-546X [email protected] Universidade Estadual de Londrina Brasil
Sant’Anna, Marcos Cezar; Kelliton Fabretti, Andrei; Mello Martins, Maria Isabel Clinical approach to canine vaginitis Semina: Ciências Agrárias, vol. 33, núm. 4, julio-agosto, 2012, pp. 1543-1553 Universidade Estadual de Londrina Londrina, Brasil
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How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative REV IS ÕE S / REV IEW S DOI: 10.5433/1679-0359.2012v33n4p1543 Clinical approach to canine vaginitis
Abordagem clínica da vaginite canina
Marcos Cezar Sant’Anna 1;Andrei Kelliton Fabretti 1; Maria Isabel Mello Martins 2*
Abstract
Vaginitis is a rare disease in adult female dogs. However, knowledge regarding this illness is important because, if secondary to reproductive tract anomalies that go uncorrected, it can cause ascending uterine infections and, consequently, subfertility or even infertility. Usually, these infections are caused by Enterobacter or microorganisms from the urogenital inferior system, s uch as Staphylococcus spp , Streptococcus spp , Escherichia coli, Proteus spp, Pseudomonas aeruginosa, Pasteurella , etc. In some cases, vaginitis may be caused by primary infections with Brucella canis , which is zoonotic, or by canine herpesvirus; both of these agents have the potential to cause reproductive failure. The diseas e can occur in any age, breed or ovarian condition and can be identi ed by vaginal cytology, vaginoscopy and culture of vaginal secretions. The most common clinical signs are erythema of the vaginal mucous, vaginal discharge, pollakiuria, licking of the vulva and attraction of male dogs, independent of the phase of the estrous cycle. This disease is generally self-limiting, and the treatment, when necessary, consists of antibiotic therapy, vaginal cleaning with antiseptic and, eventually, surgical correction of predisposing abnormalities. Key words: In ammation/infection vaginal, reproduction, bitch
Resumo
A vaginite é uma afecção rara em cadelas adultas. É uma causa importante de subfertilidade ou infertilidade, quando secundária à anomalias do trato reprodutivo. Normalmente, são causadas por enterobactérias ou pela microbiota do sistema urogenital inferior, tais como Staphylococcus spp , Streptococcus spp , Escherichia coli, Proteus spp , Pseudomonas aeruginosa, Pasteurella , entre outras. Em alguns casos, pode ser primária como infecções por Brucella canis , a qual é uma zoonose ou herpesvírus canino, importante causa de falhas reprodutivas. A afecção acomete fêmeas de qualquer idade, raça ou condição ovariana. Os sinais clínicos envolvem mucosa vaginal hiperêmica, corrimento vulvar, polaquiúria, lambedura vulvar, e atração de machos independente da fase do ciclo estral. Pode ser diagnosticada por citologia vaginal, vaginoscopia e cultura da secreção. A enfermidade, muitas vezes, é autolimitante e o tratamento, quando necessário, é realizado com infusão vaginal de antissépticos ou antibióticos e, eventualmente, correção cirúrgica de anormalidades predisponentes. Palavras-chave: In amação/infecção vaginal, reprodução, cadela
1 Mestrando(s) do Programa de Pós-Graduação em Ciência Animal, área de Sanidade Animal, Universidade Estadual de Londrina,UEL, Londrina, PR. E-mail: [email protected]; [email protected] 2 MSc, PhD. Profª de Teriogenologia de Animais de Companhia. Deptº de Clínicas Veterinárias, UEL, Londrina, PR. E-mail: [email protected] * Author for corespondence Recebido para publicação 09/11/10 Aprovado em 20/06/12 1543 Semina: Ciências Agrárias, Londrina, v. 33, n. 4, p. 1543-1554, jul./ago. 2012 Sant’Anna, M. C.; Fabretti, A. K.; Martins, M. I. M.
