Granuloma inguinale

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Granuloma inguinale
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Donovanosis
Specialty Infectious disease   Blue pencil.svg

Granuloma inguinale (also known as donovanosis) is a bacterial disease caused by Klebsiella granulomatis (formerly known as Calymmatobacterium granulomatis) [1] characterized by genital ulcers. It is endemic in many less-developed regions. It is also known as donovanosis, [2] granuloma genitoinguinale, [2] granuloma inguinale tropicum, [2] granuloma venereum, [3] granuloma venereum genitoinguinale, [2] lupoid form of groin ulceration, [2] serpiginous ulceration of the groin, [2] ulcerating granuloma of the pudendum, [2] and ulcerating sclerosing granuloma.

Bacteria A domain of prokaryotes – single celled organisms without a nucleus

Bacteria are a type of biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a number of shapes, ranging from spheres to rods and spirals. Bacteria were among the first life forms to appear on Earth, and are present in most of its habitats. Bacteria inhabit soil, water, acidic hot springs, radioactive waste, and the deep portions of Earth's crust. Bacteria also live in symbiotic and parasitic relationships with plants and animals. Most bacteria have not been characterised, and only about half of the bacterial phyla have species that can be grown in the laboratory. The study of bacteria is known as bacteriology, a branch of microbiology.

Disease abnormal condition negatively affecting organisms

A disease is a particular abnormal condition that negatively affects the structure or function of part or all of an organism, and that is not due to any external injury. Diseases are often construed as medical conditions that are associated with specific symptoms and signs. A disease may be caused by external factors such as pathogens or by internal dysfunctions. For example, internal dysfunctions of the immune system can produce a variety of different diseases, including various forms of immunodeficiency, hypersensitivity, allergies and autoimmune disorders.

Klebsiella granulomatis is Gram-negative, rod-shaped bacterium of the genus Klebsiella known to cause the sexually transmitted disease granuloma inguinale. It was called Calymmatobacterium granulomatis.

Contents

The disease often goes untreated because of the scarcity of medical treatment in the countries in which it is found. In addition, the painless genital ulcers can be mistaken for syphilis. [4] The ulcers ultimately progress to destruction of internal and external tissue, with extensive leakage of mucus and blood from the highly vascular lesions. The destructive nature of donovanosis also increases the risk of superinfection by other pathogenic microbes.

Syphilis sexually transmitted infection

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum subspecies pallidum. The signs and symptoms of syphilis vary depending in which of the four stages it presents. The primary stage classically presents with a single chancre but there may be multiple sores. In secondary syphilis, a diffuse rash occurs, which frequently involves the palms of the hands and soles of the feet. There may also be sores in the mouth or vagina. In latent syphilis, which can last for years, there are few or no symptoms. In tertiary syphilis, there are gummas, neurological problems, or heart symptoms. Syphilis has been known as "the great imitator" as it may cause symptoms similar to many other diseases.

Mucus slippery secretion produced by, and covering, mucous membranes

Mucus is a polymer. It is a slippery aqueous secretion produced by, and covering, mucous membranes. It is typically produced from cells found in mucous glands, although it may also originate from mixed glands, which contain both serous and mucous cells. It is a viscous colloid containing inorganic salts, antiseptic enzymes, immunoglobulins, and glycoproteins such as lactoferrin and mucins, which are produced by goblet cells in the mucous membranes and submucosal glands. Mucus serves to protect epithelial cells in the respiratory, gastrointestinal, urogenital, visual, and auditory systems; the epidermis in amphibians; and the gills in fish, against infectious agents such as fungi, bacteria and viruses. Most of the mucus produced is in the gastrointestinal tract.

Blood specialized bodily fluid in animals

Blood is a body fluid in humans and other animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells.

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 led to partial autoamputation of the penis. The patient tested positive for HIV-2 and had been infected for six years. [5]

Infection invasion of a host by disease-causing organisms

Infection is the invasion of an organism's body tissues by disease-causing agents, their multiplication, and the reaction of host tissues to the infectious agents and the toxins they produce. Infectious disease, also known as transmissible disease or communicable disease, is illness resulting from an infection.

