Equine Endometritis Associated with Chaetomium Sp : Two Cases Report

Two cases of unusual equine endometritis associated with Chaetomium s p are described in the article. The mares displayed infertility. The cytology revealed filamentous structures in both cases and the cultures yielded Chatomium sp which had never been described as an-endometritis agent. Chatomium growth usually in cellulose medium. The fungus, perhaps present on the stable floor, could colonize the uterus as an oppor tunist because of the failure in uterine defense mechanism.


Introduction
Fungal endometritis refers to the inflammation of the uterine lining caused by the colonization of fungal organism. Because it creates an incorrect environment for an embryo, it is an important cause of infertility in the mare despite being relatively uncommon [1]. Actually, fungal growth is considered to be present in 1 to 5% of the cases. Yeast organisms most reported to colonize the equine reproductive tract include Candida spp and Aspergillus spp [2]. Clinical signs include subclinical infection to profuse vaginal discharge, moreover infertility is recurrent. The prognosis for fungal endometritis is guarded to poor [3].

Case 1
A 6-years-old Andalusian mare was referred to the Equine Reproduction Service (ERS), Veterinary Faculty of Barcelona in March 2004 because of infertility problems. The mare was born and bred in Spain, without previous foaling. The owner informed that the mare, when she was 3 years old, suffered an important vagino-cervical laceration as a consequence of a first mating, by a vigorous stallion with a large penis. A practitioner treated the laceration in field conditions; then the mare has been flushed, treated with intrauterine antibiotics and mated repeatedly, the following 3 years, but with no pregnancy result. In the ERS, the transrectal ultrasound examination showed an hyperechogenic cervix with two hypoechogenic areas that let guess a fibrotic cervix.         Once diagnosed, the treatment of fungal endometritis use to be unrewarding and recurrence of yeast infections is common [4].
Treatment involves physical removal of infectious organisms by uterine lavage, systemic or intrauterine administration of antifungal agents. Ideally, selection of an antifungal agent should be based on results of antifungigrams for each case of fungal endometritis and empirical treatment should be avoided [2]. As a chronic treatment, repair of abnormal conformation or damage in the reproductive anatomy should be performed. That includes surgical repair as the common Caslick's procedure, perineal body reconstruction or cervical laceration repair [1].
To our best knowledge, this is the first report of Chatomium sp associated with equine endometritis. Chaetomium sp is a genus of filamentous fungi (Phylum Ascomycota, Class Sordariomycetes).
Species of the ascomycete genus Chaetomium are important in the decomposition of plant and other cellulose-rich materials, and can be isolated easily from dung, plant debris and soil. The genus contains a number of species capable of growth at elevated temperatures as well as a few species that cause infections in vertebrates. Chaetomium globolusum is the most prevalent clinical species and mainly affect the nails and skin in humans. It also causes cerebral and systemic infections with high mortality rates [5]. Chaetomium globolusum is important to vertebrates' health as a contaminant in indoor environments since it is known to produce mycotoxins [6].

Conclusion
The interest of this case report is that this fungus use to grow in cellulose medium, perhaps stable floor, and this has never been described as endometritis agent. Obviously, Chaetomium growth is considered to be secondary due to underlying factors impairing the local immunity. In fact, the first mare had an acute endometritis, with bacteria growth, and the second one had an-endometriosis.
Defects in genital anatomy, lymphatic drainage, cervical function, excessive intrauterine manipulations facilitate the colonization of the uterus by opportunistic fungi. But, the real question is that if the fungus agent can survive in uterine medium, and if it would be contagious for human and/or others animals.