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Yeast Infection in Uterus

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  • Yeast Infection in Uterus

    Can anyone tell me anything? My mare was just diagnosed and it is very very expensive to treat ... and was told to "pray" after treating... does anyone know what the chances of breeding success are after treating?

    Thanks!

  • #2
    Honestly it is a crap shoot. Some yeast infections clear up just fine and the mares go on to successfully carry a foal. But honestly, more often, they are just very, very difficult to get rid of. There are several different ways to treat them, none of which work in every situation. We have had some success treating with lufeneron, although it hasn't turned out to be the miracle worker that it was initially believed to be. We have had better luck with ketaconazole lavages, as long as the sensitivity testing shows that the yeast is sensitive to it. In one extreme case we used a medium strong DMSO lavage that worked beautifully, but I would only reccomend that as a last resort, as you can create scar tissue if you aren't careful. The thing with yeast infections is that they tend to come back, even if you can get them cleared up in the first place. I don't mean to discourage you, but they can be a bad deal.
    Already excited about our 2016 foals! Expecting babies by Indoctro, Diamant de Semilly, Zirocco Blue and Calido!
    https://www.facebook.com/pages/Hills...h/112931293227

    Comment

    • Original Poster

      #3
      Thanks for the info. This is a tough situation.... It is going to be very expensive to treat and it sounds like after more than $1000 treatment it is a guessing game.... I just have no idea what I am going to do.

      Anyone else with experiences?

      Comment


      • #4
        Not so bad from my experience.

        I've heard that it is a crap shoot but from my personal experience it is not. I have successfully treated three different mares for yeast. It requires flushing on at least two heat cycles. All 3 mares went on to settle in foal easily and deliver without issue. If you have a good repro vet I would think your chances are very good. Also, I think that if you can recycle the mare as soon as possible after the first cycle of flushing it gives the yeast less opportunity to start growing again.

        Now, the longer you leave a mare dirty with yeast the more damaging and the more difficult it can be to clean up. I did have a mare that probably had a yeast infection for at least three years before I had her (based on what previous owners told me about attempting to breed her) and I did not know that she had a problem for at least 9 months so we are talking about being dirty for close to 4 years. We flushed on 2 cycles and were able to get her in foal on the next cycle...with only one cover.

        Incidentally, I now routinely culture all my mares for bacteria AND fungus before breeding. They say it is rare but after having 3 mares with yeast I do not consider it to be all that rare. It takes more time to get the results (appx. 21 days) and is an added expense but sure is less expensive than trying to get your mare in foal a couple of times and then doing the culture later when they start to suspect that there is a fungal infection. Been there.
        Altamont Sport Horses
        Trakehners * Knabstruppers * Appaloosa Sport Horses
        Home of stallions: Ambrosius af Asgard "Atlantis" & Hollywood Hot Spot
        Birmingham, AL

        Comment

        • Original Poster

          #5
          Thanks Altamont! This is some refreshing news. I love this mare so I am willing to try treating her. I believe that this may have been a problem for about a year. Last year she would get pregnant and then at 30 days nothing.. The vet was less experienced and I have an expert this year so we will see how it goes....

          Comment


          • #6
            We've had fairly good success in treating yeast infections in mares, but I think probably the biggest reason for that success is being extremely aggressive. I don't think treatment is particularly expensive, but the fact that it often isn't treated sufficiently which results in having to repeat the treatment again and again is where the dollars add up. We've had very good success using Lufenuron which is the product used to treat fleas on cats (I know...weird <smile>). But, we've also had good success using a DMSO/Betadine lavage. Below is an excerpt from our course notes with regards to dealing with bacterial, yeast and fungal infections. I included the information on bacterial infections as often mares are lavaged and "treated" with antibiotics when there is no bacterial infection or without first identifying what the bacteria is. Antibiotics tend to be grossly overused and it does have the very real risk of creating a problem that didn't exist. Obviously, discuss options with your veterinarian, but if you are willing to hang in there, you "can" be successful.

