View source for Klebsiella granulomatis

==Background==

*Also called granuloma inguinale, donovanosis, granuloma venereum

===Microbiology===

*[[Stain::Gram-negative]] [[Cellular shape::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 [[Usual incubation period::50 days]] with a wide range from [[Incubation period range::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==

*Refer to [[genital ulcer disease]]
*Also includes [[squamous cell carcinoma]] of the penis

== 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 ==

* Test for other [[Sexually-transmitted infection|sexually-transmitted infections]]
* [[Is treated by::Azithromycin]] 1 g PO weekly (or 500 mg PO daily) for at least 3 weeks and until lesion is healed
** Second-line is [[TMP-SMX]] 160/800 mg PO bid or [[doxycycline]] 100 mg PO bid
** In pregnancy, can use [[erythromycin]] 500 mg PO qid
** Can add adjunctive [[gentamicin]] 1 mg/kg q8h if the lesion is slow to heal
** In children, [[azithromycin]] 20 mg/kg
* If it does not heal, it may need biopsy to exclude [[squamous cell carcinoma]]

== 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 ==

* 2016 European guideline on donovanosis. ''Int J STD AIDS''. 2016;27(8):605-607. doi: [https://doi.org/10.1177/0956462416633626 10.1177/0956462416633626]

{{DISPLAYTITLE:''Klebsiella granulomatis''}}

[[Category:Gram-negative bacilli]]
[[Category:Infectious diseases]]