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Donovanosis – A Case Report with a Review of Literature

Received: 9 June 2023    Accepted: 28 June 2023    Published: 6 July 2023
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Abstract

Donovanosis (Granuloma inguinale) is a sexually transmitted bacterial infection affecting the genital, perineal, and perianal regions. It is caused by Klebsiella granulomatis, formerly known as Donovania granulomatis and Calymmatobacterium granulomatis. Without treatment, the infection followed a chronic progressive course with the formation of ulcerations. Upon chronification, severe tissue destruction occurs and malignant transformation is possible. Healing is complete with timely diagnosis and treatment. Donovanosis has not been reported in Bulgaria and herein, we present the first clinical case of this "exotic" for our country sexually transmitted bacterial infection. Our patient was a 38-year-old man of Nigerian origin. The dermatological status is represented by papular and erosive-ulcerative lesions on the skin of the foreskin, the body of the penis, the scrotum and the lower abdomen. Upon Giemsa staining of ulcus material, Donovan corpuscles are found in monocytes. The histopathological examination a lesion demonstrated irregular acanthosis, focal dyskeratosis in the lower epidermal segment, moderate spongiosis, papillary oedema, edema swollen endothelium obstructing the vessels of small and medium caliber, abundant granulomatous tuberculoid infiltrate of epithelioid cells and lymphocytes around the blood vessels in the middle dermis and interstitial. Infectious granulomas are represented by tissue macrophages, epithelioid cells and lymphocytes located around areas of collagen necrosis. Based on the anamnesis, dermatological status and examinations, the diagnosis of donovanosis was made. Epithelialization of the ulks occurred after an extended course of systemic treatment with doxycyclin for 20 days, followed by azax for 7 days. The topical treatment included baths with potassium permanganate and fusidine cream.

Published in International Journal of Clinical Dermatology (Volume 6, Issue 1)
DOI 10.11648/j.ijcd.20230601.12
Page(s) 10-13
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Donovanosis, Sexually Transmitted Infection, Genital Ulceration, Diagnosis, Treatment

References
[1] O’Farrell, N. Donovanosis. Sexually Transmitted Infections. 2002; 78 (6): 452–457.
[2] Belda Junior, W. Donovanosis. Anais brasileiros de dermatologia. 2020; 95 (6): 675–683.
[3] Murray PR, Rosenthal KS, Pfaller MA. Medical Microbiology (5th ed.). 2005; Philadelphia: Elsevier Mosby. p. 336. ISBN 978-0-323-03303-9.
[4] Muller EE, Kularatne R. The changing epidemiology of genital ulcer disease in South Africa: has donovanosis been eliminated?. Sex Transm Infect. 2020; 96 (8): 596–600.
[5] McLeod K. Précis of operations performed in the wards of the first surgeon, medical college hospital, during the year 1880. Ind Med Gaz. 1881; 16 (5): 123–130.
[6] Donovan C. Medical cases from Madras General Hospital. Ulcerating granuloma of the pudenda. Ind Med Gaz. 1905; 40: 414.
[7] Marmell M, Santora E. Donovanosis - Granuloma inguinale. Incidence, nomenclature, diagnosis. Am J Syph Gonor Ven Dis. 1950; 34: 83–90.
[8] Kampmeier R. Granuloma inguinale. Sex Transm Dis. 1984; 11: 318–321.
[9] Ahmed N, Pillay A, Lawler M, et al. Donovanosis causing lymphadenitis, mastoiditis and meningitis in a child. Lancet. 2015; 385 (9987): 2644.
[10] Martins S, Jardim MML. Donovanose. In: Belda W. Jr, Di Chiacchio N., Criado P. R., editors. Tratado de Dermatologia. Ed Atheneu; São Paulo: 2018: 1587–1592.
[11] Goldberg J. Studies on Granuloma inguinale V. Isolation of a bacterium resembling donovania granulomatis from the faeces of a patient with granuloma inguinale. Br J Vener Dis. 1962; 38: 99–102.
[12] Santiago-Wickey JN, Crosby B. Granuloma Inguinale. 2022 Aug 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 30020678.
[13] Carter JS, Bowden FJ, et al. Phylogenetic evidence for reclassification of Calymatobacterium granulomatis as Klebsiella granulomatis comb. noev. Int J Syst Bacteriol. 1999; 49: 1695–1700.
[14] Ramachander M, Jayalaxmi S, Pankaja P. A study of donovanosis at Guntur. Ind J Dermatol Venereol. 1967; 33: 237–244.
[15] Sethi S, Sarkar R, Garg V. Squamous cell carcinoma complicating donovanosis not a thing of thr past. Int J STD AIDS. 2014; 25: 894–897.
[16] O’Farrel N, Hoosen AA, Coetzee K, et al. A rapid stain for the diagnosis of granuloma inguinale Genitourin Med. 1990; 66: 200-201.
[17] Aragão HB, Vianna G. Pesquisa sobre o granuloma venéreo. Mem Inst Oswaldo Cruz. 1913; 5: 211–238.
[18] O’Farrel N, Hoosen A, Kingston M. 2018 UK National guideline for the management of donovanosis. Int J STD AIDS. 2018: 1–3.
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  • APA Style

    Hristo Mangarov, Valentina Broshtilova, Atanas Batashki, Yoanna Velevska, Petar Vatov, et al. (2023). Donovanosis – A Case Report with a Review of Literature. International Journal of Clinical Dermatology, 6(1), 10-13. https://doi.org/10.11648/j.ijcd.20230601.12

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    ACS Style

    Hristo Mangarov; Valentina Broshtilova; Atanas Batashki; Yoanna Velevska; Petar Vatov, et al. Donovanosis – A Case Report with a Review of Literature. Int. J. Clin. Dermatol. 2023, 6(1), 10-13. doi: 10.11648/j.ijcd.20230601.12