Introduction The causes of canine vaginitis are variable and can be classi ed as primary, in the case of infection The vagina is a tubular structure extending from the junction of the vaginal vestibule to the cervix. In with canine herpes virus type I (HVC I) and bitches, the vagina is relatively long, with an average Brucella canis , or secondary in cases of immature length of 10 cm in medium-sized females (SILVA; reproductive tract diseases, immunosuppressive SILVA; CARDOSO, 2002). This peculiarity makes drugs (the hormone androgen and zinc intoxication), the examination of the vagina dif cult when or prophylactic antibiotics, which reduce bacterial performed without instruments of adequate size microbiota and allow the overgrowth of pathogenic (PURSWELL, 2004). The anterior portion of the strains (JOHNSON, 2009). Additional causes vagina is narrow (5-7 mm), which makes inspection include hyper- or hypoestrogenism, urinary tract of the cervix dif cult, even with an endoscope, if it infection or urinary incontinence, genital infections is not appropriate to the size of the animal (SILVA; such as pyometra, metritis or uterine stump SILVA; CARDOSO, 2002; PURSWELL, 2004). abscess, vaginal trauma, chemical irritation due to urovagina, mechanical irritation caused by foreign The vaginal vestibule is shared by the urinary and bodies or tumors, anatomic abnormalities of the reproductive tracts (SILVA; SILVA; CARDOSO, genitourinary system and vaginal atrophy after 2002; HAFEZ; HAFEZ, 2004; PURSWELL, 2004). From the vaginal junction vestibule, there castration (SODERBERG, 1986; JOHNSTON; is a downward inclination toward the vestibule KUSTRITZ; OLSON, 2001; PURSWELL, 2004; that ends in the ventral commissure of the vulva, TILLEY; SMITH, 2007; JOHNSON, 2009). and the urinary meatus is in the vestibule oor, approximately 5 mm distal to the vaginal junction Bacterial Vaginitis vestibule (SILVA; SILVA; CARDOSO, 2002; HAFEZ; HAFEZ, 2004). Bacterial vaginitis is usually secondary to hormonal disorders, nutritional de ciencies, Vaginitis is an in ammation of the vagina and prophylactic use of antibiotics, or poor sanitary vaginal vestibule, which may or may not have an infectious cause (JOHNSON, 1991; HAFEZ; conditions that predispose to increased bacterial HAFEZ, 2004). It can occur at any age, breed or proliferation (HASHIMOTO et al., 2002). It ovarian condition and is suggestive of anatomical is usually caused by enterobacteria or by the abnormalities of the reproductive tract, which microbiota of the lower urogenital system, including can often be corrected with surgical repair Staphylococcus spp , Streptococcus spp, Proteus (SODERBERG, 1986; JOHNSTON; KUSTRITZ; mirabilis and vulgaris, Pseudomonas aeruginosa, OLSON, 2001; JOHNSON, 2009). Haemophilus, Escherichia coli and Pasteurella haemolytica (TILLEY; S MITH , 2007; AVILA et al., Study of this disease is important because 2008). Klebsiella sp ., Shigella sp. and Citrobacter knowledge of the characteristics of the disease allows sp can be found less frequently (AVILA et al., 2008) diagnosis, identi cation of the primary causes and correction, when possible. When the primary Hashimoto et al. (2002) identi ed the main cause of the disease is not corrected, recurrence is bacteria that cause vaginitis: coagulase-positive frequent. Staphylococcus (27.28%), Proteus spp (18.18%), Streptococcus spp (18.18%), coagulase-negative This study aimed to review information about the etiology, clinical features, diagnostic methods, Staphylococcus (9.09%), E. coli (9.09%) and reproductive losses, treatment and peculiarities coagulase-positive Staphylococcus associated of canine vaginitis in young and adult animals, with Streptococcus spp (18.18%). Pasteurella, focusing on the etiological causes. Pseudomonas, Mycoplasma and Chlamydophila are 1544 Semina: Ciências Agrárias, Londrina, v. 33, n. 4, p. 1543-1554, jul./ago. 2012 Clinical approach to canine vaginitis also common causes (JOHNSTON; KUSTRITZ; canal, placenta, testis, epididymis and prostate OLSON, 2001). Often, immature bitches have greater (G REENE ; C ARMICHAEL , 2006). numbers of coagulase-positive Staphylococcus Several studies have assessed the prevalence (FELDMAN; NELSON, 1996). These bacterial of canine brucellosis in different regions of Brazil, agents can cause local infections in the vagina, as where the differences found usually depend on the well as reproductive damage, infertility, embryonic population studied and the diagnostic test employed. death or abortion (HOLLETT, 2006). In Alfenas, in the state of Minas Gerais, Vaginitis caused by B.canis infection will be the prevalence of B. canis using the agar gel discussed hereafter. immunodiffusion (AGID) screening test was 14.2% (90/635), but only 2.8% was con rmed by the agglutination test with 2 – mercaptoethanol (SAL – Vaginitis caused by Brucella canis 2 – MET) (ALMEIDA, et al., 2004). In the region of Vaginitis