Penis primary sexual organ of male animals

A penis is the primary sexual organ that male animals use to inseminate sexually receptive mates during copulation. Such organs occur in many animals, both vertebrate and invertebrate, but males do not bear a penis in every animal species, and in those species in which the male does bear a so-called penis, the penes in the various species are not necessarily homologous. For example, the penis of a mammal is at most analogous to the penis of a male insect or barnacle.

Anus opening at the opposite end of an animals digestive tract from its mouth

The anus is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, unwanted semi-solid matter produced during digestion, which, depending on the type of animal, may include: matter which the animal cannot digest, such as bones; food material after all the nutrients have been extracted, for example cellulose or lignin; ingested matter which would be toxic if it remained in the digestive tract; and dead or excess gut bacteria and other endosymbionts.

Mechanism

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 mild or absent. Tissue biopsy and Wright-Giemsa stain are 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. [6]

Diagnosis is the identification of the nature and cause of a certain phenomenon. Doctor Diagnosis is used in many different disciplines with variations in the use of logic, analytics, and experience to determine "cause and effect". In systems engineering and computer science, it is typically used to determine the causes of symptoms, mitigations, and solutions.

Granulation tissue is new connective tissue and microscopic blood vessels that form on the surfaces of a wound during the healing process. Granulation tissue typically grows from the base of a wound and is able to fill wounds of almost any size. Examples of granulation tissue can be seen in pyogenic granulomas and pulp polyps. Its histological appearance is characterized by proliferation of fibroblasts and new thin-walled, delicate capillaries (angiogenesis), infiltrated inflammatory cells in a loose extracellular matrix.

Lymphadenopathy disorder of lymph nodes

Lymphadenopathy or adenopathy is disease of the lymph nodes, in which they are abnormal in size or consistency. Lymphadenopathy of an inflammatory type is lymphadenitis, producing swollen or enlarged lymph nodes. In clinical practice, the distinction between lymphadenopathy and lymphadenitis is rarely made and the words are usually treated as synonymous. Inflammation of the lymphatic vessels is known as lymphangitis. Infectious lymphadenitis affecting lymph nodes in the neck is often called scrofula.

They appear deep purple when stained with Wright's stain. [6] These intracellular inclusions are the encapsulated Gram-negative rods of the causative organisms. [6] They were discovered by Charles Donovan. [7]

Wrights stain histologic stain that facilitates the differentiation of blood cell types

Wright's stain is a histologic stain that facilitates the differentiation of blood cell types. It is classically a mixture of eosin (red) and methylene blue dyes. It is used primarily to stain peripheral blood smears, urine samples, and bone marrow aspirates which are examined under a light microscope. In cytogenetics, it is used to stain chromosomes to facilitate diagnosis of syndromes and diseases.

Charles Donovan Irish entomologist

Charles Donovan MD was an Irish medical officer in the Indian Medical Service. He is best remembered for his discoveries of Leishmania donovani as the causative agent of visceral leishmaniasis, and Klebsiella granulomatis as that of donovanosis. The son of a judge in India, he was born in Calcutta and completed his primary education in India, and continued secondary school in Cork City, Ireland. He graduated in medicine from Trinity College, Dublin and joined the Indian Medical Service. He participated in British expeditions to Mandalay in Burma, Royapuram and Mangalore in India, Afghanistan, and finally Madras, where he spent the rest of his service. He was professor at Madras Medical College from 1898 until his retirement in 1919.

Classification

The first known name for this condition was "serpiginous ulcer", which dates to 1882. [8] [9] The proper clinical designation for donovanosis is "granuloma inguinale". [4] A 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 seen on microscopy, which are a diagnostic sign.

Granuloma inflammation consisting of immune cells known as macrophages

A granuloma is a structure formed during inflammation that is found in many diseases. It is a collection of immune cells known as macrophages. Granulomas form when the immune system attempts to wall off substances it perceives as foreign but is unable to eliminate. Such substances include infectious organisms including bacteria and fungi, as well as other materials such as keratin and suture fragments.

