Managing Fungal Endometritis in Broodmares

Mare infertility is a frustrating problem with a variety of causes. Fortunately, many of them are treatable. One manageable condition is fungal endometritis (inflammation of the inner uterus lining, or endometrium).

At the 2012 Hagyard Bluegrass Equine Symposium, held Nov. 1-4 in Lexington, Ky., Ryan Ferris, DVM, MS, an assistant professor in the Department of Clinical Sciences at the Colorado State University (CSU) Equine Reproduction Laboratory, discussed managing fungal endometritis in broodmares.

"While we don't see (fungal endometritis) very often, when we do it can be an important cause of infertility," he relayed. This ailment can be difficult to both diagnose and treat, he said.

Ferris said that there are a wide variety of causative organisms for fungal endometritis, but the vast majority are Candida sp., Aspergillus sp., and Mucor sp. type organisms.

Several factors can predispose a mare to developing fungal endometritis, Ferris said, including:

  • Poor perineal conformation;
  • Delayed uterine clearance;
  • Intrauterine antibiotic treatment;
  • Compromised immune function (caused by conditions such as pituitary pars intermedia disorder, or equine Cushing's disease); and
  • Previous bouts of bacterial endometritis.

When diagnosing mares potentially affected with fungal endometritis, Ferris said he takes several steps, including:

  • Obtaining a thorough history, paying special attention to instances of unexplained infertility, dystocia (difficult birth), administration of intrauterine antibiotic infusions, retained fetal membranes, progesterone supplementation, previous fungal infections, and breed ("Saddlebreds have an increased incidence of fungal endometritis," he noted);
  • Performing a physical exam, noting any general health conditions the patient has and closely evaluating the mare's perineal anatomy;
  • Performing a uterine ultrasound, looking for large volumes of echogenic (cloudy or gray) fluid and a lack of specificity; and
  • Performing endometrial cytology, culture, biopsy, and other special techniques (including polymerase chain reaction [PCR] assays, used to detect viral nucleic acids).

Ferris noted that when trying to identify a fungal organism, cytology, cultures, and biopsy all work well and have their own advantages. He also noted that researchers at CSU, over the last three years, have developed a PCR assay to quickly and sensitively evaluate for a DNA "fingerprint" of fungal organisms infecting the mare's uterus.

Once a diagnosis has been made, treating the ailment becomes the priority. Ferris said fungal endometritis treatment should have a multidimensional approach, which includes reducing the fungal organism load (via uterine lavage, or flushing), reducing fungal replication, and killing the fungal organisms (using systemic and intrauterine therapy).

Additionally, the veterinarian must correct any predisposing factors to prevent or lessen the mare's chances of developing fungal endometritis in the future, he said.

Ferris concluded that diagnosis and treatment might be a challenge, but correcting any predisposing factors and using a multidimensional treatment approach will give the mare the best chance at recovery.

Disclaimer: Seek the advice of a qualified veterinarian before proceeding with any diagnosis, treatment, or therapy.