Granuloma Inguinale

Front 1

What is Granuloma inguinale?

Back 1

A chronic and progressively destructive, but poorly communicable bacterial disease of the skin and mucous membranes of the external genitalia, inguinal and anal regions.

Front 2

Where are the lesions usually found?

Back 2

Lesions occur most commonly in warm, moist surfaces such as the folds between the thighs, the perianal area, the scrotum, or the vulvar labia and vagina. The genitalia are involved in close to 90% of cases, the inguinal region in
close to 10%, the anal region in 5%–10% and distant sites in 1%–5%.

Front 3

How is Granuloma inguinale identified?

Back 3

Intracytoplasmic rod shaped organisms (Donovan bodies) in Wright- or Giemsa-stained smears
of granulation tissue or on histological examination of biopsy specimens. the presence of large infected mononuclear cells filled with deeply staining Donovan bodies is pathognomonic.

Front 4

What is the infectious agent?

Back 4

Klebsiella granulomatis (Donovania granulomatis, Calymmatobacterium granulomatis), a Gram-negative bacillus, is the presumed causal agent this is not certain.

Front 5

What is the occurrence?

Back 5

Rare in industrialized countries, but cluster outbreaks occasionally occur. Endemic in tropical and subtropical areas, such as central and northern Australia, southern India, Papua New Guinea, Viet Nam; occasionally in Latin America, the Caribbean islands and central, eastern and southern Africa. It is more frequently seen among males than females and among people of lower socioeconomic status; it may occur in children aged 1–4 years but is predominantly seen at ages 20–40.

Front 6

What is the reservoir?

Back 6

Humans

Front 7

What is the mode of transmission?

Back 7

Presumably by direct contact with lesions during sexual activity, but in various studies only 20%–65% of sexual partners were infected, thus not quite fulfilling the criteria for sexual transmission. Donovanosis occurs in sexually inactive individuals and the very young, suggesting that some cases are transmitted nonsexually.

Front 8

What is the incubation period?

Back 8

Unknown; probably between 1 and 16 weeks

Front 9

What is the period of communicability?

Back 9

Unknown; probably for the duration
of open lesions on the skin or mucous membranes.

Front 10

WHat is the susceptibility and resistance?

Back 10

Susceptibility is variable; immunity
apparently does not follow attack.

Front 11

What are the preventive measures?

Back 11

Except for those measures applicable only to syphilis, preventive measures are those for Syphilis, 9A. Educational programs in endemic areas should stress the importance of early diagnosis and treatment.

Front 12

Report to local health authority

Back 12

A reportable disease in most
states and countries, Class 3

Front 13

What is the specific treatment?

Back 13

Azithromycin is effective and its long tissue half-life allows a flexible dosing regimen and short course treatment. Erythromycin, trimethoprim-sufamethoxazole and doxycycline have been reported to be effective but drug-resistant strains of the organism occur. Treatment is continued for 3 weeks or until the lesions have resolved;
recurrence is not rare but usually responds to a repeat course unless malignancy is present. Single dose treatment with ceftriaxone IM or ciprofloxacin PO are anecdotally reported to be effective.