            ◊ Intra-uterine:
            • This is the most commonly used route;
            • If bacterial, infusion with either a low liquid volume containing a suitable antibiotic, or a high-volume saline lavage containing the antibiotic may be used. Sufficient dosage and duration of treatment must be achieved to prevent development of a resistant organism;
            o Some non-antibiotic solutions such as vinegar or mannose result in favourable resolution of certain pathogens – specifically pseudomonas spp. and streptococcus equi subspecies zooepidemicus respectively;
             Add 25 grams of mannose to 500-ml of pre-sterilized physiological saline solution.
            • If a Yeast, human yeast medications have been used with success, as well as lavage with vinegar or dilute acetic acid;
            • With fungus, a dilute povidone-iodine lavage, or the use of an anti-fungal medication has been used with limited success;
            • Intra-vaginal and intra-uterine use of Lufenuron (Program® Novartis Animal Health Inc., Basle, Switzerland) has been found to be beneficial in the treatment of fungal infections (Hess MB, Parker NA, Purswell BJ, Dascanio JD (2002). Use of lufenuron as a treatment for fungal endometritis in four mares. J Am Vet Med Assoc. 2002 Jul 15;221(2):266-7, 240);
            • Grapefruit seed extract or Tea Tree Oil may be beneficial in the treatment of both uterine yeast and fungus infections;
            • Treatment of a bacterial infection with one antibiotic will sometimes result in a super-infection of either Pseudomonas aeruginosa or a yeast or fungal infection. These can be hard to treat and very damaging to the reproductive tract;
            o Use of 2-8 drops (2 drops in 50-ml; 8 drops in 1L) of grapefruit seed extract mixed with the infusion antibiotic can assist in preventing this occurrence;
            • Irritative therapy is practiced by some using dilute povidone-iodine, hypertonic saline, or cell-free filtrates of streptococcal cultures;
            o The idea behind this therapy is to provoke a more active uterine inflammatory response.
            o An emulsion of purified mycobacterium cell walls marketed as “Settle” (Bioniche Animal Health USA, Inc. Athens, GA 30601) has been shown to have beneficial results if used to treat endometritis caused by Strep. Equi sub. Zooepidemicus (Rogan, D. et al. (2004). Immunotherapeutic activity of a mycobacterial cell wall formulation in treating Streptococcus zooepidemicus-induced endometritis in mares. Proc. Modern Vaccines/Adjuvant Formulation, Prague, Czech Rep., September 15-17, Proc. on CD, Index.html: 8). It can be used either IV or intra-uterine.
             Use of IV Equimune (Bioniche Animal Health USA, Inc. Athens, GA 30601), has been shown to have similar success (Fumuso E., Gonzales C., Videla doma I., Inchausti E., Tallarico M., Berestin V., Wade J., Aguilar J., Losinno L., Soto P., Bowden R.A. (2000). Effect of an immunomodulator in mares resistant and susceptible to endometritis. Proc. Second International Conference on Experimental and Clinical Reproductive Immunobiology: 104)
            • The previously used method of intra-uterine infusion of the mares’ own plasma has seen revival of popularity in the face of increasing resistance to antibiotics.
            ◊ External:
            • Suturing of the labia in a “Caslick’s procedure” is a useful process to prevent re-infection.

            Hope that helps!

            Kathy St.Martin
            Equine Reproduction Short Courses
            http://www.euqine-reproduction.com
            Last edited by Equine Reproduction; Apr. 12, 2008, 09:58 PM.
            Equine-Reproduction.com Now offering one on one customized training!
            Leg-Up Equestrian Assistance Program, Inc. A 501(c)(3) non-profit charity

            Comment


            • #7
              Happy, healthy filly!

