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==Overview==
==Overview==
Clinically, the disease is commonly characterized as painless, progressive ulcerative lesions without regional [[lymphadenopathy]].
Donovanosis is commonly characterized as painless, progressive ulcerative lesions without regional [[lymphadenopathy]]. Patients in later stages may present with scarring, [[elephantiasis]]-like swelling of [[genitals]] or perianal area, or stenosis of the [[urethra]], [[vagina]], or [[anus]]. Typical lesion characteristics include: beefy red color, nontender, emitting rank odor, elevated above skin, smooth and rolled edge, serpiginous outline. Physical examination of lesions can classify donovanosis into ulcerogranulomatous, hypertrophic, necrotic, and sclerotic variants. Common locations in males include: [[coronal sulcus]], [[Prepuce|subpreputial]] region, and [[anus]]. Common locations in females include: [[labia minora]], [[cervix]], and [[fourchette]].
 
==Physical Examination==
==Physical Examination==
Clinically, the disease is commonly characterized as painless, progressive ulcerative lesions without regional [[lymphadenopathy]]. The lesions are highly vascular (i.e., beefy red appearance) and bleed easily on contact. However, the clinical presentation also can include hypertrophic, necrotic, or sclerotic variants.
*In early stages donovanosis commonly presents as a nontender, progressive [[Ulcer|ulcerative]] lesions without regional [[lymphadenopathy]].<ref name="O'Farrell" />
:*90% of cases involve [[genital]] region
:*10% of cases involve [[inguinal]] region
*Patients in late stages present with the following signs:<ref name="VelhoSouza2008">{{cite journal|last1=Velho|first1=Paulo Eduardo Neves Ferreira|last2=Souza|first2=Elemir Macedo de|last3=Belda Junior|first3=Walter|title=Donovanosis|journal=Brazilian Journal of Infectious Diseases|volume=12|issue=6|year=2008|issn=1413-8670|doi=10.1590/S1413-86702008000600015}}</ref>
:*Scarring
:*[[Elephantiasis]]-like swelling
:*[[Stenosis]] of the [[urethra]], [[vagina]], or [[anus]]
 
===Typical Lesion Characteristics===
*Beefy red color
*Nontender
*Emit rank odor
*Elevated above skin
*Smooth, rolled edge
*Serpiginous outline<ref name="Richens">{{cite journal| author=Richens J| title=The diagnosis and treatment of donovanosis (granuloma inguinale). | journal=Genitourin Med | year= 1991 | volume= 67 | issue= 6 | pages= 441-52 | pmid=1774048 | doi= | pmc=PMC1194766 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1774048  }} </ref>
 
Four variants can be further classified according to their clinical presentation:<ref name="O'Farrell">{{cite journal| author=O'Farrell N| title=Donovanosis. | journal=Sex Transm Infect | year= 2002 | volume= 78 | issue= 6 | pages= 452-7 | pmid=12473810 | doi= | pmc=PMC1758360 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12473810  }} </ref>
{| style="font-size: 85%;"
! style="width: 160px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Type}}
! style="width: 300px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Clinical Appearance}}
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | '''Ulcerogranulomatous'''
| style="background: #F5F5F5; padding: 5px;" | beefy red, non-tender, bleeds easily
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | '''Hypertrophic or Verrucous'''
| style="background: #F5F5F5; padding: 5px;" | irregular edge, dry
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | '''Necrotic'''
| style="background: #F5F5F5; padding: 5px;" | foul smelling, deep, tissue destruction
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | '''Sclerotic'''
| style="background: #F5F5F5; padding: 5px;" | dry, cicatricial, fibrous scar tissue
|}
 
===Common Locations in Males===
*[[Coronal sulcus]]
*[[Prepuce|Subpreputial]] region
*[[Anus]]<ref name=" O'Farrell"></ref>
 
===Common Locations in Females===
*[[Labia minora]]
*[[Cervix]]
*[[Fourchette]]<ref name=" O'Farrell"></ref>
 
===Extragenital Lesion Locations===
Extragenital lesions occur in 6% of patients, typically in the following locations:<ref name="Richens" />
:*[[Mouth (human)|mouth]]
:*[[cheek]]
:*[[neck]]
:*[[pharynx]]
:*[[larynx]]
:*[[nose]]
:*[[thorax]]
 
==Gallery==
<gallery>
<gallery>
Image:SOA-Donovanosis-male.jpg|Genital ulcer in a male patient with Donovanosis.<SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>


Image:SOA-Donovanosis-male.jpg|Genital ulcer in a male patient with Donovanosis.
File:SOA-Donovanosis-female.jpg|Genital ulcer in a female patient with Donovanosis.<SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
File:SOA-Donovanosis-female.jpg|Genital ulcer in a female patient with Donovanosis.


