Donovania Granulomatis

1. Dr.T.V.Rao MD Donovania GranulomatisCalymmatobacterium Granulomatis Dr.T.V.Rao MD

2. Dr.T.V.Rao MD Granuloma inguinale • The intracellular organism responsible for granuloma inguinale was initially described by Donovan over a century ago, and subsequently, the bacterium was classified in 1913 as Calymmatobacteriumgranulomatis.

3. Dr.T.V.Rao MD Granuloma Inguinale • Granuloma inguinale is a bacterial disease caused by Klebsiella granulomatis characterized by ulcerative genital lesions. It is endemic in many less developed regions. It is also known as donovanosis, granuloma, genitoinguinale, granuloma inguinale tropicum, granuloma venereum, granuloma venereum genitoinguinale, lupoid form of groin ulceration

4. Dr.T.V.Rao MD Granuloma inguinale • Granuloma inguinale is a chronic bacterial infection. Granuloma inguinale is characterized by intracellular inclusions in macrophages referred to as Donovan bodies. Granuloma inguinale usually affects the skin and mucous membranes in the genital region, where it results in nodular lesions that evolve into ulcers

5. Dr.T.V.Rao MD Morphology • Rounded Coco bacilli size is 1 -2 microns found in cystic spaces in large mononuclear cells • Bipolar condensation of chromatin resembling closed safety pin appearance • Capsulated and non motile • Gram negative • Grown on egg yolk • Modified Levanthal agar

6. Dr.T.V.Rao MD Morphology • Pleomorphic gram-negative bacilli with characteristically prominent polar granules. Many very long chains, looking like coiled filamentous forms, were present, and single organisms tended to be comma shaped. • I

7. Dr.T.V.Rao MD Pathogenesis • After contracting the infection it may take from 1 week to 3 months for any signs and symptoms to appear. The nodular type consists of soft lumps that are typically beefy red in colour and tend to bleed easily. These are usually painless despite ulceration.

8. Dr.T.V.Rao MD Clinical Presentations • 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.

9. Dr.T.V.Rao MD Clinical Presentations • 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

10. Dr.T.V.Rao MD Clinical Appearance • The incubation period is uncertain. Estimates range between 1–360 days, 3–40 days, 14–28 days, and 17 days. This wide range is probably multifactorial and may reflect either late presentation and denial or non-sexual transmission. The finding that experimental lesions were induced in humans 50 days after inoculation is a more realistic assessment

11. Dr.T.V.Rao MD Typical manifestation as venereal disease

12. Dr.T.V.Rao MD Progress of Infection • The genital region is affected in 90% of cases and the inguinal area in 10%. The anatomical areas affected most frequently are, in men, the coronal sulcus, subpreputial region, and anus and in women, the labia minora, fourchette, and occasionally the cervix and upper genital tract. Ulcers are more common in uncircumcised men with poor standards of genital hygiene.

13. Dr.T.V.Rao MD Distribution • The most common locations of granuloma inguinale lesions in men are the sulcocoronal and balanopreputial regions, as well as the anus. • In women, granuloma inguinale lesions occur on the labia minora, the mons veneris, the fourchette, and/or the cervix. Cervical involvement occurs in 10% of cases. • Children are frequently infected via contact with an adult; however, this is not necessarily the result of sexual abuse

14. Dr.T.V.Rao MD Extragenital Infections • Extra genital lesions account for 6% of cases and are the subject of ever increasing numbers of case reports. Sites of infection include lip, gums, cheek, palate, pharynx, neck, nose, larynx, and chest. Rarely, disseminated donovanosis with spread to bone and liver may occur and is usually associated with pregnancy and cervical infection.

15. Dr.T.V.Rao MD Hypertrophic Type of Disease • The hypertrophic or verrucous type consists of large dry warty masses that resemble genital warts .The necrotic type presents as dry ulcers that evolve into scarred areas .

16. Dr.T.V.Rao MD Diagnosis of Infection • 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.

17. Dr.T.V.Rao MD Tissue smear Examination • Tissue smear stained by rapid Giemsa (RapiDiff) technique showing numerous Donovan bodies in a monocyte.

18. Dr.T.V.Rao MD Tissue Biopsy • 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. They appear deep purple when stained with Wright's stain

19. Dr.T.V.Rao MD Treating …..with • 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, but the full treatment period must be followed in order to minimize the possibility of relapse.

20. Dr.T.V.Rao MD Treating Antibiotics • Tetracycline • Cotromoxazole • Chloramphenicol • Gentamycin • Quinolones • Newer macrocodes

21. Dr.T.V.Rao MD Epidemiology • Donovanosis has a curious geographical distribution with “hotspots” in Papua New Guinea, KwaZulu-Natal, and eastern Transvaal in South Africa, parts of India and Brazil, and among the Aboriginal community in Australia. Sporadic cases are reported elsewhere in southern Africa, the West Indies, and South America. The largest epidemic was reported among the Marind-anim people in Papua New Guinea where, between 1922–52, 10 000 cases were identified from a population of 15 000

22. Dr.T.V.Rao MD • Programme Created By Dr.T.V.Rao MD for Medical and Paramedical Students in the Developing World • Email • doctortvrao@gmail.com