due to B.canis infection is considered Botucatu in the state of São Paulo, the prevalence was primary (JOHNSTON; KUSTRITZ; OLSON, 2001) 0.84% using population and diagnostic test similar and important in the differential diagnosis of dogs to that used in the previous study (M ORAES et al., presenting with lesions and/or vaginal secretions 2002). Keid et al. (2004) studied the prevalence of and a history of reproductive problems. In general, brucellosis in 12 commercial kennels in São Paulo Brucellae commonly infect the reproductive organs state, where the seroprevalence by AGID ranged of males and females that have reached sexual from 40 to 77%. When blood culture analysis was maturity, and each species of Brucella tends to used instead, the prevalence ranged from 2.7 to infect a speci c animal species ( QUINN , 2004). 54.54%. B.canis is a small, unencapsulated gram-negative There are few studies about the human prevalence coccobacillus that is unable to move or form of brucellosis in Brazil. Spinola and Costa (1972) spores. These bacteria are facultative intracellular detected a brucellosis seroprevalence of 10.8% parasites (PESSEGUEIRO; BARATA; CORREIA, in the workers at a slaughterhouse in Salvador – 2003). The major transmission route is venereal; Bahia. In São Paulo, serum samples were analyzed however, additional modes of transmission include from 330 humans from a clinical laboratory by vaginal discharge after abortion, milk from infected SAL, using speci c agglutinins for B. canis , and bitches, blood transfusions, vaginoscopy, arti cial a prevalence of 1.21% was found (LARSSON, insemination and contaminated needles (B ROWN ; 1980). This result highlights the importance of the PIETZ; RANGER, 1975). diagnosis and prevention of canine brucellosis and its zoonotic potential. These bacteria gain entry through ingestion or mucous membrane exposure of the host (genital, oronasal and/or conjunctival). Transmission through Viral vaginitis skin injuries is also possible (CFSPH, 2009). After Viral vaginitis is caused by herpes virus type penetrating the tissue, the pathogen is phagocytosed I (HVC I) infection, which only infects domestic and transported to regional lymph nodes, remaining dogs, wild dogs and cell cultures (COMERCIO, within macrophages. Inhibition of the lysosomal 2004). function of leukocytes is the main intracellular Several studies have shown a high prevalence of defense mechanism of Brucella (Q UINN , 2004). HVC I in various populations. Reading and Field The bacterium targets lymphoid tissues and steroid- dependent organs like the uterus, vestibulovaginal (1998) evaluated 325 dogs brought to the Cambridge School of Veterinary Medicine for medical care and 1545 Semina: Ciências Agrárias, Londrina, v. 33, n. 4, p. 1543-1554, jul./ago. 2012 Sant’Anna, M. C.; Fabretti, A. K.; Martins, M. I. M.
routine surgery and found an average seroprevalence 1) (FELDMAN; NELSON, 1996; JOHNSTON; of 80%. KUSTRITZ; OLSON, 2001; J OHNSON , 2009; MUSHTAQ , 2008). Another seroepidemiological study in South Africa evaluated 328 canines older than one year The digital inspection of the vagina is important of age from 38 reproduction kennels. Seropositivity to evaluate the vaginal vestibule, the urethral crest was found in 22% of the samples, and seventeen and the vestibulovaginal junction, and it is useful kennels (45%) had at least one positive sample for identifying persistent hymen, stenosis, or (NOTHLING et al., 2007). When comparing the vaginal anomalies or tumors, although the size of prevalence of HCV I in kennels with and without the animal can limit the extent of the examination reproductive problems, Dahlbom et al. (2009) (PURSWELL, 2004; TILLEY; SMITH, 2007). noted signi cantly higher titers in kennels with The evaluation of vaginal cytology can identify reproductive problems, where 100% of the samples in ammatory cells, neoplastic cells, blood or feces had titers considered positive, compared to 62% beyond the phase of the estrous cycle (TILLEY; positivity in the kennels without reproductive SMITH , 2007). When neutrophils are shown in problems. large quantities, it is important to differentiate of the diestrus, phase of the estrous cycle that shows Clinical Signs and Diagnosis lots of these in ammatory cells, which in this case are not degenerate. During vaginal infections, many Clinical signs involve mucopurulent or purulent neutrophils are in the process of degeneration, which mucoid vulvar discharge, which is rarely bloody can occur in the presence or absence of bacteria. and is present in 90% of bitches with vaginitis. The chronicity of the process culminates with an Symptoms including pollakiuria, licking the increase of lymphocytes and macrophages. To vagina and attraction of males, regardless of the locate the infection, additional tests such as vaginal cycle phase, are observed in 10% of cases (Figure endoscopy may be required (PURSWELL, 2004).
