1) Donovanosis is a sexually transmitted bacterial infection caused by Klebsiella granulomatis that affects the genital and anal skin and mucous membranes.
2) It is diagnosed by identifying intracellular Donovan bodies in phagocytes from lesions stained with Wright's or Giemsa stain.
3) The infection typically presents initially as a painless papule or pustule in the genital region that progresses through ulcerative and scar tissue stages if left untreated.
Presentation include some details on genital ulcers and typical features, differential diagnosis, causing organisms, diagnosis and treatment.
Presentation prepaired and done by 3rd year medical students of Faculty of Medicine, University of Ruhuna, Sri Lanka during STI appointment under the guidance of Consultant Venereologist, STI clinic Mahamodara, Galle.
Done by
Dias P G N J
Dilanka I W G M
Dinuraji K S H
Skin warts are benign tumours caused by infection of keratinocytes with HPV, visible as well‐defined hyperkeratotic protrusions. We will explore the detailed types, presentation, and treatment modalities of most common warts.
Erythroderma is defined as the scaling erythematous dermatitis involving 90% or more of the cutaneous surface.
Also known as exfoliative dermatitis
Idiopathic exfoliative dermatitis – also known as the “red man syndrome”, is characterized by marked palmoplantar keratoderma, dermatopathic lymphadenopathy,increased IgE.
Increased skin perfusion leads to
Temperature dysregulation >
Resulting in skin loss and hypothermia >
High output state >
Cardiac failure
BMR raises to compensate for heat loss
Increased dehydration due to transpiration (similar to burns)
All lead to negative nitrogen balance and characterized by edema, hypoalbuminemia, loss of muscle mass.
Presentation include some details on genital ulcers and typical features, differential diagnosis, causing organisms, diagnosis and treatment.
Presentation prepaired and done by 3rd year medical students of Faculty of Medicine, University of Ruhuna, Sri Lanka during STI appointment under the guidance of Consultant Venereologist, STI clinic Mahamodara, Galle.
Done by
Dias P G N J
Dilanka I W G M
Dinuraji K S H
Skin warts are benign tumours caused by infection of keratinocytes with HPV, visible as well‐defined hyperkeratotic protrusions. We will explore the detailed types, presentation, and treatment modalities of most common warts.
Erythroderma is defined as the scaling erythematous dermatitis involving 90% or more of the cutaneous surface.
Also known as exfoliative dermatitis
Idiopathic exfoliative dermatitis – also known as the “red man syndrome”, is characterized by marked palmoplantar keratoderma, dermatopathic lymphadenopathy,increased IgE.
Increased skin perfusion leads to
Temperature dysregulation >
Resulting in skin loss and hypothermia >
High output state >
Cardiac failure
BMR raises to compensate for heat loss
Increased dehydration due to transpiration (similar to burns)
All lead to negative nitrogen balance and characterized by edema, hypoalbuminemia, loss of muscle mass.
This is a presentation on cutaneous manifestations of tuberculosis. tuberculosis is a very important disease especially in the sub-Saharan region.
The pictures are not mine( from internet sites) and the study material majorly used was Fitzpatrick dermatology and extrapulmonary TB by Alper Senner. If anyone feels like some of the information is from their site and has been wrongly used do contact me via : lilacpreton12@gmail.com . This information is only for educational purposes.
Clinical immunology is the study of diseases caused by disorders of the immune system (failure, aberrant action, and malignant growth of the cellular elements of the system). It also involves diseases of other systems, where immune reactions play a part in the pathology and clinical features.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
2. The Definition
• Donovanosis (Granuloma inguinale) is a sexually
transmitted (Venereal), bacterial infection that
affects skin and mucous membranes of anal and
genital areas.
• Its name is derived from granuloma, a medical ter
m for a mass or growth of granulation tissue, and
inguinale, a Latin word that means located in the
groin.
• Granulation tissue is tissue formed during wound
healing that is rich in blood capillaries and has a
rough lumpy surface.
3. The Definition
• Diagnosis is made by microscopic examination
and identification of “Safety-Pin” shaped
cellular bodies named as “Donovan Bodies” in
the cytoplasm of phagocytes (Macrophages)
taken from a lesion and dyed with Wright's or
Giemsa stain or by histological examination of
a biopsy specimen.
• Therefore it is called Donovanosis
4. The Etiology
• Donovanosis is caused by Klebsiella
granulomatis (formerly called as
Calymmatobacterium granulomatis); small
gram-negative rod bacillus.
• They are non motile and encapsulated
organisms
• There are observed in macrophages cytoplasm
as “Donovan Bodies”
5. Donovan Bodies
Clusters of blue- or black-staining, bipolar chromatin condensations in
large mononuclear cells in granulation tissue infected with Klebsiella
(Calymmatobacterium granulomatis).
6. Epidemiology
• It occurs worldwide but is most common in
tropical or subtropical countries, where it is
associated with poverty and poor hygiene.
• As many as 20% of male patients with sexually
transmitted diseases (STDs) in tropical countries
have granuloma inguinale.
• All patients who have or are suspected of having
granuloma inguinale are also tested for syphilis
because concurrent infection is common.
7. Epidemiology
• Most patients are between are between the ages of
20 and 40 years.
• It occurs more frequently in men than in women
and is associated with anal intercourse.
• Its occurrence in children and sexually inactive
adults indicates that it may also be spread by
contact with human faeces.
