Klebsiella granulomatis: Difference between revisions
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Klebsiella granulomatis
(Created page with "{{DISPLAYTITLE:''Klebsiella granulomatis''}} == Background == * Also called granuloma inguinale or donovanosis === Microbiology === * Stain::Gram-negative Cellular s...") |
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{{DISPLAYTITLE:''Klebsiella granulomatis''}} |
{{DISPLAYTITLE:''Klebsiella granulomatis''}} |
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− | == |
+ | ==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 |
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+ | *Major complication is [[squamous cell carcinoma]] |
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− | == |
+ | ==Differential Diagnosis== |
− | * |
+ | *Refer to [[genital ulcer disease]] |
+ | *Also includes [[squamous cell carcinoma]] of the penis |
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+ | |||
+ | == Diagnosis == |
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+ | |||
+ | * Direct microscopy |
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+ | ** Swab rolled across lesion then across a slide |
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+ | ** Stain with Giemsa, which should show large mononuclear cells with intracytoplasmic cysts fillwed with Gram-negative Donovan bodies |
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+ | * Culture not available |
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+ | * PCR where available |
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+ | * Serology not reliable |
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+ | |||
+ | == Management == |
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+ | |||
+ | * Test for other [[Sexually-transmitted infection|sexually-transmitted infections]] |
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+ | * [[Is treated by::Azithromycin]] 1 g PO weekly (or 500 mg PO daily) for at least 3 weeks and until lesion is healed |
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+ | ** Second-line is [[TMP-SMX]] 160/800 mg PO bid or [[doxycycline]] 100 mg PO bid |
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+ | ** In pregnancy, can use [[erythromycin]] 500 mg PO qid |
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+ | ** Can add adjunctive [[gentamicin]] 1 mg/kg q8h if the lesion is slow to heal |
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+ | ** In children, [[azithromycin]] 20 mg/kg |
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+ | * If it does not heal, it may need biopsy to exclude [[squamous cell carcinoma]] |
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+ | |||
+ | == Prevention == |
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+ | |||
+ | === Neonatal Infection === |
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+ | |||
+ | * To prevent neonatal acquisition, children born to mothers with donovanosis should be prophylactically treated with [[azithromycin]] 20 mg/kg PO daily for 3 days |
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+ | |||
+ | == Further Reading == |
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+ | |||
+ | * 2016 European guideline on donovanosis. ''Int J STD AIDS''. 2016;27(8):605-607. doi: [https://doi.org/10.1177/0956462416633626 10.1177/0956462416633626] |
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[[Category:Gram-negative bacilli]] |
[[Category:Gram-negative bacilli]] |
Revision as of 21:50, 7 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
Further Reading
- 2016 European guideline on donovanosis. Int J STD AIDS. 2016;27(8):605-607. doi: 10.1177/0956462416633626