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Granuloma inguinale
Classification and external resources

Donovanosis of the penis.
ICD-10 A58.
ICD-9 099.2
DiseasesDB 3888
MedlinePlus 000636
eMedicine derm/172
MeSH D006100

Granuloma inguinale (also known as "Donovanosis",[1], "Granuloma genitoinguinale",[1] "Granuloma inguinale tropicum,"[1] "Granuloma venereum"[2]:275, "Granuloma venereum genitoinguinale"[1], "Lupoid form of groin ulceration",[1] "Serpiginous ulceration of the groin",[1] "Ulcerating granuloma of the pudendum"[1], "Ulcerating sclerosing granuloma") is a bacterial disease that has reached endemic proportions in many underdeveloped regions. Because of the scarcity of medical treatment, the disease often goes untreated. The disease is characterized by painless genital ulcers which can be mistaken for syphilis.[3] However, they ultimately progress to destruction of internal and external tissue, with extensive leakage of mucus and blood from the highly vascular “beefy red” lesions. The destructive nature of donovanosis also increases the risk of superinfection by other pathogenic microbes.

Contents

Classification and terminology

The first known name for this condition was "serpiginous ulcer", which dates to 1882.[4][5].

The proper clinical designation for donovanosis is granuloma inguinale.[6] Granuloma is a nodular type of inflammatory reaction, and inguinale refers to the inguinal region, which is commonly involved in this infection. The disease is commonly known as donovanosis, after the Donovan Bodies which are a diagnostic sign.

The causative organism, Klebsiella granulomatis, used to be called Calymmatobacterium granulomatis (some source still use this classification)[7][8], from the Greek kalymma (a hood or veil), referring to the lesions that contain the bacteria. Prior to this it was called Donovania granulomatis, named after the Donovan Bodies.[9] The species name granulomatis refers to the granulomatous lesions. The organism was recently reclassified under the genus Klebsiella,[10][11] a drastic taxonomic change, since it involved changing the organism's phylum. However, polymerase chain reaction (PCR) techniques using a colorimetric detection system showed a 99% similarity with other species in the Klebsiella genus.[citation needed]

Symptoms

Small, painless nodules appear after about 10–40 days of the contact with the bacteria. Later the nodules burst, creating open, fleshy, oozing lesions. The infection spreads, mutilating the infected tissue. The infection will continue to destroy the tissue until treated. The lesions occur at the region of contact typically found on the shaft of the penis, the labia, or the perineum. Rarely, the vaginal wall or cervix is the site of the lesion. At least one case in India lead to partial auto-amputation of the penis. The patient tested positive for HIV-2 and had been infected for six years. [12]

Transmission

The microorganism spreads from one host to another through contact with the open sores.

Diagnosis

The diagnosis is based on the patient's sexual history and on physical examination revealing a painless, "beefy-red ulcer" with a characteristic rolled edge of granulation tissue. In contrast to syphilitic ulcers, inguinal lymphadenopathy is generally absent. Tissue biopsy and Wright-Giemsa stain is used to aid in the diagnosis. The presence of Donovan bodies in the tissue sample confirms donovanosis. Donovan bodies are rod-shaped oval organisms that can be seen in the cytoplasm of mononuclear phagocytes or histiocytes in tissue samples from patients with granuloma inguinale.[13] They appear deep purple when stained with Wright's stain.[13] These intracellular inclusions are the encapsulated gram-negative rods of the causative organisms.[13] They were discovered by Charles Donovan.[14]

Treatment

Three weeks of treatment with erythromycin, streptomycin, or tetracycline, or 12 weeks of treatment with ampicillin are standard forms of therapy. Normally, the infection will begin to subside within a week of treatment, however, the full treatment period must be followed in order to minimize the possibility of relapse.

Prevention

The disease is effectively treated with antibiotics, therefore, developed countries, like the United States, have a very low incidence of donovanosis, (approximately 100 cases reported each year in the United States.) However, sexual contacts with individuals in endemic regions dramatically increases the risk of contracting the disease. Avoidance of these sexual contacts, and STD testing before beginning a sexual relationship, are effective preventative measures for donovanosis.

See also

References

  1. ^ a b c d e f g Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0. 
  2. ^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0. 
  3. ^ Murray P. et al. (2005), Medical Microbiology, fifth ed., Elsevier Mosby, p. 336.
  4. ^ Rashid RM, Janjua SA, Khachemoune A (2006). "Granuloma inguinale: a case report". Dermatol. Online J. 12 (7): 14. PMID 17459300. http://dermatology-s10.cdlib.org/127/case_reports/inguinale/khachemoune.html. 
  5. ^ McLeod K. Precis of operations performed in the wards of the first surgeon, Medical College Hospital, during the year 1881. Indian Med Gazette 1882;11:113.
  6. ^ Murray P. et al. (2005), Medical Microbiology, fifth ed., Elsevier Mosby, p. 336.
  7. ^ granuloma inguinale at Dorland's Medical Dictionary
  8. ^ O'Farrell N (December 2002). "Donovanosis". Sex Transm Infect 78 (6): 452–7. PMID 12473810. 
  9. ^ Murray P. et al. (2005), Medical Microbiology, fifth ed., Elsevier Mosby, p. 336.
  10. ^ * Boye K, Hansen DS (February 2003). "Sequencing of 16S rDNA of Klebsiella: taxonomic relations within the genus and to other Enterobacteriaceae". Int. J. Med. Microbiol. 292 (7-8): 495–503. PMID 12635932. 
  11. ^ Carter JS, Bowden FJ, Bastian I, Myers GM, Sriprakash KS, Kemp DJ (October 1999). "Phylogenetic evidence for reclassification of Calymmatobacterium granulomatis as Klebsiella granulomatis comb. nov". Int. J. Syst. Bacteriol. 49 Pt 4: 1695–700. PMID 10555350. 
  12. ^ http://www.ijdvl.com/article.asp?issn=0378-6323;year=2008;volume=74;issue=5;spage=490;epage=492;aulast=Chandra
  13. ^ a b c thefreedictionary.com > Donovan bodies Retrieved on Nov 29, 2009
  14. ^ Donovan, C.: Ulcerating Granuloma of the Pudenda, Indian Medical Gazette 40:414, 1905

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