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Donovania granulomatis

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Donovania granulomatis

Donovania granulomatis

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  • 1. Donovania Granulomatis Calymmatobacterium Granulomatis Dr.T.V.Rao MD Dr.T.V.Rao MD 1
  • 2. Granuloma inguinaleThe intracellular organismresponsible for granulomainguinale was initially described byDonovan over a century ago, andsubsequently, the bacterium wasclassified in 1913 asCalymmatobacteriumgranulomatis. Dr.T.V.Rao MD 2
  • 3. Granuloma InguinaleGranuloma inguinale is a bacterial diseasecaused by Klebsiella granulomatischaracterized by ulcerative genital lesions.It is endemic in many less developedregions. It is also known as donovanosis,granuloma, genitoinguinale, granulomainguinale tropicum, granuloma venereum,granuloma venereum genitoinguinale,lupoid form of groin ulceration Dr.T.V.Rao MD 3
  • 4. Granuloma inguinaleGranuloma inguinale is achronic bacterialinfection. Granulomainguinale is characterizedby intracellular inclusionsin macrophages referredto as Donovan bodies.Granuloma inguinaleusually affects the skinand mucous membranesin the genital region,where it results in nodularlesions that evolve into Dr.T.V.Rao MD 4ulcers
  • 5. MorphologyRounded Coco bacilli size is 1 -2microns found in cystic spaces in largemononuclear cellsBipolar condensation of chromatinresembling closed safety pinappearanceCapsulated and non motileGram negativeGrown on egg yolkModified Levanthal agar Dr.T.V.Rao MD 5
  • 6. 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. Dr.T.V.Rao MD 6I
  • 7. PathogenesisAfter contracting the infection itmay take from 1 week to 3 monthsfor any signs and symptoms toappear. The nodular type consistsof soft lumps that are typicallybeefy red in colour and tend tobleed easily. These are usuallypainless despite ulceration. Dr.T.V.Rao MD 7
  • 8. Clinical PresentationsSmall, painless nodulesappear after about 10–40days of the contact withthe bacteria. Later thenodules burst, creatingopen, fleshy, oozinglesions. The infectionspreads, mutilating theinfected tissue. Theinfection will continue todestroy the tissue untiltreated. Dr.T.V.Rao MD 8
  • 9. 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 Dr.T.V.Rao MD 9 of the lesion
  • 10. Clinical AppearanceThe incubation period is uncertain.Estimates range between 1–360 days, 3–40 days, 14–28 days, and 17 days. Thiswide range is probably multifactorial andmay reflect either late presentation anddenial or non-sexual transmission. Thefinding that experimental lesions wereinduced in humans 50 days afterinoculation is a more realistic assessment Dr.T.V.Rao MD 10
  • 11. Typical manifestation as venereal disease Dr.T.V.Rao MD 11
  • 12. Progress of InfectionThe genital region is affected in 90% ofcases and the inguinal area in 10%. Theanatomical areas affected most frequentlyare, in men, the coronal sulcus,subpreputial region, and anus and inwomen, the labia minora, fourchette, andoccasionally the cervix and upper genitaltract. Ulcers are more common inuncircumcised men with poor standards ofgenital hygiene. Dr.T.V.Rao MD 12
  • 13. DistributionThe most common locations of granulomainguinale lesions in men are thesulcocoronal and balanopreputial regions,as well as the anus.In women, granuloma inguinale lesionsoccur on the labia minora, the mons veneris,the fourchette, and/or the cervix. Cervicalinvolvement occurs in 10% of cases.Children are frequently infected via contactwith an adult; however, this is notnecessarily the result of sexual abuse Dr.T.V.Rao MD 13
  • 14. Extragenital InfectionsExtra genital lesions account for 6% ofcases and are the subject of everincreasing numbers of case reports. Sitesof infection include lip, gums, cheek,palate, pharynx, neck, nose, larynx, andchest. Rarely, disseminated donovanosiswith spread to bone and liver may occurand is usually associated with pregnancyand cervical infection. Dr.T.V.Rao MD 14
  • 15. Hypertrophic Type of DiseaseThe hypertrophic orverrucous typeconsists of large drywarty masses thatresemble genitalwarts .The necrotictype presents asdry ulcers thatevolve into scarredareas . Dr.T.V.Rao MD 15
  • 16. Diagnosis of InfectionThe diagnosis is based on thepatients sexual history and onphysical examination revealinga painless, "beefy-red ulcer"with a characteristic rolled edgeof granulation tissue. Incontrast to syphilitic ulcers,inguinal lymphadenopathy isgenerally absent. Dr.T.V.Rao MD 16
  • 17. Tissue smear Examination Tissue smear stained by rapid Giemsa (RapiDiff) technique showing numerous Donovan bodies in a monocyte. Dr.T.V.Rao MD 17
  • 18. Tissue BiopsyTissue biopsy and Wright-Giemsa stain isused to aid in the diagnosis. The presenceof Donovan bodies in the tissue sampleconfirms donovanosis. Donovan bodiesare rod-shaped, oval organisms that canbe seen in the cytoplasm of mononuclearphagocytes or Histiocytes in tissuesamples from patients with granulomainguinale. They appear deep purple whenstained with Wrights stain Dr.T.V.Rao MD 18
  • 19. Treating …..withThree weeks of treatment witherythromycin, streptomycin, ortetracycline, or 12 weeks of treatmentwith ampicillin are standard forms oftherapy. Normally, the infection willbegin to subside within a week oftreatment, but the full treatment periodmust be followed in order to minimizethe possibility of relapse. Dr.T.V.Rao MD 19
  • 20. Treating AntibioticsTetracyclineCotromoxazoleChloramphenicolGentamycinQuinolonesNewer macrocodes Dr.T.V.Rao MD 20
  • 21. EpidemiologyDonovanosis has a curious geographicaldistribution with “hotspots” in Papua NewGuinea, KwaZulu-Natal, and eastern Transvaalin South Africa, parts of India and Brazil, andamong the Aboriginal community in Australia.Sporadic cases are reported elsewhere insouthern Africa, the West Indies, and SouthAmerica. The largest epidemic was reportedamong the Marind-anim people in Papua NewGuinea where, between 1922–52, 10 000 caseswere identified from a population of 15 000 Dr.T.V.Rao MD 21
  • 22. Programme Created ByDr.T.V.Rao MD for Medical and Paramedical Students in the Developing World Email doctortvrao@gmail.com Dr.T.V.Rao MD 22