Lgv by aseem

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Lymphogranuloma Venereum, LGV, Strumous Buboe, Durand-Nicolas-Favre disease

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Lgv by aseem

  1. 1. LYMPHOGRANULOMA VENEREUM
  2. 2. Synonyms Tropical or Climatic bubo Durand-Nicholas-Favre disease Lymphogranuloma inguinale Poradenitis inguinalis Strumous bubo
  3. 3. History • Walkee in 1833 first identified • Caddy 1902 “Climatic bubo” India • Durand-Nicolas-Favre 1913 “LGI” • Frei 1925 – Intradermal Test • 1927  Chlamydia Trachomatis causal agent
  4. 4. DEFINITION • • • • • • Sexually transmitted disease A disease affecting the Lymphatic System Caused by Chlamydia Trachomatis Serovars L1-L2-L3 Regional Suppurative LAN preceded by a small transient inconspicuous lesion at Inoculation Site
  5. 5. EPIDEMIOLOGY • 6% Prevalence Rate in Clinics • Endemic to India • 20 - 40 yrs. • Male : female = 5 :1 • Urban, sexual promiscuity, low socio- economic status.
  6. 6. AETIOLOGY • Chlamydia Biovar LGV Serovar L1/L2/L3 • Obligate intracellular, Gram negative bacillus with humans as Natural Hosts by Sexual Transmission / Perinatal infection • Intracytoplasmic inclusion bodies • Controls the organelles of host cells for own growth and protein synth • Cell cycle – 48 to 72 hrs
  7. 7.  sss
  8. 8. PATHOGENESIS • • • • • • Entry into cell as Metabolically inactive elementary body (Eb) by receptor mediated endocytosis. Conversion to Active Reticulate Bodies which multiply , condense and form Eb  burst out of host cells Lymphangitis, perilymphangitis, necrosis of lymph nodes PMN stellate abscess- bubo Healing by fibrosis - esthiomene, adhesions Dissemination rare
  9. 9.  sas
  10. 10. CLINICAL FEATURES Primary stage Incubation period : 3-12 days. Single, painless, evanescent, inconspicuous Papule / vesicle / Erosion / Ulcer ?herpetiform Male – coronal sulcus, prepuce, glans, urethra Female - endocervix, post vaginal wall Oral / Rectal localization NSU BUBONULUS – Lymphangitic nodules over dorsal penis  Chord-like swelling
  11. 11. PRIMARY LESION
  12. 12. BUBONULUS
  13. 13. Secondary ‘INGUINAL’ stage • 02-06 wk after primary lesion Inflammatory swelling of Inguinal nodes in males perirectal and iliac nodes in females  ‘BUBOES’  Fluctuant if untreated  Multilocular Suppuration (70%) • • Unilateral 2/3rd cases • Constitutional symptoms with bubo Blue ball sign / Livid colour of overlying skin over Bubo predicts rupture • • Groove sign of Greenblat (20%)
  14. 14. GROOVE’S SIGN
  15. 15. ‘BLUE-BALL’ SIGN
  16. 16. SECONDARY STAGE • ‘Stage of Diagnosis’ ? Women Dissemination (Rare, hematogenous) • Arthritis • Ocular inflammatory disease • Pneumonitis • Hepatitis • EN / EM
  17. 17. TERTIARY STAGE • • Develops in 25% of untreated GENITO-ANO-RECTAL syndrome, more common in women / MSM Clinical features • • Hyperplastic Ulcerative lesions Proctocolitis • Bloody purulent discharge • Pruritis Ani • Tenessemus
  18. 18. TERTIARY STAGE • Lymphatic tissue hyperplasia (LYMPHORROIDS / PERI-ANAL CONDYLOMAS) • • Chronic Ulceration / Scarring Fistulae / Strictures Mechanisms Peno-Anal Intercourse Posterior Urethral spread Direct Spread from Vaginal Secretions Lymphatic Dissemination by Cx
  19. 19. PROCTO-COLITIS
  20. 20. COMPLICATIONS • Genital Elephantiasis • Ram-rod / Ram-horn / Saxophone Penis
  21. 21. COMPLICATIONS • ESTHIOMENE / Vulval Elephantiasis
  22. 22. COMPLICATIONS • CA RECTUM (2-5%) • EPIDIDYMO-ORCHITIS • PROSTATITIS • SEMINAL VESICULITIS
  23. 23. Extragenital manifestations  Ocular manifestations • Can occur at any stage common with L2 Conjunctivitis, Episcleritis, Keratitis, Iritis Submaxillary, post auricular LN • • •  Cutaneous manifestations Id eruptions Ilio-Psoas Abscess
  24. 24. Differential diagnosis Primary stage      Genital herpes Primary syphilis Chancroid Traumatic ulcer NGU Secondary stage       Chancroid Syphilis Genital herpes Bubonic Plague Tuberculosis Septic LAN
  25. 25. Investigations       Leucocytosis Raised ESR Hyperproteinemia with raised globulin False positive VDRL Microscopy with giemsa stain Frei’s test
  26. 26. Investigations      Microscopy / Identification Gram stain, Giemsa stain, Warthin Starry, Machiavello Isolation Culture on McCoy / HeLa Cell Line (Brown Inclusion bodies) Histopathology – Stellate Abscesses / Gran Infiltrate Serological tests: CFT, PCR, NAAT, IMMUNOFLUORESCENCE CT / MRI, Lymphography
  27. 27. Management  General measures  Medical Cap Doxycycline 100 mg bd Tab Erythromycin 500 mg qid Tab Azithro 1gm/wk  21days Erythromycin 7.5- 12.5 mg/kg qid for 2-3wk for children and pregnant patients
  28. 28.  Surgical Bubo aspiration preferred over I & D Sx - elephantiasis, esthiomene, sinus, fistulae, stricture dilatation  Partner management (All contacts in 60 days) azithromycin 1 gm orally single dose or doxycycline 100 mg BD X 07 days

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