Chapter 174- Granuloma inguinale

Question 1

Rare, chronic progressive ulcerative disease that mainly affects genital and perigenital skin

Answer 1

Granuloma inguinale/Donovanosis

Question 2

Causative agent of GI

Answer 2

Klebsiella granulomatis

Calymmatobacterium granulomatis

Question 3

Confirmatory dx of GI

Answer 3

Demonstration of intracellular Donovan bodies on histology

Question 4

GI is most commonly seen in individuals with ___ socioeconomic status and secually active adults between ages ___

Answer 4

Lower; 20-40 years old

Question 5

All GI cases are sexually transmitted.

True or False

Answer 5

False, GI can occur in sexually inactive adults

Question 6

Transvaginal transmission of GI during delivery can occur.

True or False

Answer 6

True, but rarely

Question 7

Incubation period for GI

Treatment period for Gi

Answer 7

2-3 weeks

3 weeks

Question 8

4 clinical types of GI

Answer 8

Ulcerogranulomatous (MC)
Hypertrophic
Necrotic
Sclerotic

Question 9

Matching type

A.Ulcerogranulomatous
B.Hypertrophic
C.Necrotic
D.Sclerotic

1. Non bleeding ulcers that form fibrous band like scars
2. Resembles condyloma acuminata
3. Highly vascular, beefy red, nontender but bleed to touch
4. Foul-smelling, deep with copious gray exudate
5. Kissing lesions
6. Extensive destruction to surrounding tissues

Answer 9

D
B
A
C
A
C

Question 10

The genital region is affected ___% and inguinal area in ___% and extragenital area in ___%

Answer 10

90%; 10%

Question 11

Most common sites involved in men (3)

Answer 11

Coronal sulcus
Prepuce
Glans penis

Question 12

Most common sites involved in females (3)

Answer 12

Labia minora
Fourchette
Perineum

Question 13

GI involvement of regional lymph nodes presenting as abscess or subcutaneous granuloma that ulcerates

Answer 13

Pseudobubo

Question 14

Sites of extragenital involvement (9)

Answer 14

Nose, cheeks, lips, gums, palate, pharynx, larynx, neck, chest

Question 15

GI presentation in exposed infants (4)

Answer 15

Meningitis
Otitis media
Mastoiditis
Lymphadenitis

Question 16

K. Granulomatis is Gram (___) facultative, nonmotile, pleomorphic bacteria that resides in cytoplasm of mononuclear cells.

Answer 16

Negative

Question 17

K. Granulomatis ___ form is encapsulated, ___ form demonstrates a closed safety pin appearance.

Answer 17

Mature; immature

Question 18

Stains to demonstrate Donovan bodies (4)

Answer 18

Gram
Wright
Giemsa
Silver

Question 19

Used to stain tissue smears for rapid diagnosis

Answer 19

Rapid Giemsa method (Rapid-Diff)

Question 20

Site of biopsy for GI

Answer 20

Advancing edge of the ulcer

Question 21

Cultures and serology play a major role in diagnosis of GI.

True or False

Answer 21

False, neither

Question 22

Culture for GI

Answer 22

Human peripheral mononuclear blood cells (HEp-2)

Question 23

Distinguishing features of GI (3)

Answer 23

Lack of pain
Beefy red appearance
Presence of kissing lesions

Question 24

GI has high rate for spontaneous healing.

True or False

Answer 24

False, no tendency

Question 25

Genital complication of GI (4)

Answer 25

Genital swelling (pseudoelephantiasis) Phimosis Paraphimosis Genital destruction

Question 26

Major risk if untreated GI

Answer 26

Increases risk of HIV transmission

Question 27

Development of carcinoma (SCC) is a serious but rare complication ___%

Answer 27

0.25%

Question 28

Addition of this antibiotic should be considered for Tx resistant cases of GI

Answer 28

Gentamicin 1mg/kg q 8 hrs

Question 29

Children with GI or born to mothers with GI should be treated with

Answer 29

Azithromycin 20mkday for 3 days

Question 30

Relapse may occur __ mos after effective therapy hence requiring long ff up

Answer 30

6-18 mos

Question 31

Complications of long standing cases (2)

Answer 31

Fistula | Abscess formation

Question 32

All sexual contacts in the previous __ months should be screened and examined

Answer 32

6 months

Question 33

Treatment of asymptomatic sexual partners of GI is necessary. True or False

Answer 33

False, not necessary

Question 34

CDC recommendation for GI (2015)

Answer 34

Azithromycin 1g PO once weekly | Or 500 mg daily for 3 weeks

Question 35

WHO recommendation for GI (2003)

Answer 35

Azithromycin 1g PO once Then 500 mg daily for 3 weeks OR Doxycycline 100 mg BID for 3 weeks

Question 36

Alternative WHO regimen for GI (4)

Answer 36

``` 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 ```

Question 37

Alternative Tx regimen for WHO (2003) (3)

Answer 37

``` Erythromycin 500 mg PO QID Or TMP-SMX (160mg/800mg) PO BID for 14 days Or Tetracycline 500 mg QID ```