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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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These terms can apply to any species of mammal. Amongst domestic animals, metritis and endometritis are most common in cattle after parturition, and the diseases are often called postpartum metritis or postpartum endometritis. These diseases in cattle are caused by bacteria and occasionally viruses. The most common bacteria that cause postpartum metritis and endometritis in cattle are "Escherichia coli", "Trueperella" (previously "Arcanobacterium") "pyogenes" and anaerobic bacteria such as "Prevotella" species and "Fusobacterium necrophorum". The virus most consistently associated with postpartum uterine disease in cattle is Bovine Herpesvirus 4 (BoHV-4). In addition, "Several specific diseases are associated with metritis or endometritis. These include brucellosis, leptospirosis, campylobacteriosis, and trichomoniasis"
In cattle, bacterial infection of the uterus affects almost all animals after parturition. Of course this doesn't mean they will get disease. In fact beef cattle rarely have disease unless they have a predisposing factor such as retained placenta or difficult parturition. However, uterine disease is common in dairy cattle - particularly high-milk-yield cows such as Holstein-Friesian cows.
Contagious equine metritis is a sexually transmitted infection in horses, recognized since 1977.
In 2014 a study reported about the first successful vaccination trials in cattle. The infection rate declined significantly.Vinícius Silva Machado, Marcela Luccas de Souza Bicalho u. a.: "Subcutaneous Immunization with Inactivated Bacterial Components and Purified Protein of Escherichia coli, Fusobacterium necrophorum and Trueperella pyogenes Prevents Puerperal Metritis in Holstein Dairy Cows." In: "PLoS ONE." 9, 2014, S. e91734, .
Metritis is inflammation of the wall of the uterus, whereas endometritis is inflammation of the functional lining of the uterus, called the endometrium The term pelvic inflammatory disease (PID) is often used for metritis.
Causes (listed in order of decreasing frequency) include endometritis, urinary tract infection, pneumonia/atelectasis, wound infection, and septic pelvic thrombophlebitis. Septic risk factors for each condition are listed in order of the postpartum day (PPD) on which the condition generally occurs.
- PPD 0: atelectasis risk factors include general anesthesia, cigarette smoking, and obstructive lung disease.
- PPD 1–2: urinary tract infections risk factors include multiple catheterization during labor, multiple vaginal examinations during labor, and untreated bacteriuria.
- PPD 2–3: endometritis ( the most common cause ) risk factors include emergency cesarean section, prolonged membrane rupture, prolonged labor, and multiple vaginal examinations during labor.
- PPD 4–5: wound infection risk factors include emergency cesarean section, prolonged membrane rupture, prolonged labor, and multiple vaginal examination during labor.
- PPD 5–6: septic pelvic thrombophlebitis risk factors include emergency cesarean section, prolonged membrane rupture, prolonged labor, and diffuse difficult vaginal childbirth.
- PPD 7–21: mastitis risk factors include nipple trauma from breastfeeding.
The number of cases of puerperal sepsis per year shows wide variations among published literature — this may be related to different definition, recording etc. Globally, bacterial infections are the cause of 10% of maternal deaths- this is more common in low income countries but is also a direct cause of maternal deaths in high income countries.
In the United States, puerperal infections are believed to occur in between one and eight percent of all births. About three die from puerperal sepsis for every 100,000 births. The single most important risk factor is Caesarean section. The number of maternal deaths in the United States is about 13 in 100,000. They make up about 11% of pregnancy related deaths in the United States.
In the United Kingdom 1985–2005, the number of "direct" deaths associated with genital tract sepsis per 100,000 pregnancies was 0.40–0.85. In 2003–2005, genital tract sepsis accounted for 14% of direct causes of maternal death.
Puerperal infections in the 18th and 19th centuries affected, on average, 6 to 9 women in every 1,000 births, killing two to three of them with peritonitis or septicemia. It was the single most common cause of maternal mortality, accounting for about half of all deaths related to childbirth, and was second only to tuberculosis in killing women of childbearing age. A rough estimate is that about 250,000–500,000 died from puerperal fever in the 18th and 19th centuries in England and Wales alone.
