Donovanosis
Encyclopedia
Granuloma inguinale is a bacteria
l disease
caused by K. granulomatis
characterized by ulcerative genital lesion
s. It is endemic
in many less developed regions. It is also known as donovanosis, granuloma genitoinguinale, granuloma inguinale tropicum, granuloma venereum, granuloma venereum genitoinguinale, lupoid form of groin ulceration, serpiginous ulceration of the groin, ulcerating granuloma of the pudendum and ulcerating sclerosing granuloma. The disease often goes untreated because of the scarcity of medical treatment in the countries in which it is found. In addition, the painless genital ulcers can be mistaken for syphilis
. The ulcers ultimately progress to destruction of internal and external tissue, with extensive leakage of mucus
and blood
from the highly vascular
lesions. The destructive nature of donovanosis also increases the risk of superinfection
by other pathogen
ic microbes.
is a nodular type of inflammatory
reaction, and inguinale refers to the inguinal
region, which is commonly involved in this infection. The disease is commonly known as donovanosis, after the Donovan bodies which are a diagnostic sign.
The causative organism, Klebsiella granulomatis
, used to be called Calymmatobacterium granulomatis, and some sources still use this classification, from the Greek kalymma (a hood or veil), referring to the lesions that contain the bacteria. Prior to this it was called Donovania granulomatis, named after the Donovan bodies. The species
name granulomatis refers to the granulomatous lesions. The organism was recently reclassified under the genus
Klebsiella, a drastic taxonomic
change, since it involved changing the organism's phylum
. However, polymerase chain reaction
(PCR) techniques using a colorimetric
detection system showed a 99% similarity with other species in the Klebsiella genus.
spreads, mutilating the infected tissue. The infection will continue to destroy the tissue until treated. The lesions occur at the region of contact typically found on the shaft of the penis
, the labia, or the perineum
. Rarely, the vagina
l wall or cervix
is the site of the lesion. At least one case in India
led to partial auto-amputation
of the penis. The patient tested positive for HIV
-2 and had been infected for six years.
is based on the patient's sexual history and on physical examination revealing a painless, "beefy-red ulcer" with a characteristic rolled edge of granulation tissue
. In contrast to syphilitic ulcers, inguinal lymphadenopathy
is generally absent. Tissue biopsy
and Wright-Giemsa stain is used to aid in the diagnosis. The presence of Donovan bodies in the tissue sample confirms donovanosis. Donovan bodies are rod-shaped, oval organisms that can be seen in the cytoplasm
of mononuclear phagocytes or histiocyte
s in tissue samples from patients with granuloma inguinale. They appear deep purple when stained with Wright's stain
. These intracellular inclusions are the encapsulated gram-negative rods of the causative organisms. They were discovered by Charles Donovan
.
, streptomycin
, or tetracycline, or 12 weeks of treatment with ampicillin
are standard forms of therapy. Normally, the infection will begin to subside within a week of treatment, but the full treatment period must be followed in order to minimize the possibility of relapse.
, have a very low incidence of donovanosis, approximately 100 cases reported each year in the United States. However, sexual contacts with individuals in endemic regions dramatically increases the risk of contracting the disease. Avoidance of these sexual contacts, and sexually transmitted disease
(STD) testing before beginning a sexual relationship, are effective preventative measures for donovanosis.
Bacteria
Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...
l disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
caused by K. granulomatis
Klebsiella granulomatis
Klebsiella granulomatis is Gram-negative, rod shaped bacteria of the genus Klebsiella known to cause the sexually transmitted disease Donovanosis. It used to be called Calymmatobacterium granulomatis....
characterized by ulcerative genital lesion
Lesion
A lesion is any abnormality in the tissue of an organism , usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.- Types :...
s. It is endemic
Endemic (epidemiology)
In epidemiology, an infection is said to be endemic in a population when that infection is maintained in the population without the need for external inputs. For example, chickenpox is endemic in the UK, but malaria is not...
in many less developed regions. It is also known as donovanosis, granuloma genitoinguinale, granuloma inguinale tropicum, granuloma venereum, granuloma venereum genitoinguinale, lupoid form of groin ulceration, serpiginous ulceration of the groin, ulcerating granuloma of the pudendum and ulcerating sclerosing granuloma. The disease often goes untreated because of the scarcity of medical treatment in the countries in which it is found. In addition, the painless genital ulcers can be mistaken for syphilis
Syphilis
Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...