• Granuloma inguinale is not highly contagious;
however, persons with weakened immune systems
are at greater risk of infection (HIV/AIDS)
8. Clinical Presentation
• The bacteria has an incubation period ranging
from eight days to twelve weeks, with an
average of two weeks to four weeks.
• This disease has gradual and slow onset, begins
with discreet papule or small pustule or lumpy
eruption of the skin.
• In 90% of patients, the initial sign of infection is
in the genital region, but a minority of patients
will develop the papule in their mouth or anal
area if their sexual contact involved those parts of
the body.
9. Clinical Presentation
• Many patients do not notice the sore because it
is small and not usually painful. In some
women, the first symptom of granuloma
inguinale is bleeding from the genitals.
10. The initial papule or pustule is typically followed by
three stages of disease;
1. In the first stage, the patient develops a mass of
pink or dull red granulation tissue in the area
around the anus.
2. In the second stage, the bacteria erode the skin to
form shallow, foul-smelling ulcers which spread
from the genital and anal areas to the thighs and
lower abdomen. The edges of the ulcers are
marked by granulation tissue.
Clinical Presentation
11. 3. In the third stage, the ulcerated areas form
deep masses of keloid or scar tissue that may
spread slowly for many years.
• Patients with long-term infections are at risk
for serious complications.
• The ulcers in second-stage granuloma
inguinale often become superinfected with
syphilis or other STD organisms.
Clinical Presentation
12. • Superinfected ulcers become painful to touch,
filled with pus and dead tissue, and are much
more difficult to treat.
• There may be sizable areas of tissue
destruction in superinfected patients.
• In addition, the scar tissue produced by third-
stage infection can grow until it closes off
parts of the patient's urinary tract.
Clinical Presentation
13. Major Sites of Lesions
• Penile ulcers (sulcocoronal and
balanopreputial)
• Labia minora
• Fourchette
• Cervix (uncommon)
14. Types of Skin Lesions
1. Ulcero-vegetative (most commonly seen) -
Painless, beefy red ulcers with clean, friable
bases and distinct, raised/rolled margins.
Autoinoculation is common.
2. Nodular - Pruritic, soft, red nodules that
ulcerate at the site of inoculation. Pseudobubo:
nodule appears clinically as a lymph node.
3. Cicatricial - Dry ulcers that progress into
scarring plaques. Lymphedema may be present
4. Hypertrophic or verrucous (relatively rare)
16. Nodular type lesion
The initial granuloma inguinale lesion is a papule or nodule that
arises at the site of inoculation. The nodule is soft, often pruritic
and erythematous, and eventually ulcerates. A nodule may be
mistaken for a lymph node [ie, pseudobubo]
18. Diagnosis
• Made by swabbing the lesion and Giemsa
staining of the air dried smear.
• Other stains that may be used are Warthin-
Starry, Gram stain, Toulidine blue and
Leishman stain.
• Smear or biopsy with Wright, Giemsa or
Warthin-Starry (silver) stain: Donovan bodies:
intracytoplasmic bipolar staining, safety pin–
shaped, inclusion bodies seen in histiocytes
19. Diagnosis
• Recommended to acquire specimen at base or
edge of ulceration or by aspirating enlarged
regional lymph node
• Culture of the organism is difficult, and needs
specialized methods using human peripheral
blood mononuclear cells or Hep-2 cells
• Polymerase chain reaction and indirect
immunofluorescence are available but not
commonly used.
20. Diagnosis
• Histology: acanthosis, dermis with histiocytes
and plasma cells, large and vacuolated
macrophages with intracellular bacilli (i.e.,
Donovan bodies).
• Granulomatous inflammation, neutrophilic
micro abscesses (particularly in ulcer bed).
• Acute and chronic granulation tissue, fibrosis
(dermal and subcutaneous cicatricial) in late
stages
21. Differential Diagnosis
1. Mycobacterial infection
2. Cutaneous tuberculosis
3. Ovarian cancer: One case report describes a
patient with chronic granuloma inguinale
(donovanosis) who presented with recurrent
abdominal pain. Results of abdominal computed
tomography (CT) scanning showed pelvic
masses that mimicked ovarian cancer.
4. Carcinoma of the cervix: One report describes
cervical donovanosis, which, on an MRI, was
indistinguishable from carcinoma of the cervix.
22. Differential Diagnosis
5. Dermatologic Manifestations of Chancroid
6. Dermatologic Manifestations of Herpes
Simplex
7. Dermatologic Manifestations of
Lymphogranuloma Venereum
8. Pediatric Syphilis
23. Treatment
• The current first-line drug is azithromycin.
• Alternative regimens include doxycycline,
ciprofloxacin, erythromycin base, and
trimethoprim-sulfamethoxazole.
• All antibiotics should be given for at least a 3-
week course and continued until re-
epithelialization of the ulcer occurs and all
signs of the disease have resolved.
24. • If the granuloma inguinale ulcers do not respond
within the first days of therapy, add an
aminoglycoside (eg, gentamicin 1 mg/kg IV q8h).
• Relapse of granuloma inguinale may occur 6-18
months after apparently effective therapy and
treatment should be reinitiated at that time.
• Since there have been past documented reports of
tetracycline resistance, it is no longer
recommended.
Treatment
25. Goal of Treatment
• The goal of pharmacotherapy for granuloma
inguinale is to reduce morbidity and to prevent
complications.