              My mare was sucessfully treated for a raging yeast infection in her uterus several years ago. In 2004 she developed the infection after the 3rd attempt at breeding her. She was treated for the infection and was not rebred that year. In 2005, I took her to New Bolton Center for a breeding workup. She became infected just from the biopsy and exam as she pools fluid and develops an inflammatory reaction to anything invasive. Her uterus was also given a Grade IIb status, a poor prognosis for conceiving. The infection was cleared up and she was inseminated once. She continued with an inflammation reaction and returned to NBC for daily lavages for a week. Result-no pregnancy. In 2006, I returned again as I had one more year to use the stud fee. This time, no biopsy or internal exam, just breeding once w/fresh cooled semen on the follicle per the ultrasound. Instead of daily lavages for the fluid accumulation, a uterine massage was used, so the uterus was not invaded. Each day, my mare returned to NBC to have the fluid massaged out, again for 6-7 days. Bingo! In foal! 11 months later? A beautiful, healthy Sir Sinclair filly. I was then told that my mare probably would get in foal again that year without problem. I decided against rebreeding her so my mare could return to work and competition. So, long story short. I had success in getting a healthy foal out of my mare post-yeast infection. You can read her story on www.ker.com. Click on US, then library. Go to EquiNews, 2007 3rd quarter. Her story, "Maternally Maude" gives a greater detailed account of my ordeal and triumph over the odds. Good luck to you and don't give up!

              Comment


              • #8
                I have absolutely no experience with horse yeast infections, but I am a clinical dietitian, and I know that yogurt (with probiotics) is helpful in preventing yeast infections in women. I know several women that had chronic yeast infection problems that have cleared up since adding yogurt to their diets regularly. So, perhaps adding a probiotic might help? It can't hurt, and they are pretty cheap. FWIW.

                Caitlin
                Caitlin
                *OMGiH I Loff my Mare* and *My Saddlebred Can Do Anything Your Horse Can Do*
                http://community.webshots.com/user/redmare01

                Comment


                • #9
                  Originally posted by Best View View Post
                  Thanks Altamont! This is some refreshing news. I love this mare so I am willing to try treating her. I believe that this may have been a problem for about a year. Last year she would get pregnant and then at 30 days nothing.. The vet was less experienced and I have an expert this year so we will see how it goes....
                  I would suspect a progesterone problem if she gets pregnant and then loses it before 30 days. You need to check her progesterone when she gets pregnant and as long as you aren't trying to breed her back ASAP if she doesn't settle then I would put her on progesterone approximately week after ovulation. That way if she does get pregnant she will not lose it before you test her and get the results back. A lot of people use Regumate but we use the injectable progesterone which is good for 7-10 days. less messy, less risky and harder to screw up than Regumate which has to be fed at the same time every day, etc. I've used the injectable for two pregnancies with a mare that has almost non-existent progesterone and she never slipped. The blood test to check progesterone only detects natural progesterone so you can give her the supplement and still pull blood on her around day 15 when you confirm she is in-foal. If her levels are low then you continue the injections to day 40 or 45 when the endometrial cups are well implanted into the uterine lining and pull another blood test to be sure there is sufficient progesterone being generated from them. If it's good then you don't have to give any more injections.

                  Do you have a good repro vet? If you mare settles but then slips before day 30 and he/she has not recommended a progesterone test I would take this as a sign that he/she is not very good with equine reproduction. And I certainly wouldn't want to use *that* vet to treat my mare with a yeast infection.
                  Altamont Sport Horses
                  Trakehners * Knabstruppers * Appaloosa Sport Horses
                  Home of stallions: Ambrosius af Asgard "Atlantis" & Hollywood Hot Spot
                  Birmingham, AL

                  Comment


                  • #10
                    Originally posted by Altamont Sport Horses View Post
                    I would suspect a progesterone problem if she gets pregnant and then loses it before 30 days. You need to check her progesterone when she gets pregnant and as long as you aren't trying to breed her back ASAP if she doesn't settle then I would put her on progesterone approximately week after ovulation. That way if she does get pregnant she will not lose it before you test her and get the results back. A lot of people use Regumate but we use the injectable progesterone which is good for 7-10 days. less messy, less risky and harder to screw up than Regumate which has to be fed at the same time every day, etc. I've used the injectable for two pregnancies with a mare that has almost non-existent progesterone and she never slipped. The blood test to check progesterone only detects natural progesterone so you can give her the supplement and still pull blood on her around day 15 when you confirm she is in-foal. If her levels are low then you continue the injections to day 40 or 45 when the endometrial cups are well implanted into the uterine lining and pull another blood test to be sure there is sufficient progesterone being generated from them. If it's good then you don't have to give any more injections.