Figure 1. Animal with vaginitis. Note the vulvar edema secondary to vaginal licking and pustules in the vulvar region.
Source : Elaboration of the authors. 1546 Semina: Ciências Agrárias, Londrina, v. 33, n. 4, p. 1543-1554, jul./ago. 2012 Clinical approach to canine vaginitis
Ideally, vaginoscopy should be performed with ulcers and hyperplasia of lymphoid follicles (Figure an endoscope, proctoscope, cystoscope or other optic 2). It can also allow the observation of exudate, in ber device of at least 15 cm in length. During the which case it is essential to determine if the origin is evaluation, it is necessary to in ate the vagina with uterine, vaginal or vestibular (PURSWELL, 2004; air. Rigid equipment provides a better sense of the TILLEY; S MITH , 2007). vagina, as it can easily overcome the natural collapse Contrast radiography is especially useful in of the vaginal folds; however, exible endoscopes cases involving obstructive vaginal neoplasia, can be used. The diameter should be 5 mm or less foreign bodies, vestibule-vaginal or rectovaginal to allow thorough inspection of the anterior vagina stenosis. Ultrasonography helps in identifying and cervix. Vaginoscopy is generally performed intraluminal vaginal neoplasias, and the distension with the animal held stationary, without the need for of the vagina with saline solution aids in this anesthesia, but in some cases there is pain due to visualization (TILLEY; S MITH , 2007). Vaginal local in ammation, and sedation may be required. biopsy may suggest the nature of any injuries such Examination can reveal anatomic abnormalities, as neoplasias, in ammation, or viral/bacterial tumors, foreign bodies, hematomas, abscesses infections (J OHNSON , 2009). and mucosal changes such as hyperemia, vesicles,
Figure 2. Animal with vaginitis caused by coagulase-negative Staphylococcus . Note the hyperemia of the vulvar mucosa and vaginal vestibule, covered with pustules and purulent exudate (arrows).
Source : Elaboration of the authors.
Bacterial vaginitis cycle. There is usually not systemic involvement (J OHNSTON ; KUSTRITZ; OLSON, 2001). The most common clinical signs of bacterial vaginitis are mucopurulent or purulent vulvar Culture and cytological analysis of vaginal discharge, pollakiuria, licking the vagina and discharge can be performed if no speci c alterations the attraction of males regardless of the estrous of the vagina can be identi ed (PURSWELL, 1547 Semina: Ciências Agrárias, Londrina, v. 33, n. 4, p. 1543-1554, jul./ago. 2012 Sant’Anna, M. C.; Fabretti, A. K.; Martins, M. I. M.