Inflammation signs of activation of the immune system

Inflammation is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molecular mediators. The function of inflammation is to eliminate the initial cause of cell injury, clear out necrotic cells and tissues damaged from the original insult and the inflammatory process, and initiate tissue repair.

In human anatomy, the groin is the junctional area between the abdomen and the thigh on either side of the pubic bone. This is also known as the medial compartment of the thigh that consists of the adductor muscles of the hip or the groin muscles. A pulled groin muscle usually refers to a painful injury sustained by straining the hip adductor muscles.

The causative organism, Klebsiella granulomatis , was called Calymmatobacterium granulomatis, and some sources still use this classification, [10] [11] 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. [4]

The specific name granulomatis refers to the granulomatous lesions. The organism was recently reclassified under the genus Klebsiella, [12] a drastic taxonomic change since it involved changing the organism's phylum. However, polymerase chain reaction techniques using a colorimetric detection system showed a 99% similarity with other species in the genus Klebsiella. [13]

Prevention

The disease is effectively treated with antibiotics, therefore, developed countries have a very low incidence of donovanosis; about 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. Using condoms, sexually transmitted disease testing before beginning a sexual relationship, and avoidance of these sexual contacts are effective preventative measures for donovanosis.

Treatment

Recommended regimen is azithromycin 1gram oral/iv once per week, alternatively doxycycline 100 mg orally twice a day or ciprofloxacin 750 mg orally twice a day or erythromycin base 500 mg orally four times a day or trimethoprim-sulfamethoxazole one double-strength (160 mg/800 mg) tablet orally twice a day. All antibiotic regimens should last for at least 3 weeks and until all lesions have completely healed. Normally, the infection will begin to subside within a week of treatment, but the full treatment period must be followed to minimize the possibility of relapse.

According to the CDC 2015 guidelines Azithromycin is the antibiotic of choice. [14]

See also

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References

  1. O’Farrell, N (2002). "Donovanosis". Sexually Transmitted Infections. 78 (6): 452–7. doi:10.1136/sti.78.6.452. PMC   1758360 . PMID   12473810.
  2. 1 2 3 4 5 6 7 Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN   978-1-4160-2999-1.
  3. James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. p. 275. ISBN   978-0-7216-2921-6.
  4. 1 2 3 Murray, Patrick R; Rosenthal, Ken S; Pfaller, Michael A (2005). Medical Microbiology (5th ed.). Philadelphia: Elsevier Mosby. p. 336. ISBN   978-0-323-03303-9.
  5. Chandra Gupta TS, Rayudu T, Murthy SV (2008). "Donovanosis with auto-amputation of penis in a HIV-2 infected person". Indian J Dermatol Venereol Leprol. 74 (5): 490–2. doi:10.4103/0378-6323.44308. PMID   19052412.
  6. 1 2 3 thefreedictionary.com > Donovan bodies Retrieved on Nov 29, 2009
  7. Donovan, C. (1905). "Ulcerating Granuloma of the Pudenda". Ind Med Gaz. 40 (11): 414–418. PMC   5162824 . PMID   29004684.
  8. Rashid RM, Janjua SA, Khachemoune A (2006). "Granuloma inguinale: a case report". Dermatol. Online J. 12 (7): 14. PMID   17459300.
  9. McLeod K. (1882). "Precis of operations performed in the wards of the first surgeon, Medical College Hospital, during the year 1881". Ind Med Gaz. 11 (5): 113–119. PMC   5136093 . PMID   28997806.
  10. " granuloma inguinale " at Dorland's Medical Dictionary
  11. O'Farrell N (December 2002). "Donovanosis". Sex Transm Infect. 78 (6): 452–7. doi:10.1136/sti.78.6.452. PMC   1758360 . PMID   12473810.
    • 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. doi:10.1078/1438-4221-00228. PMID   12635932.
  12. 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. doi:10.1099/00207713-49-4-1695. PMID   10555350.
  13. "Granuloma Inguinale (Donovanosis) - 2015 STD Treatment Guidelines". www.cdc.gov. Retrieved 2018-08-23.

Further reading

Classification
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External resources