                    Do you have a good repro vet? If you mare settles but then slips before day 30 and he/she has not recommended a progesterone test I would take this as a sign that he/she is not very good with equine reproduction. And I certainly wouldn't want to use *that* vet to treat my mare with a yeast infection.
                    Have you had a uterine biopsy done on this mare? I would say a poor uterine condition (scar tissue, etc) is a far more common reason to lose a pregnancy between 14 days and 30 days. True progesterone deficiency in mares is actually not all the common. If she has had infections and is getting pregnant but not staying pregnant, I would definitely have a biopsy done to see if she is even able to carry a foal full term.
                    Already excited about our 2016 foals! Expecting babies by Indoctro, Diamant de Semilly, Zirocco Blue and Calido!
                    https://www.facebook.com/pages/Hills...h/112931293227

                    Comment


                    • #11
                      Originally posted by Altamont Sport Horses View Post
                      I would suspect a progesterone problem if she gets pregnant and then loses it before 30 days.
                      I wouldn't. I agree wholeheartedly with Hillside on this one. The mare that has truly low progesterone levels is not very common. If there is indeed progesterone problem, the pregnancy is usually lost before day 21. Remember, progesterone is the hormone that keeps the mare from returning to estrus.

                      You need to check her progesterone when she gets pregnant and as long as you aren't trying to breed her back ASAP if she doesn't settle then I would put her on progesterone approximately week after ovulation.
                      First, in order to accurately ascertain whether or not a mare truly has low progesterone levels, it requires multiple tests over multiple days. Progesterone levels vary dramatically throughout the day and from day to day.

                      A lot of people use Regumate but we use the injectable progesterone which is good for 7-10 days. less messy, less risky and harder to screw up than Regumate which has to be fed at the same time every day, etc.
                      I agree that the injectable progesterone is easier to deal with, but there are now several different types available.

                      I've used the injectable for two pregnancies with a mare that has almost non-existent progesterone and she never slipped. The blood test to check progesterone only detects natural progesterone so you can give her the supplement and still pull blood on her around day 15 when you confirm she is in-foal.
                      Wrong. The blood test that checks progesterone levels will not detect ALTRENOGEST - the synthetic form of progesterone found in Regumate. However, the injectable progesterone available from BET Pharmacy - P4 - is detectable in the blood test and therefore will give you an incorrect reading on what the mare is actually producing. BET Pharmacy does now have an injectable, long acting altrenogest available, as well, so that "is" an alternative. But, as noted above by both Hillside and myself, the low progesterone mare is rare.

                      Do you have a good repro vet? If you mare settles but then slips before day 30 and he/she has not recommended a progesterone test I would take this as a sign that he/she is not very good with equine reproduction. And I certainly wouldn't want to use *that* vet to treat my mare with a yeast infection.
                      There are other issues that would come to mind long before progesterone levels would be a concern. As Hillside noted, a uterine biopsy would be first on my list...right after a uterine culture and cytology. I really feel for vets these days because there is so much misinformation about the use of progesterone supplementation. It is viewed as a panacea for so many breeders and unfortunately, what many don't realize, it doesn't come without risks! For example, putting a mare on it that does have a yeast infection is a recipe for disaster as you have essentially closed the incubator and are preventing the mare from naturally returning to estrus - which is when the mare naturally attempts to clear up problems in the uterus. Indeed, a mare returning to estrus prematurely is an indication that there may be something "brewing" and further diagnostics should be performed.

                      Additionally, and a little more food for thought. Research is now indicating that placing a mare unnecessarily on supplemental progesterone, you may very well be creating the very condition you are attempting to treat - a mare that is low on progesterone! It apparently is creating a negative feedback in the mare and she essentially shuts down her own progesterone production.

                      While there are certainly mares out there that don't produce sufficient levels of progesterone to maintain a pregnancy, one also must consider that you are breeding an animal that is reproductively "challenged" and potentially perpetuating the problem.

                      Hope that helps!

                      Kathy St.Martin
                      Equine Reproduction Short Courses
                      http://www.equine-reproduction.com
                      Equine-Reproduction.com Now offering one on one customized training!
                      Leg-Up Equestrian Assistance Program, Inc. A 501(c)(3) non-profit charity

                      Comment


                      • #12
                        Good...Some other ideas why the mare may not be staying in foal! All of these are worth looking in to. Just because something is considered "rare" doesn't mean you shouldn't verify. I was told yeast infections are rare. Obviously they aren't that rare. I would consider a biopsy and a progesterone test in the appropriate sequence, of course.