2004). Urinalysis and urine culture are desirable, Serological diagnosis can be performed using the as infections or tumors of the urinary tract may following techniques: Rapid Slide Agglutination Test initially be confused with vaginitis (FELDMAN; (RSAT), SAL and AGID ELISA. The diagnosis is NELSON, 1996). con rmed by the isolation of B. canis from positive The results from bacterial culture should be dogs by serological screening. Blood culture is the interpreted carefully. Bacteria isolated from bitches preferred method because it allows an early diagnosis with vaginitis are generally similar to the vaginal (from ten days after infection). However, polymerase microbiota in number and species (RONSEE et chain reaction (PCR) has been studied for the al., 2004; J OHNSON , 2009; MUSHTAQ, 2008). de nitive diagnosis of B. canis and shows a diagnostic The growth of opportunistic aerobic pathogens, performance similar to that of microbiological anaerobic bacteria and mycoplasma on the culture culture. PCR is faster but more expensive than material of an asymptomatic animal does not denote microbiological culture (KEID, 2006). infection. However, in symptomatic animals, if there is overgrowth of a single organism (more than 100 colony forming units), this organism Viral vaginitis should provisionally be considered responsible for In puppies, the rst clinical signs of viral vaginitis the infection (PURSWELL, 2004; RONSEE et al., present nonspeci cally as apathy, anorexia, and 2004; VERSTEGEN; DHALIWAL; VERSTEGEN- persistent crying, leading to death within a few days ONCLIN, 2008). (OLIVEIRA et al., 2009). The culture and sensitivity test results are more Infected adult animals are usually asymptomatic, important in determining the proper antibiotic to be as the virus remains latent in the body and can be used than to diagnose vaginitis (J OHNSON , 2009). reactivated when host immunity is compromised by stressful situations such as pregnancy and immunosuppressive therapy, making the animal a Vaginitis caused by Brucella canis carrier and disseminator of the virus (COMERCIO, The clinical sign of vaginitis reported most often 2004). Clinical signs may appear as diffuse by owner is miscarriage during the nal third of papulo-vesicular lesions on the vaginal mucosa gestation. However, brucellosis may result in fetal (S CHAEFERS -OKKENS, 1996; VERSTEGEN; death or resorption in the rst third of pregnancy. DHALIWAL; VERSTEGEN-ONCLIN, 2008). After abortion, an extended viscous serosanguinous A few days after infection, the lesions become vaginal discharge that may last 1-6 weeks is rm, similar to lymphoid follicles, and they commonly observed. This discharge contains a regress completely in 14-18 days (J OHNSTON ; large number of bacteria, which, due to its zoonotic KUSTRITZ; OLSON, 2001). potential, can serve as a source of infection to other dogs and humans (HOLLETT, 2006). Because of Reproductive failure due to herpesvirus infection these clinical signs, brucellosis is considered an can also occur and is characterized by infertility due important differential diagnosis for dogs presenting to early embryonic death before implantation, fetal vaginal discharge, infertility, abortions and vaginitis. resorption, abortion with expulsion of developed and ossi ed fetuses, stillbirths, underdeveloped The diagnosis of canine brucellosis should be newborns or neonatal death (J OHNSTON ; performed based on patient history, clinical signs, KUSTRITZ; OLSON, 2001). and serological screening associated with bacterial isolation from blood or contaminated tissue The diagnosis of viral vaginitis is obtained based (G REEN E; C ARMICHAEL , 2006). on serology, where speci c antibodies against
1548 Semina: Ciências Agrárias, Londrina, v. 33, n. 4, p. 1543-1554, jul./ago. 2012 Clinical approach to canine vaginitis herpesvirus are measured. It is worth mentioning B. canis is sensitive to various disinfectants like that considerable titers are detectable only 2-3 hypochlorite and 70% alcohol. It is important weeks after infection or reactivation of the virus and to perform periodic serological evaluation, to then decrease; in a few months, they are no longer quarantine new animals and to discard seropositive signi cant because the virus is poorly immunogenic animals. These actions are important because there and may enter latency (S CHAEFERS -OKKENS, is no vaccine for B. canis (CFSPH, 2009). 