"Taylorella equigenitalis" is susceptible to most antibiotics, although the carrier state in mares is difficult to eliminate. Most mares with acute endometritis recover spontaneously. Recommended therapy is to infuse the uterus with an antibiotic such as penicillin, cleansing the clitoral area with 2% chlorhexidine solution and then applying chlorhexidine or nitrofurazone ointment to the clitoral fossa and sinuses. The entire treatment is repeated daily for five days.
It is relatively easy to eliminate the carrier state in stallions using local disinfectant. With the stallion's penis dropped and the glans extended from the foreskin, the shaft of the penis, including the folds of the prepuce and the urethral fossa, should be cleansed daily for five days with a 2% chlorhexidine solution. After drying, nitrofurazone cream is applied to these areas.
Signs in mares appear ten to fourteen days after breeding to an infected or carrier stallion. A gray to creamy vulvar discharge mats the hair of the buttocks and tail, although in many cases, the discharge is absent and the infection is not apparent. Most mares recover spontaneously, although many become carriers. Infected mares are usually infertile during the acute illness. However, the infertility only lasts a few weeks, after which pregnancy is possible.
Stallions do not show signs of infection. The first indication of the carrier state is lack of pregnancy in the mares covered by the stallion.
The pathogenic agent is found everywhere except New Zealand. The bacterium is extremely sustainable and virulent: a single organism is able to cause an infection. The common source of infection is inhalation of contaminated dust, contact with contaminated milk, meat, or wool, and particularly birthing products. Ticks can transfer the pathogenic agent to other animals. Transfer between humans seems extremely rare and has so far been described in very few cases.
Some studies have shown more men to be affected than women, which may be attributed to different employment rates in typical professions.
“At risk” occupations include:
- Veterinary personnel
- Stockyard workers
- Farmers
- Sheep shearers
- Animal transporters
- Laboratory workers handling potentially infected veterinary samples or visiting abattoirs
- People who cull and process kangaroos
- Hide (tannery) workers
Equine venereal diseases are sexually transmitted infections in horses. They include contagious equine metritis (CEM) (caused by "Taylorella equigenitalis") and equine coital exanthema (caused by equine herpesvirus 3).
This disease affects the external genitalia, and is caused by equine herpesvirus 3. This disease remains with the horse for all its life. Equine coital exanthema is believed to only be transmitted during the acute phase of the disease through serous fluid from the blisters during sexual intercourse, and via breeding tools, handlers, etc.
Clinical signs include cute small lesions, no bigger than 2 mm in diameter around the vulva in mares, and on the sheath in stallions. The small bumps blister and then rupture, leaving raw, ulcerated, painful sores. While the majority of the symptoms are external, the presence of the virus can cause small and large plaque variants in tissues.
Protection is offered by Q-Vax, a whole-cell, inactivated vaccine developed by an Australian vaccine manufacturing company, CSL Limited. The intradermal vaccination is composed of killed "C. burnetii" organisms. Skin and blood tests should be done before vaccination to identify pre-existing immunity, because vaccinating people who already have an immunity can result in a severe local reaction. After a single dose of vaccine, protective immunity lasts for many years. Revaccination is not generally required. Annual screening is typically recommended.
In 2001, Australia introduced a national Q fever vaccination program for people working in “at risk” occupations. Vaccinated or previously exposed people may have their status recorded on the Australian Q Fever Register, which may be a condition of employment in the meat processing industry. An earlier killed vaccine had been developed in the Soviet Union, but its side effects prevented its licensing abroad.
Preliminary results suggest vaccination of animals may be a method of control. Published trials proved that use of a registered phase vaccine (Coxevac) on infected farms is a tool of major interest to manage or prevent early or late abortion, repeat breeding, anoestrus, silent oestrus, metritis, and decreases in milk yield when "C. burnetii" is the major cause of these problems.