Klebsiella granulomatis: Difference between revisions

Revision as of 01:50, 8 August 2020

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

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 infections
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

@@ Line 1: / Line 1: @@
 {{DISPLAYTITLE:''Klebsiella granulomatis''}}
-== Background ==
+==Background==
-* Also called granuloma inguinale or donovanosis
+*Also called granuloma inguinale, donovanosis, granuloma venereum
-=== Microbiology ===
+===Microbiology===
-* [[Stain::Gram-negative]] [[Cellular shape::bacillus]]
+*[[Stain::Gram-negative]] [[Cellular shape::bacillus]]
-* Previously known as ''Donovania granulomatis'' and ''Calymmatobacterium granulomatis''
+*Previously known as ''Donovania granulomatis'' and ''Calymmatobacterium granulomatis''
-=== Epidemiology ===
+===Epidemiology===
-* Essentially worldwide in low- and middle-income countries, but high rates in Papua New Guinea, KwaZulu-Natal and eastern Transvaal in South Africa, India, Brazil, and among Aboriginal Australians
+*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 ==
+==Clinical Manifestation==
-* Incubation period is unclear, possibly somewhere between [[Usual incubation period::3 to 40 days]] with a wide range from [[Incubation period range::1 to 360 days]]
+*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
+*Presents as a firm papule or subcutaneous nodule that eventually ulcerates
-** Almost all in genitals, but 10% can be inguinal
+**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
+**Case reports of extragenital lesions in lips, gums, cheeks, palate, pharynx, neck, nose, larynx, and chest
-* Four types:
+*Four types:
-** Ulcerogranulamatous: most common type, shows as a beefy red, non-tender ulcer that bleed
+**Ulcerogranulamatous: most common type, shows as a beefy red, non-tender ulcer that bleed
-** Hypertrophic or verrucous: irregular edge, sometimes dry
+**Hypertrophic: raised, irregular edge, sometimes dry
-** Necrotic: deep ulcer causing tissue destruction
+**Necrotic: deep ulcer causing tissue destruction and foul odor
-** Dry, sclerotic, or cicatricial: fibrous with scar tissue
+**Sclerotic: fibrous with scar tissue
+*Rarely disseminates to liver and bone
+*Major complication is [[squamous cell carcinoma]]
-== Differential Diagnosis ==
+==Differential Diagnosis==
-* Refer to [[genital ulcer disease]]
+*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]
 [[Category:Gram-negative bacilli]]