1996, VERSTEGEN; DHALIWAL; VERSTEGEN- ONCLIN, 2008). Viral vaginitis It is also possible to isolate the virus from the infected tissues of adult hosts, such as the oral There is no effective treatment, but viral vaginitis cavity and the genital and upper respiratory tracts, is fortunately self-limiting (PURSWELL, 2004). To but the sensitivity of this method is low (only 20%). prevent herpesvirus infection, we must focus on Performing PCR with samples taken from nasal or prevention, with actions like local hygiene, good genital tissues can con rm infection (VERSTEGEN; nutrition and local heating because herpesvirus is DHALIWAL; VERSTEGEN-ONCLIN, 2008). adapted to lower temperatures (PURSWELL, 2004; VERSTEGEN ; DHALIWAL; VERSTEGEN- Additionally, the most common necropsy ONCLIN, 2008). ndings are hemorrhage in the renal cortex, hepatomegaly, splenomegaly and petechiae in the For immunization, it is recommended that liver and pleura (O LIVEIRA et al., 2009). females are vaccinated a month before estrous, with a booster dose administered during mating if the animal does not express antibody titers greater than Treatment 1:128. A third dose is applied during the second half of pregnancy, and the antibodies are subsequently Vaginitis by Brucella canis passed to offspring via the colostrum. This As canine brucellosis has zoonotic potential, protocol is used in Europe and the United States treatment is discouraged. However, the treatment of (V ERSTEGEN ; DHALIWAL; VERSTEGEN- animals with high emotional value may be indicated ONCLIN, 2008). and takes the form of castration, prolonged antibiotic In severe cases, intraperitoneal inoculation of therapy and rigorous serological monitoring 1-5 ml of plasma from hyper-immunized animals (M EGID et al., 2002). and Acyclovir, a guanosine analog that interrupts Various antimicrobial agents have been tested viral replication by inhibition of DNA polymerase for their ef cacy in vitro against Brucella spp ., may be used (VERSTEGEN; DHALIWAL; and susceptibility has been demonstrated for VERSTEGEN-ONCLIN, 2008). Brazil does not tetracyclines, chloramphenicol, aminoglycosides, have a vaccine available on the market yet. third generation cephalosporins and quinolones. However, a single course of therapy with a single drug has not shown clinical ef cacy in vivo; the Characteristics of Vaginitis Based on Age of best results are obtained with longer treatments with Bitch antibiotics including tetracyclines and streptomycin Juvenile vaginitis Canine brucellosis is commonly introduced in commercial kennels through infected animals Etiology or by newly acquired semen. This disease can be Juvenile vaginitis comprises 40-52% of reported controlled with good hygiene practices because cases of vaginitis. Affected animals usually do not 1549 Semina: Ciências Agrárias, Londrina, v. 33, n. 4, p. 1543-1554, jul./ago. 2012 Sant’Anna, M. C.; Fabretti, A. K.; Martins, M. I. M.
demonstrate systemic involvement (JOHNSTON; According to Tilley and Smith (2007), inducing KUSTRITZ; OLSON, 2001). pharmacological estrous in juvenile females with severe or chronic vaginitis that have been Immaturity of the reproductive physiology castrated may be advantageous. For this purpose, and immune system predisposes young animals oral administration of diethylstilbestrol every 24 to in ammation and/or vaginal infections hours for seven consecutive days is recommended. (PURSWELL, 2004). Additionally, the treatment should be continued for two days after the onset of bleeding. However, Clinical signs and diagnosis this treatment may not resolve the disease, and the use of estrogen can result in signi cant side effects For neonates, the severe clinical status and poor such as bone marrow aplasia, diabetes mellitus and prognosis are attributed to low body temperature thromboembolic disorders, which can be fatal to (which favors viral replication), an immature dogs (T ILLEY ; S MITH , 2007). immune system and a lack of maternal antibodies transmitted via the colostrum (C ARMICHAEL ; GREENE , 2006). Vaginitis in Adult Bitches Juvenile vaginitis occurs in prepubertal females Etiology and is characterized by mucous or mucopurulent In adult animals, approximately 70% of vaginitis vulvar discharge, and systemic involvement is is secondary to predisposing causes or to a decrease usually absent (PURSWELL, 2004). In most cases, of estrogen in castrated females (JOHNSTON; the disease is self-limiting (PURSWELL, 2004; KUSTRITZ; OLSON, 2001; JOHNSON, 2009). JOHNSON , 2009). Anatomical abnormalities of the reproductive The diagnosis is made based on suspected tract are identi ed in 35% of adult females etiology. Culture of vaginal secretions from these with vaginitis, and the most common of these animals generally does not show signi cant bacterial abnormalities are vulvar anomalies, hypertrophy growth (J OHNSTON ; KUSTRITZ; OLSON, 2001). of the clitoris, vaginal stenosis derived from longitudinal or transverse bands of connective tissue Treatment in the vagina or vaginal atresia (J OHNSON , 