1) Granuloma inguinale is a chronic bacterial infection caused by Klebsiella granulomatis characterized by genital ulcers and nodular lesions. 2) It is transmitted sexually and causes painless nodules that develop into fleshy, oozing ulcers affecting the genital region. 3) Diagnosis involves identifying intracellular Donovan bodies in tissue samples stained with Wright-Giemsa stain. Treatment requires 3 weeks of antibiotics like erythromycin or tetracycline to minimize relapse.

1. Donovania Granulomatis
Calymmatobacterium
Granulomatis
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2. 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.
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3. 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
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4. 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
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5. 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
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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.
I
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7. 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.
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8. 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.
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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
of the lesion
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10. 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
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11. Typical manifestation as venereal
disease
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12. 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.
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13. 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
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14. 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.
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15. 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 .
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16. 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.
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17. Tissue smear Examination
Tissue smear
stained by rapid
Giemsa (RapiDiff)
technique
showing
numerous
Donovan bodies
in a monocyte.
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18. 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
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19. 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.
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20. Treating Antibiotics
Tetracycline
Cotromoxazole
Chloramphenicol
Gentamycin
Quinolones
Newer
macrocodes Dr.T.V.Rao MD 20

21. 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
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22. Programme Created By
Dr.T.V.Rao MD for Medical and
Paramedical Students in the
Developing World
Email
doctortvrao@gmail.com
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