</gallery>
====Skin====
=====Genitalia=====
<gallery>
Image:Donovanosis01.jpg|Donovanosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Donovanosis01.jpg|Donovanosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>


Image:Enterobacteria62.jpeg|Granuloma inguinale, or Donovanosis, accompanied by perianal skin ulceration due to the bacterium, Klebsiella granulomatis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Enterobacteria54.jpeg|Donovanosis of penis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Enterobacteria53.jpeg|Donovanosis of penis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Enterobacteria51.jpeg|Preputial granulomatous lesion due to Donovanosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Enterobacteria49.jpeg|Bilaterally infected inguinal lymph nodes due to a Calymmatobacterium granulomatis bacteria. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image: Granuloma inguinale11.jpeg| This patient presented with a case of systemically disseminated Donovanosis of the ankle due to C. granulomatis bacteria. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Granuloma inguinale10.jpeg| This male presented with a penile lesion that was found to be granuloma inguinale, also called “genital ulcerative disease”. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Granuloma inguinale09.jpeg| This male presented with a penile lesion of roughly 40 days duration that was determined to be granuloma inguinale. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Granuloma inguinale08.jpeg| This 19 year old woman presented with an perianal granuloma inguinale lesion of about 8 months duration. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Granuloma inguinale07.jpeg| This patient presented with an ulcerated glans penis due to Donovanosis, or granuloma inguinale. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Granuloma inguinale06.jpeg| This image depicts an intravaginal view revealing a cervical lesion, which had been diagnosed as a case of Donovanosis, also known as granuloma inguinale. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Granuloma inguinale05.jpeg| This image depicts the penis of a male with its foreskin retracted, revealing a suppurative lesion involving the glans and prepuce.  <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Granuloma inguinale03.jpeg| This image depicts the penis of a male patient who had presented with a lesion located on the lateral preputial skin just proximal to the corona of the glans. The lesion was characterized as a penile granulomata, due to a case of Donovanosis, or granuloma inguinale.  <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Granuloma inguinale02.jpeg| This patient showed manifestations of granuloma inguinale, also known as Donovanosis, involving swelling and subcutaneous granulomas of the inguinal lymph nodes, bilaterally.  <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Granuloma inguinale01.jpeg| This was a very large erosive cutaneous lesion in the perineal region of this patient, which had been diagnosed as Donovanosis, otherwise known as granuloma inguinale.  <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
</gallery>
</gallery>


==References==
==References==
<references/>
{{reflist|2}}


[[Category:Sexually transmitted infections]]
[[Category:Sexually transmitted infections]]
[[Category:Bacterial diseases]]
[[Category:Bacterial diseases]]
[[Category:Infectious disease]]
 
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Latest revision as of 17:37, 18 September 2017

Donovanosis Microchapters

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Patient Information

Overview

Historical Perspective

Pathophysiology

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Classification

Differentiating Donovanosis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]; Kiran Singh, M.D. [3]; Nate Michalak, B.A.

Overview

Donovanosis is commonly characterized as painless, progressive ulcerative lesions without regional lymphadenopathy. Patients in later stages may present with scarring, elephantiasis-like swelling of genitals or perianal area, or stenosis of the urethra, vagina, or anus. Typical lesion characteristics include: beefy red color, nontender, emitting rank odor, elevated above skin, smooth and rolled edge, serpiginous outline. Physical examination of lesions can classify donovanosis into ulcerogranulomatous, hypertrophic, necrotic, and sclerotic variants. Common locations in males include: coronal sulcus, subpreputial region, and anus. Common locations in females include: labia minora, cervix, and fourchette.

Physical Examination

  • Patients in late stages present with the following signs:[2]

Typical Lesion Characteristics

  • Beefy red color
  • Nontender
  • Emit rank odor
  • Elevated above skin
  • Smooth, rolled edge
  • Serpiginous outline[3]

Four variants can be further classified according to their clinical presentation:[1]

Type Clinical Appearance
Ulcerogranulomatous beefy red, non-tender, bleeds easily
Hypertrophic or Verrucous irregular edge, dry
Necrotic foul smelling, deep, tissue destruction
Sclerotic dry, cicatricial, fibrous scar tissue

Common Locations in Males

Common Locations in Females

Extragenital Lesion Locations

Extragenital lesions occur in 6% of patients, typically in the following locations:[3]

Gallery

References

  1. ↑ 1.0 1.1 1.2 1.3 O'Farrell N (2002). "Donovanosis". Sex Transm Infect. 78 (6): 452–7. PMC 1758360. PMID 12473810.
  2. ↑ Velho, Paulo Eduardo Neves Ferreira; Souza, Elemir Macedo de; Belda Junior, Walter (2008). "Donovanosis". Brazilian Journal of Infectious Diseases. 12 (6). doi:10.1590/S1413-86702008000600015. ISSN 1413-8670.
  3. ↑ 3.0 3.1 Richens J (1991). "The diagnosis and treatment of donovanosis (granuloma inguinale)". Genitourin Med. 67 (6): 441–52. PMC 1194766. PMID 1774048.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 "Dermatology Atlas".
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 "Public Health Image Library (PHIL)".


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