2009). As the vaginal secretions do not show signi cant Vaginitis can be caused by factors that result bacterial contamination, the use of antibiotics in accumulation of urine or discharge from the is contraindicated (J OHNSTON ; KUSTRITZ; vagina, such as stenosis of the vaginal vestibule OLSON, 2001). junction, which can be identi ed by digital touch and requires treatment by digital dilatation or Some authors do not recommend the castration vaginectomy for correction in severe and recurrent of animals affected by this disease before the rst cases (PURSWELL, 2004). The accumulation of estrous or until clinical signs have been resolved urine in the vaginal vestibule may be caused by because some bitches with prepubescent vaginitis urinary incontinence, common in cases of ectopic heal spontaneously when they enter proestrus/ ureters, hypoestrogenism (PURSWELL, 2004; estrous. However, the relationship of castration TILLEY; SMITH, 2007), recto-vaginal stulas or or the estrous cycle to the incidence of vaginitis by other congenital problems in the reproductive in young bitches needs to be further elucidated system (JOHNSON, 2009). The normal ow of (PURSWELL, 2004; JOHNSON, 2009). urine and vaginal secretions may also be disrupted
1550 Semina: Ciências Agrárias, Londrina, v. 33, n. 4, p. 1543-1554, jul./ago. 2012 Clinical approach to canine vaginitis by foreign bodies, granulomas and neoplasms, predisposing factors are not corrected (JOHNSTON; especially those due to transmissible venereal KUSTRITZ; OLSON, 2001; JOHNSON, 2009). tumors and leiomyomas (PURSWELL, 2004; Drugs like ampicillin, amoxicillin and TILLEY; SMITH, 2007). clavulanate, trimethoprim-sulphonamide, enro oxacin and cephalosporins are generally effective against gram-positive and gram-negative Clinical signs and diagnosis microorganisms of the genitourinary tract. The clinical signs vary depending on the Tetracycline and chloramphenicol are effective etiology. However, approximately 30% of bitches against gram-negative pathogens (JOHNSON, with vaginitis do not have any clinical signs, and 2009). healing is spontaneous in 73% of cases, although Cleansing of the vagina can be helpful in the this may take months or years (J OHNSON , 1991; removal of accumulated secretions. For this purpose, JOHNSTON; KUSTRITZ; OLSON, 2001). 0.05% chlorhexidine, 0.5% povidone-iodine or The cytology samples collected from adult 0.2% nitrofurazone can be used twice daily until dogs are more often septic in nature than samples the discharge is reduced. The use of saline solution from animals with prepubertal vaginitis, and four to six times a day can also help to remove the approximately 80% of cultures showed bacterial vaginal secretions. Additionally, the administration growth (J OHNSTON ; KUSTRITZ; OLSON, 2001). of vitamin C helps to control infections by acidifying the local secretions (TILLEY; S MITH , 2007).
Treatment Surgical treatment is recommended for the correction of anatomic abnormalities, removal The key to overcoming vaginitis is to identify of foreign bodies or extirpation of tumors. and correct the anatomical abnormalities and Vaginectomy can be performed as a last resort in predisposing factors (S ODERBERG , 1986; patients which are refractory to medical treatment JOHNSON , 1991; JOHNSTON; KUSTRITZ; (TILLEY; S MITH , 2007). OLSON, 2001; J OHNSON , 2009; M USHTAQ , 2008). In adult bitches, the use of antibiotics for one Final Considerations month is recommended, and these are selected by Canine vaginitis needs to be further studied and culture and sensitivity tests of vaginal specimens. If understood to assist the clinician in the identi cation the discharge is cytologically purulent or the animal and resolution of triggering factors because relapses displays excessive discomfort, as shown by frequent of the disease are frequent when no correction is licking of the vagina, it is recommended to wash the performed. perivulvar area to prevent spread of the infection to The use of vaginal secretion cultures usually adjacent areas (JOHNSTON; KUSTRITZ; OLSON, cannot de ne the etiologic agent of vaginitis 2001). because the presence of resident microbial growth The use of antibiotics is recommended in makes it dif cult to determine if bacteria caused animals whose vaginal cultures have demonstrated the disease. However, the isolation of some bacteria signi cant growth of a single bacterial species that are known to cause reproductive damage is of and also in animals with infections present in great importance for breeding animals. The use of other systems, such as the urinary tract. However, an antibiogram is useful to select the best antibiotic recurrence is frequent if abnormalities and to be used, if necessary.