. The ulcers ultimately progress to destruction of internal and external tissue, with extensive leakage of mucus
Mucus
In vertebrates, mucus is a slippery secretion produced by, and covering, mucous membranes. Mucous fluid is typically produced from mucous cells found in mucous glands. Mucous cells secrete products that are rich in glycoproteins and water. Mucous fluid may also originate from mixed glands, which...
and blood
Blood
Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....
from the highly vascular
Vascular
Vascular in zoology and medicine means "related to blood vessels", which are part of the circulatory system. An organ or tissue that is vascularized is heavily endowed with blood vessels and thus richly supplied with blood....
lesions. The destructive nature of donovanosis also increases the risk of superinfection
Superinfection
In virology, superinfection is the process by which a cell, that has previously been infected by one virus, gets coinfected with a different strain of the virus, or another virus at a later point in time. Viral superinfections of serious conditions can lead to resistant strains of the virus, which...
by other pathogen
Pathogen
A pathogen gignomai "I give birth to") or infectious agent — colloquially, a germ — is a microbe or microorganism such as a virus, bacterium, prion, or fungus that causes disease in its animal or plant host...
ic microbes.
Classification and terminology
The first known name for this condition was "serpiginous ulcer", which dates to 1882. The proper clinical designation for donovanosis is now "granuloma inguinale". A granulomaGranuloma
Granuloma is a medical term for a tiny collection of immune cells known as macrophages. Granulomas form when the immune system attempts to wall off substances that it perceives as foreign but is unable to eliminate. Such substances include infectious organisms such as bacteria and fungi as well as...
is a nodular type of inflammatory
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
reaction, and inguinale refers to the inguinal
Inguinal
In human anatomy, the inguinal region refers to either the groin or the lower lateral regions of the abdomen. It may also refer to:* Conjoint tendon, previously known as the inguinal aponeurotic falx, a structure formed from the transversus abdominis insertion into the pecten pubis* Granuloma...
region, which is commonly involved in this infection. The disease is commonly known as donovanosis, after the Donovan bodies which are a diagnostic sign.
The causative organism, Klebsiella granulomatis
Klebsiella granulomatis
Klebsiella granulomatis is Gram-negative, rod shaped bacteria of the genus Klebsiella known to cause the sexually transmitted disease Donovanosis. It used to be called Calymmatobacterium granulomatis....
, used to be called Calymmatobacterium granulomatis, and some sources still use this classification, from the Greek kalymma (a hood or veil), referring to the lesions that contain the bacteria. Prior to this it was called Donovania granulomatis, named after the Donovan bodies. The species
Species
In biology, a species is one of the basic units of biological classification and a taxonomic rank. A species is often defined as a group of organisms capable of interbreeding and producing fertile offspring. While in many cases this definition is adequate, more precise or differing measures are...
name granulomatis refers to the granulomatous lesions. The organism was recently reclassified under the genus
Genus
In biology, a genus is a low-level taxonomic rank used in the biological classification of living and fossil organisms, which is an example of definition by genus and differentia...
Klebsiella, a drastic taxonomic
Biological classification
Biological classification, or scientific classification in biology, is a method to group and categorize organisms by biological type, such as genus or species. Biological classification is part of scientific taxonomy....
change, since it involved changing the organism's phylum
Phylum
In biology, a phylum The term was coined by Georges Cuvier from Greek φῦλον phylon, "race, stock," related to φυλή phyle, "tribe, clan." is a taxonomic rank below kingdom and above class. "Phylum" is equivalent to the botanical term division....
. However, polymerase chain reaction
Polymerase chain reaction
The polymerase chain reaction is a scientific technique in molecular biology to amplify a single or a few copies of a piece of DNA across several orders of magnitude, generating thousands to millions of copies of a particular DNA sequence....
(PCR) techniques using a colorimetric
Colorimetry (chemical method)
In physical and analytical chemistry, colorimetry or colourimetry is a technique "used to determine the concentration of colored compounds in solution."...
detection system showed a 99% similarity with other species in the Klebsiella genus.
Symptoms
Small, painless nodules appear after about 10–40 days of the contact with the bacteria. Later the nodules burst, creating open, fleshy, oozing lesions. The infectionInfection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
spreads, mutilating the infected tissue. The infection will continue to destroy the tissue until treated. The lesions occur at the region of contact typically found on the shaft of the penis
Penis
The penis is a biological feature of male animals including both vertebrates and invertebrates...
, the labia, or the perineum
Anus
The anus is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, unwanted semi-solid matter produced during digestion, which, depending on the type of animal, may be one or more of: matter which the animal cannot digest,...
. Rarely, the vagina
Vagina
The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...
l wall or cervix
Cervix
The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall...
is the site of the lesion. At least one case in India
India
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...
led to partial auto-amputation
Amputation
Amputation is the removal of a body extremity by trauma, prolonged constriction, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for...
of the penis. The patient tested positive for HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
-2 and had been infected for six years.