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    AMA Style

    Hristo Mangarov, Valentina Broshtilova, Atanas Batashki, Yoanna Velevska, Petar Vatov, et al. Donovanosis – A Case Report with a Review of Literature. Int J Clin Dermatol. 2023;6(1):10-13. doi: 10.11648/j.ijcd.20230601.12

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  • @article{10.11648/j.ijcd.20230601.12,
      author = {Hristo Mangarov and Valentina Broshtilova and Atanas Batashki and Yoanna Velevska and Petar Vatov and Svetlana Bezhanova and Irina Iungareva and Sonya Marina},
      title = {Donovanosis – A Case Report with a Review of Literature},
      journal = {International Journal of Clinical Dermatology},
      volume = {6},
      number = {1},
      pages = {10-13},
      doi = {10.11648/j.ijcd.20230601.12},
      url = {https://doi.org/10.11648/j.ijcd.20230601.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcd.20230601.12},
      abstract = {Donovanosis (Granuloma inguinale) is a sexually transmitted bacterial infection affecting the genital, perineal, and perianal regions. It is caused by Klebsiella granulomatis, formerly known as Donovania granulomatis and Calymmatobacterium granulomatis. Without treatment, the infection followed a chronic progressive course with the formation of ulcerations. Upon chronification, severe tissue destruction occurs and malignant transformation is possible. Healing is complete with timely diagnosis and treatment. Donovanosis has not been reported in Bulgaria and herein, we present the first clinical case of this "exotic" for our country sexually transmitted bacterial infection. Our patient was a 38-year-old man of Nigerian origin. The dermatological status is represented by papular and erosive-ulcerative lesions on the skin of the foreskin, the body of the penis, the scrotum and the lower abdomen. Upon Giemsa staining of ulcus material, Donovan corpuscles are found in monocytes. The histopathological examination a lesion demonstrated irregular acanthosis, focal dyskeratosis in the lower epidermal segment, moderate spongiosis, papillary oedema, edema swollen endothelium obstructing the vessels of small and medium caliber, abundant granulomatous tuberculoid infiltrate of epithelioid cells and lymphocytes around the blood vessels in the middle dermis and interstitial. Infectious granulomas are represented by tissue macrophages, epithelioid cells and lymphocytes located around areas of collagen necrosis. Based on the anamnesis, dermatological status and examinations, the diagnosis of donovanosis was made. Epithelialization of the ulks occurred after an extended course of systemic treatment with doxycyclin for 20 days, followed by azax for 7 days. The topical treatment included baths with potassium permanganate and fusidine cream.},
     year = {2023}
    }
    

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    AU  - Hristo Mangarov
    AU  - Valentina Broshtilova
    AU  - Atanas Batashki
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    AU  - Svetlana Bezhanova
    AU  - Irina Iungareva
    AU  - Sonya Marina
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    DO  - 10.11648/j.ijcd.20230601.12
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    JF  - International Journal of Clinical Dermatology
    JO  - International Journal of Clinical Dermatology
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    EP  - 13
    PB  - Science Publishing Group
    SN  - 2995-1305
    UR  - https://doi.org/10.11648/j.ijcd.20230601.12
    AB  - Donovanosis (Granuloma inguinale) is a sexually transmitted bacterial infection affecting the genital, perineal, and perianal regions. It is caused by Klebsiella granulomatis, formerly known as Donovania granulomatis and Calymmatobacterium granulomatis. Without treatment, the infection followed a chronic progressive course with the formation of ulcerations. Upon chronification, severe tissue destruction occurs and malignant transformation is possible. Healing is complete with timely diagnosis and treatment. Donovanosis has not been reported in Bulgaria and herein, we present the first clinical case of this "exotic" for our country sexually transmitted bacterial infection. Our patient was a 38-year-old man of Nigerian origin. The dermatological status is represented by papular and erosive-ulcerative lesions on the skin of the foreskin, the body of the penis, the scrotum and the lower abdomen. Upon Giemsa staining of ulcus material, Donovan corpuscles are found in monocytes. The histopathological examination a lesion demonstrated irregular acanthosis, focal dyskeratosis in the lower epidermal segment, moderate spongiosis, papillary oedema, edema swollen endothelium obstructing the vessels of small and medium caliber, abundant granulomatous tuberculoid infiltrate of epithelioid cells and lymphocytes around the blood vessels in the middle dermis and interstitial. Infectious granulomas are represented by tissue macrophages, epithelioid cells and lymphocytes located around areas of collagen necrosis. Based on the anamnesis, dermatological status and examinations, the diagnosis of donovanosis was made. Epithelialization of the ulks occurred after an extended course of systemic treatment with doxycyclin for 20 days, followed by azax for 7 days. The topical treatment included baths with potassium permanganate and fusidine cream.
    VL  - 6
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Author Information
  • Department of Dermatology and Venereology, Medical Institute of the Ministry of Internal Affairs, Sofia, Bulgaria

  • Department of Dermatology and Venereology, Military Medical Academy, Sofia, Bulgaria

  • Department of Special Surgery, Medical University, Plovdiv, Bulgaria

  • Department of Infectious Diseases, Parasitology and Dermatovenereology, Medical University, Varna, Bulgaria

  • Department of Surgical Diseases, MB Urology, Medical University, Varna, Bulgaria

  • Department of Dermatology and Venereology, Medical Institute of the Ministry of Internal Affairs, Sofia, Bulgaria

  • Department of Dermatology and Venereology, Medical Institute of the Ministry of Internal Affairs, Sofia, Bulgaria

  • Department of Dermatology and Venereology, Medical Institute of the Ministry of Internal Affairs, Sofia, Bulgaria

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