Donovanosis pathophysiology

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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]; Nate Michalak, B.A.

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Overview

Klebsiella granulomatis may be transmitted through sexual contact, direct contact, or fecal contamination. K. granulomatis may also autoinoculate, resulting in multiple lesions. The pathogenesis of K. granulomatis is not well characterized. K. granulomatis replicates intracellularly within monocytes after being phagocytosed. Monocytes eventually rupture, recruiting additional monocytes and causing the formation of granulomas. On microscopic examination, pleomorphic Donovan bodies can be seen within the cytoplasm or phagosomes of monocytes.

Pathophysiology

Transmission

• Klebsiella granulomatis may be transmitted through sexual contact.
• Although donovanosisis is typically considered a sexually transmitted disease, studies indicate it may also develop through fecal contamination or direct contact.
• K. granulomatis may also autoinoculate, resulting in multiple lesions that appear to be mirror images of each other.

Pathogenesis

• The pathogenesis of K. granulomatis is not well characterized.
• K. granulomatis is phagocytosed by macrophages.
• K. granulomatis is able to avoid destruction and replicates intracellularly within these monocytes.
• Monocytes eventually rupture, recruiting additional monocytes and causing the formation of granulomas.

Microscopic Pathology

• Donovan bodies (K. granulomatis) are seen within phagosomes or in the cytoplasm of monocytes or histocytes.
• Morphology of Donovan bodies:

• Pleomorphic ranging from coccus to bacillus
• 1-2 X 0.5-0.7 μm
• May or may not be capsulated
• Non-motile

• Epidermis of lesion borders show a degree of hyperplasia.
• A dense infiltrate of plasma cells is seen in the dermis.