Transmission
The microorganism spreads from one host to another through contact with the open sores.Diagnosis
The diagnosisDiagnosis
Diagnosis is the identification of the nature and cause of anything. Diagnosis is used in many different disciplines with variations in the use of logics, analytics, and experience to determine the cause and effect relationships...
is based on the patient's sexual history and on physical examination revealing a painless, "beefy-red ulcer" with a characteristic rolled edge of granulation tissue
Granulation tissue
Granulation tissue is the perfused, fibrous connective tissue that replaces a fibrin clot in healing wounds. Granulation tissue typically grows from the base of a wound and is able to fill wounds of almost any size it heals...
. In contrast to syphilitic ulcers, inguinal lymphadenopathy
Lymphadenopathy
Lymphadenopathy is a term meaning "disease of the lymph nodes." It is, however, almost synonymously used with "swollen/enlarged lymph nodes". It could be due to infection, auto-immune disease, or malignancy....
is generally absent. Tissue biopsy
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
and Wright-Giemsa stain is used to aid in the diagnosis. The presence of Donovan bodies in the tissue sample confirms donovanosis. Donovan bodies are rod-shaped, oval organisms that can be seen in the cytoplasm
Cytoplasm
The cytoplasm is a small gel-like substance residing between the cell membrane holding all the cell's internal sub-structures , except for the nucleus. All the contents of the cells of prokaryote organisms are contained within the cytoplasm...
of mononuclear phagocytes or histiocyte
Histiocyte
A histiocyte is a cell that is part of the mononuclear phagocyte system . The mononuclear phagocytic system is part of the organism's immune system...
s in tissue samples from patients with granuloma inguinale. They appear deep purple when stained with Wright's stain
Wright's stain
Wright's stain is a histologic stain that facilitates the differentiation of blood cell types. It is used primarily to stain peripheral blood smears and bone marrow aspirates which are examined under a light microscope...
. These intracellular inclusions are the encapsulated gram-negative rods of the causative organisms. They were discovered by Charles Donovan
Charles Donovan
Colonel Charles Donovan MD was born in Calcutta. At the age of thirteen he was sent to Cork City to live with his grandfather to advance his secondary and university education. He studied at Queen's College, Cork and Trinity College, Dublin Colonel Charles Donovan MD (1863–1951) was born in...
.
Treatment
Three weeks of treatment with erythromycinErythromycin
Erythromycin is a macrolide antibiotic that has an antimicrobial spectrum similar to or slightly wider than that of penicillin, and is often used for people who have an allergy to penicillins. For respiratory tract infections, it has better coverage of atypical organisms, including mycoplasma and...
, streptomycin
Streptomycin
Streptomycin is an antibiotic drug, the first of a class of drugs called aminoglycosides to be discovered, and was the first antibiotic remedy for tuberculosis. It is derived from the actinobacterium Streptomyces griseus. Streptomycin is a bactericidal antibiotic. Streptomycin cannot be given...
, or tetracycline, or 12 weeks of treatment with ampicillin
Ampicillin
Ampicillin is a beta-lactam antibiotic that has been used extensively to treat bacterial infections since 1961. Until the introduction of ampicillin by the British company Beecham, penicillin therapies had only been effective against Gram-positive organisms such as staphylococci and streptococci...
are standard forms of therapy. Normally, the infection will begin to subside within a week of treatment, but the full treatment period must be followed in order to minimize the possibility of relapse.
Prevention
The disease is effectively treated with antibiotics, therefore, developed countries, like the United StatesUnited States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, have a very low incidence of donovanosis, approximately 100 cases reported each year in the United States. However, sexual contacts with individuals in endemic regions dramatically increases the risk of contracting the disease. Avoidance of these sexual contacts, and sexually transmitted disease
Sexually transmitted disease
Sexually transmitted disease , also known as a sexually transmitted infection or venereal disease , is an illness that has a significant probability of transmission between humans by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex...
(STD) testing before beginning a sexual relationship, are effective preventative measures for donovanosis.
External links
- Gavin Hart MD, MPH Transcript of the lecture given at the Australian Society for Infectious Diseases/Australasian College of Tropical Medicine Conference at Palm Cove (Cairns), Queensland on 19 April 1999.
- Research supporting Klebsiella Genus classification
- http://www.epigee.org/health/granu_ingui.html
- http://www.healthatoz.com/healthatoz/Atoz/ency/granuloma_inguinale.jsp
- http://www.indepthlearning.org/std/STDnew.php/76C.html
- http://www.stdservices.on.net/publications/pdf/donovanosis.pdf
- http://www.fasthealth.com/dictionary/c/Calymmatobacterium.php
- Resource Library:Granuloma inguinale
- http://www.bacterio.cict.fr/e/enterobacteriaceae.html
- http://www.mansfield.ohio-state.edu/~sabedon/biol3018.htm
- http://www.dscc.edu/bwilliams/Biology/Monera.htm