Klebsiella granulomatis

Background

• Also called granuloma inguinale or donovanosis

Microbiology

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

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

Clinical Manifestation

• Incubation period is unclear, possibly somewhere between 3 to 40 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 or verrucous: irregular edge, sometimes dry
  • Necrotic: deep ulcer causing tissue destruction
  • Dry, sclerotic, or cicatricial: fibrous with scar tissue

Differential Diagnosis

• Refer to genital ulcer disease