Chapter 174- Granuloma inguinale Flashcards
Rare, chronic progressive ulcerative disease that mainly affects genital and perigenital skin
Granuloma inguinale/Donovanosis
Causative agent of GI
Klebsiella granulomatis
Calymmatobacterium granulomatis
Confirmatory dx of GI
Demonstration of intracellular Donovan bodies on histology
GI is most commonly seen in individuals with ___ socioeconomic status and secually active adults between ages ___
Lower; 20-40 years old
All GI cases are sexually transmitted.
True or False
False, GI can occur in sexually inactive adults
Transvaginal transmission of GI during delivery can occur.
True or False
True, but rarely
Incubation period for GI
Treatment period for Gi
2-3 weeks
3 weeks
4 clinical types of GI
Ulcerogranulomatous (MC)
Hypertrophic
Necrotic
Sclerotic
Matching type
A.Ulcerogranulomatous
B.Hypertrophic
C.Necrotic
D.Sclerotic
- Non bleeding ulcers that form fibrous band like scars
- Resembles condyloma acuminata
- Highly vascular, beefy red, nontender but bleed to touch
- Foul-smelling, deep with copious gray exudate
- Kissing lesions
- Extensive destruction to surrounding tissues
D B A C A C
The genital region is affected ___% and inguinal area in ___% and extragenital area in ___%
90%; 10%
Most common sites involved in men (3)
Coronal sulcus
Prepuce
Glans penis
Most common sites involved in females (3)
Labia minora
Fourchette
Perineum
GI involvement of regional lymph nodes presenting as abscess or subcutaneous granuloma that ulcerates
Pseudobubo
Sites of extragenital involvement (9)
Nose, cheeks, lips, gums, palate, pharynx, larynx, neck, chest
GI presentation in exposed infants (4)
Meningitis
Otitis media
Mastoiditis
Lymphadenitis
K. Granulomatis is Gram (___) facultative, nonmotile, pleomorphic bacteria that resides in cytoplasm of mononuclear cells.
Negative
K. Granulomatis ___ form is encapsulated, ___ form demonstrates a closed safety pin appearance.
Mature; immature
Stains to demonstrate Donovan bodies (4)
Gram
Wright
Giemsa
Silver
Used to stain tissue smears for rapid diagnosis
Rapid Giemsa method (Rapid-Diff)
Site of biopsy for GI
Advancing edge of the ulcer
Cultures and serology play a major role in diagnosis of GI.
True or False
False, neither
Culture for GI
Human peripheral mononuclear blood cells (HEp-2)
Distinguishing features of GI (3)
Lack of pain
Beefy red appearance
Presence of kissing lesions
GI has high rate for spontaneous healing.
True or False
False, no tendency
Genital complication of GI (4)
Genital swelling (pseudoelephantiasis)
Phimosis
Paraphimosis
Genital destruction
Major risk if untreated GI
Increases risk of HIV transmission
Development of carcinoma (SCC) is a serious but rare complication ___%
0.25%
Addition of this antibiotic should be considered for Tx resistant cases of GI
Gentamicin 1mg/kg q 8 hrs
Children with GI or born to mothers with GI should be treated with
Azithromycin 20mkday for 3 days
Relapse may occur __ mos after effective therapy hence requiring long ff up
6-18 mos
Complications of long standing cases (2)
Fistula
Abscess formation
All sexual contacts in the previous __ months should be screened and examined
6 months
Treatment of asymptomatic sexual partners of GI is necessary.
True or False
False, not necessary
CDC recommendation for GI (2015)
Azithromycin 1g PO once weekly
Or 500 mg daily for 3 weeks
WHO recommendation for GI (2003)
Azithromycin 1g PO once
Then 500 mg daily for 3 weeks
OR
Doxycycline 100 mg BID for 3 weeks
Alternative WHO regimen for GI (4)
Doxycycline 100 mg BID for 3 weeks Or Erythromycin 500 mg PO QID Or TMP-SMX (160mg/800mg) PO BID Or Ciprofloxacin 750 mg BID
Alternative Tx regimen for WHO (2003) (3)
Erythromycin 500 mg PO QID Or TMP-SMX (160mg/800mg) PO BID for 14 days Or Tetracycline 500 mg QID
