Klebsiella granulomatis: Difference between revisions
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Klebsiella granulomatis
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===Microbiology=== |
===Microbiology=== |
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*Previously known as ''Donovania granulomatis'' and ''Calymmatobacterium granulomatis'' |
*Previously known as ''Donovania granulomatis'' and ''Calymmatobacterium granulomatis'' |
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Latest revision as of 05:50, 12 October 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