                        I don't know when she had her mare ultrasounded but unless she did it a couple of times in the first month we don't know if she lost it by day 21 or by day 30.

                        Not sure which agent my vet has used as a progesterone supplement but I was told that what he was using wouldn't be detected on the blood test so the reading would be accurate. If you have a good repro vet then I would think he/she would use the correct agent so that the natural progesterone could be evaluated again later without skewing the results. Also, there are usually some other indications of poor progesterone levels such as poor uterine tone which a good repro vet would also recognize. If a mare shows signs of low progesterone I would consider putting her on progesterone for one week before knowing the blood test results...provided I had ruled out other issues just so I didn't lose what I had worked so hard for and paid so much money to attain. With regards to clearing the uterus and screwing up her natural progesterone production, *I* wouldn't think that delaying her with one progesterone injection is going to cause her serious damage if you have ruled out a uterine issue already. I'm sure, however, that the experts here can correct me with scientific evidence if that is indeed the case. Obviously she has already cultured the mare and found out she has yeast. I'm assuming they also cultured for bacteria.

                        We know very little about this mare and her reproductive history so this is all conjecture. So, how old is your mare? Was your mare ever bred before you got her? Has she foaled before? Has she had problem pregnancies? Has she had a biopsy done before? When was the mare ultrasounded after breeding?

                        What would be more likely with a young-ish maiden mare...poor progesterone or a scarred uterus/other significant uterine tissue problems (obviously other than the yeast that they have already detected)?
                        Altamont Sport Horses
                        Trakehners * Knabstruppers * Appaloosa Sport Horses
                        Home of stallions: Ambrosius af Asgard "Atlantis" & Hollywood Hot Spot
                        Birmingham, AL

                        Comment


                        • #13
                          Originally posted by Altamont Sport Horses View Post
                          What would be more likely with a young-ish maiden mare...poor progesterone or a scarred uterus/other significant uterine tissue problems (obviously other than the yeast that they have already detected)?

                          Honestly, in a maiden mare that was having difficulty settling I would do the biopsy before the progesterone testing. I have had multiple maiden (and less than 10 years of age) mares in my recipient herd come up with very poor biopsy scores. Some of them probably because they had infections that hadn't been addressed in a timely fashion that had damaged the uterus. Some of the them for unknown reasons. As both Kathy and I have stressed, the truly low progesterone mare is actually quite uncommon. And I would never go so far as to say that yeast infections are rare in mares; more uncommon than bacterial infections, but not rare.
                          You just have to realize that far too many mares are put on progesterone for no good reason (other than the owner needs medicating, if you get my meaning). I would not put a mare with a past history of yeast infections on any progesterone supplementation unless I had a very, very compelling reason. Meaning unless I had multiple progesterone assays done over the course of a day or two and they were all unequivocally low then I wouldn't do.


                          Something else to consider in maidens, even in "young-ish" ones is delayed uterine clearance. And those are just a few things I would explore before jumping on the progesterone wagon.
                          Already excited about our 2016 foals! Expecting babies by Indoctro, Diamant de Semilly, Zirocco Blue and Calido!
                          https://www.facebook.com/pages/Hills...h/112931293227

                          Comment


                          • #14
                            Kathy - It seems that if this mare had an ongoing fungal (or bacterial) infection the uterus would be so inhospitable that there would be no embryo to observe at a 15 day ultrasound. Is this correct? If so, I would think that this particular infection that she has now actually developed sometime during the last breeding season. And that would also mean she hasn't been brewing a nasty infection for a *really* long time which would be a good thing as far as the prognosis for both treating the fungal infection with a good outcome as well as minimizing uterine tissue damage. Is this a fair assumption?
                            Altamont Sport Horses
                            Trakehners * Knabstruppers * Appaloosa Sport Horses
                            Home of stallions: Ambrosius af Asgard "Atlantis" & Hollywood Hot Spot
                            Birmingham, AL

                            Comment


                            • #15
                              Originally posted by Altamont Sport Horses View Post
                              Kathy - It seems that if this mare had an ongoing fungal (or bacterial) infection the uterus would be so inhospitable that there would be no embryo to observe at a 15 day ultrasound. Is this correct?
                              Bacterial and fungal infections tend to create a hostile environment for the conceptus to drop in. The mare's natural immune response when battling infections is to return to estrus prematurely. So, if indeed the mare has/had an ongoing infection, chances are any pregnancy would be lost prior to the stage that one would be able to observe it on ultrasound.