1551 Semina: Ciências Agrárias, Londrina, v. 33, n. 4, p. 1543-1554, jul./ago. 2012 Sant’Anna, M. C.; Fabretti, A. K.; Martins, M. I. M.
Determining the primary cause of vaginitis problems. Reproduction in Domestic Animals, n. 44, n. can be challenging, as routine laboratory tests are 1, p. 128-131, 2009. often not enlightening. The best tools are a well- FELDMAN, E. C.; NELSON, R. W. Vaginal defects, conducted clinical examination, vaginal inspection vaginits, and vaginal infection. In: ______. Canine and feline endocrinology and reproduction . 2 nd ed. by digital vaginoscopy and serological screening Philadelphia: W.B. Saunders Company, 1996. chap. 26, for infectious agents such as canine herpesvirus p. 661-663. and Brucella canis. These are primary agents that GREENE, C. E.; CARMICHAEL, L. E. Canine may be associated with vaginitis and reproductive brucellosis. In: GREENE, C. E. Infectious diseases of problems such as infertility and miscarriage. the dog and cat . 3. rd ed. Philadelphia: Elsevier Inc, 2006. chap. 40, p. 369-380. HAFEZ, E.; HAFEZ, E. S. E. Female reproduction References anatomy. In: ______. Animal reproduction. 7 th ed. São Paulo: Manole, 2004. chap. 2, p. 27-28. ALMEIDA, A. C.; SANTORELLI, A.; BRUZADELLI, R. M. Z.; OLIVEIRA, M. M. N. F. Seroepidemiology of HASHIMOTO , V. Y.; ANZAI, E. K.; GALHARDO, canine brucellosis caused by Brucella canis and Brucella J. A.; DIAS, J. A.; GIORDANO, G. P.; PRETTO, L. abortus in the city of Alfenas, MG. Brazilian Archive of G.; FREITAS, J. C. Bacterial agents isolated from Veterinary Medicine and Animal Science, v. 56, n. 2, p. bitches with vaginitis. In: ANNUAL MEETING OF 275-275. 2004. SCIENTIFIC INITIATION, 11., 2002, Maringá. Proceedings... Maringá: Maringá State University, 2002. AVILA, M. O.; CAMARGO, L. M.; BENETTI, A. unpaged. H.; ALARCON, L. F. Vaginal mucosal microbiota of healthy female canine clinically served at the veterinary HOLLETT, R. B. Canine brucelosis: Outbreaks and Hospital of Cuiabá´s University, MT. In: BRAZILIAN compliance. Theriogenology, Philadelphia, v. 66, n. 3, p. CONGRESS OF VETERINARY MEDICINE, 35., 2008, 575-587, 2006. Grasslands. Proceedings ... Grasslands: Conbravet, 2008. JOHNSON, C. A. Diagnosis and treatment of chronic unpaged. vaginitis in the bitch. The Veterinary Clinics of North BROWN, C. M.; PIETZ, D. E.; RANGER, C. R. America. Small Animal Practice, Charleston, v. 21, n. 3, Experimental Brucella canis infection in the dog. In: p. 523-531, 1991. WORLD VETERINARY CONGRESS , 20., 1975, ______. Disorders of the vagina and uterus. In: NELSON, Thessaloniki. Proceedings… Thessaloniki: WSAVA, R. W.; COUTO, C. G. Small Animal Internal Medicine . 1975. p. 1795-1800. 4th ed. Rio de Janeiro: Elsivier, 2009. chap. 57, p. 911- CARMICHAEL, L. E.; GREENE, C. E. Canine 926. herpesvirus. In: GREENE, C. E. Infectious diseases of JOHNSTON, S. D.; KUSTRITZ, M. V. R.; OLSON, nd the dog and cat . 2 ed. Philadelphia: W.B. Saunders, P. N. S. Disorders of the canine vagina, vestibule and 2006. p. 47-53. vulva. In: ______. Canine and ine therioegenology . CENTER FOR SECURITY & PUBLIC HEALTH – Philadelphia: WB Saunders, 2001. cap. 12, p. 235-237. CFSPH. Canine brucellosis : Brucella canis contagious KEID, L. B. Evaluation of direct and indirect methods abortion, undulant fever. CFSPH, 2009. july. Available of diagnosis of brucellosis in naturally infected dogs . at:
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