Fungal endometritis in the mare

Fungal endometritis is a relatively uncommon condition in mares, accounting for less than 5% of diagnosed endometritides. Moreover, it
is generally accepted that fungal infection is opportunistic and can only become established in a chronically disturbed uterine/vaginal environment, pneumovagina, persistent endometritis and repeated intrauterine antibiotic therapy are commonly cited as predisposing factors.
However, because the exact conditions that allow fungal colonization of the uterus are obscure, recidivism is common and there are currently no treatments proven to offer a high likelihood of resolution, uterine infection with hyphal fungi or, in particular, yeasts is a considerable therapeutic challenge with a poor prognosis. While both the identity of the causal organism and the duration of infection may affect
the response to intrauterine treatment, it is sensible to simultaneously correct any suspected predispositions (e.g. pneumovagina) and to
treat against a potential reservoir of infection in the caudal reproductive tract (vagina and clitoral fossa). In the author’s experience, intrauterine infusion of 2% acetic acid for 3 days or an anti-fungal such as clotrimazole or nystatin for 5-7 days yields a resolution rate of approximately 20% per treatment cycle. If initial treatment is not successful, a prolonged period of breeding rest to allow the re-establishment of
uterine and vaginal environments capable of withstanding fungal overgrowth can be surprisingly effective.