                              If so, I would think that this particular infection that she has now actually developed sometime during the last breeding season. And that would also mean she hasn't been brewing a nasty infection for a *really* long time which would be a good thing as far as the prognosis for both treating the fungal infection with a good outcome as well as minimizing uterine tissue damage. Is this a fair assumption?
                              In reading through the OP's original posts, it would appear that the mare would become pregnant and would have lost the pregnancy prior to 30 days. Hence the statement by both Hillside and I, that a uterine biopsy would be our first plan of attack. The fact that the mare becomes pregnant and then loses the pregnancy is an indication that something may be discovered by having a biopsy done.

                              With regards to whether or not the infection - either fungal or bacterial - has been brewing for a long time or not, it would be nothing but speculation and I learned a LONG time ago to not waste time on speculations or assumptions, especially without being directly involved or knowing all the facts.

                              Hope that helps!

                              Kathy St.Martin
                              Equine Reproduction Short Courses
                              http://www.equine-reproduction.com
                              Equine-Reproduction.com Now offering one on one customized training!
                              Leg-Up Equestrian Assistance Program, Inc. A 501(c)(3) non-profit charity

                              Comment


                              • #16
                                I second the probiotics

                                Originally posted by RedMare01 View Post
                                I have absolutely no experience with horse yeast infections, but I am a clinical dietitian, and I know that yogurt (with probiotics) is helpful in preventing yeast infections in women. I know several women that had chronic yeast infection problems that have cleared up since adding yogurt to their diets regularly. So, perhaps adding a probiotic might help? It can't hurt, and they are pretty cheap. FWIW.
                                Adding too much yogurt may upset the stomach. I would try a powdered or tablet form just to avoid the dairy-related stomach upset. I usually give Acidophilus in a tablet for my dogs when thy have upset stomachs. I haven't tried any formulas that are specific to horses, but something like Fastrack or the other pastes could work too. Good Luck!

                                Comment

                                • Original Poster

                                  #17
                                  Thank you for all of these responses...... To answer some of the questions...

                                  This mare has had 3 wonderful foals with no problems conceiving. We had a biopsy and cultures done last year all were clean and this year we did both again and found the yeast infection. She is 15 years old but has been checked out by a very good repro vet and I am told her uterus looks great.

                                  Yes, she has been put on the regumate for each pregnancy. I have not used the injectable so I have no experience with the difference.

                                  She is now on an immune boosting supplement and will get IV injections to boot the immune system from the vet this week.

                                  I will let you know how this turns out for us! Thanks again!

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                                  • #18
                                    Originally posted by sspeight View Post
                                    Adding too much yogurt may upset the stomach. I would try a powdered or tablet form just to avoid the dairy-related stomach upset. I usually give Acidophilus in a tablet for my dogs when thy have upset stomachs. I haven't tried any formulas that are specific to horses, but something like Fastrack or the other pastes could work too. Good Luck!
                                    Yes, I meant a powdered probiotic for horses...the yogurt was for people!

                                    Caitlin
                                    Caitlin
                                    *OMGiH I Loff my Mare* and *My Saddlebred Can Do Anything Your Horse Can Do*
                                    http://community.webshots.com/user/redmare01

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                                    • Original Poster

                                      #19
                                      Results of Treatment

                                      We have successfully treated the yeast infection and are planning to breed next week!

                                      All tests confirm that the uterus is not clean... Keep your fingers crossed that we have no more issues over the next month or so...

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                                      • #20
                                        A question for Hillside H Ranch ..... Would you put a mare with a bad looking CL on progesterone?
                                        Siegi Belz
                                        www.stalleuropa.com
                                        2007 KWPN-NA Breeder of the Year
                                        Dutch Warmbloods Made in the U. S. A.

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