Klebsiella granulomatis

From IDWiki
Klebsiella granulomatis

Background

  • Also called granuloma inguinale, donovanosis, granuloma venereum

Microbiology

  • Gram-negative bacillus
  • Previously known as Donovania granulomatis and Calymmatobacterium granulomatis

Epidemiology

  • Rare, with most cases in Papua New Guinea, KwaZulu-Natal and eastern Transvaal in South Africa, India, Brazil, and Aboriginal communities in Australia

Clinical Manifestation

  • Incubation period is unclear, possibly somewhere between 50 days with a wide range from 1 to 360 days
  • Presents as a firm papule or subcutaneous nodule that eventually ulcerates
    • Almost all in genitals, but 10% can be inguinal
    • Case reports of extragenital lesions in lips, gums, cheeks, palate, pharynx, neck, nose, larynx, and chest
  • Four types:
    • Ulcerogranulamatous: most common type, shows as a beefy red, non-tender ulcer that bleed
    • Hypertrophic: raised, irregular edge, sometimes dry
    • Necrotic: deep ulcer causing tissue destruction and foul odor
    • Sclerotic: fibrous with scar tissue
  • Rarely disseminates to liver and bone
  • Major complication is squamous cell carcinoma

Differential Diagnosis

Diagnosis

  • Direct microscopy
    • Swab rolled across lesion then across a slide
    • Stain with Giemsa, which should show large mononuclear cells with intracytoplasmic cysts fillwed with Gram-negative Donovan bodies
  • Culture not available
  • PCR where available
  • Serology not reliable

Management

Prevention

Neonatal Infection

  • To prevent neonatal acquisition, children born to mothers with donovanosis should be prophylactically treated with azithromycin 20 mg/kg PO daily for 3 days

Further Reading