Donovanosis physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Donovanosis}} | {{Donovanosis}} | ||
{{CMG}} {{AE}} {{KD}}; {{KS}}; {{NRM}} | |||
==Overview== | ==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]], [[Prepuce|subpreputial]] region, and [[anus]]. Common locations in females include: [[labia minora]], [[cervix]], and [[fourchette]]. | |||
==Physical Examination== | ==Physical Examination== | ||
*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> | <gallery> | ||
Image:SOA-Donovanosis-male.jpg|Genital ulcer in a male patient with Donovanosis. | 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> | ||
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> | |||
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> | ||
| Line 25: | Line 77: | ||
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: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: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 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> | ||
| Line 54: | Line 99: | ||
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> | 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> | |||
==References== | ==References== | ||
{{reflist|2}} | |||
[[Category:Sexually transmitted infections]] | [[Category:Sexually transmitted infections]] | ||
[[Category:Bacterial diseases]] | [[Category:Bacterial diseases]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
Latest revision as of 17:37, 18 September 2017
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Donovanosis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Donovanosis physical examination On the Web |
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American Roentgen Ray Society Images of Donovanosis physical examination |
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Risk calculators and risk factors for Donovanosis physical examination |
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
- In early stages donovanosis commonly presents as a nontender, progressive ulcerative lesions without regional lymphadenopathy.[1]
- Patients in late stages present with the following signs:[2]
- 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[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
- Coronal sulcus
- Subpreputial region
- Anus[1]
Common Locations in Females
Extragenital Lesion Locations
Extragenital lesions occur in 6% of patients, typically in the following locations:[3]
Gallery
-
![Genital ulcer in a male patient with Donovanosis.Adapted from Dermatology Atlas.[4]](/images/5/5d/SOA-Donovanosis-male.jpg)
Genital ulcer in a male patient with Donovanosis.Adapted from Dermatology Atlas.[4]
-
![Genital ulcer in a female patient with Donovanosis.Adapted from Dermatology Atlas.[4]](/images/e/e7/SOA-Donovanosis-female.jpg)
Genital ulcer in a female patient with Donovanosis.Adapted from Dermatology Atlas.[4]
-
![Donovanosis. Adapted from Dermatology Atlas.[4]](/images/3/38/Donovanosis01.jpg)
Donovanosis. Adapted from Dermatology Atlas.[4]
-
![Granuloma inguinale, or Donovanosis, accompanied by perianal skin ulceration due to the bacterium, Klebsiella granulomatis. Adapted from Dermatology Atlas.[4]](/images/0/0b/Enterobacteria62.jpeg)
Granuloma inguinale, or Donovanosis, accompanied by perianal skin ulceration due to the bacterium, Klebsiella granulomatis. Adapted from Dermatology Atlas.[4]
-
![Donovanosis of penis. Adapted from Dermatology Atlas.[4]](/images/1/17/Enterobacteria54.jpeg)
Donovanosis of penis. Adapted from Dermatology Atlas.[4]
-
![Donovanosis of penis. Adapted from Dermatology Atlas.[4]](/images/a/a6/Enterobacteria53.jpeg)
Donovanosis of penis. Adapted from Dermatology Atlas.[4]
-
![Preputial granulomatous lesion due to Donovanosis. Adapted from Dermatology Atlas.[4]](/images/7/7f/Enterobacteria51.jpeg)
Preputial granulomatous lesion due to Donovanosis. Adapted from Dermatology Atlas.[4]
-
![Bilaterally infected inguinal lymph nodes due to a Calymmatobacterium granulomatis bacteria. Adapted from Dermatology Atlas.[4]](/images/a/a2/Enterobacteria49.jpeg)
Bilaterally infected inguinal lymph nodes due to a Calymmatobacterium granulomatis bacteria. Adapted from Dermatology Atlas.[4]
-
![This patient presented with a case of systemically disseminated Donovanosis of the ankle due to C. granulomatis bacteria. From Public Health Image Library (PHIL). [5]](/images/4/4a/Granuloma_inguinale11.jpeg)
This patient presented with a case of systemically disseminated Donovanosis of the ankle due to C. granulomatis bacteria. From Public Health Image Library (PHIL). [5]
-
![This male presented with a penile lesion that was found to be granuloma inguinale, also called “genital ulcerative disease”. From Public Health Image Library (PHIL). [5]](/images/3/3c/Granuloma_inguinale10.jpeg)
This male presented with a penile lesion that was found to be granuloma inguinale, also called “genital ulcerative disease”. From Public Health Image Library (PHIL). [5]
-
![This male presented with a penile lesion of roughly 40 days duration that was determined to be granuloma inguinale. From Public Health Image Library (PHIL). [5]](/images/f/f8/Granuloma_inguinale09.jpeg)
This male presented with a penile lesion of roughly 40 days duration that was determined to be granuloma inguinale. From Public Health Image Library (PHIL). [5]
-
![This 19 year old woman presented with an perianal granuloma inguinale lesion of about 8 months duration. From Public Health Image Library (PHIL). [5]](/images/5/50/Granuloma_inguinale08.jpeg)
This 19 year old woman presented with an perianal granuloma inguinale lesion of about 8 months duration. From Public Health Image Library (PHIL). [5]
-
![This patient presented with an ulcerated glans penis due to Donovanosis, or granuloma inguinale. From Public Health Image Library (PHIL). [5]](/images/a/a4/Granuloma_inguinale07.jpeg)
This patient presented with an ulcerated glans penis due to Donovanosis, or granuloma inguinale. From Public Health Image Library (PHIL). [5]
-
![This image depicts an intravaginal view revealing a cervical lesion, which had been diagnosed as a case of Donovanosis, also known as granuloma inguinale. From Public Health Image Library (PHIL). [5]](/images/2/2e/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. From Public Health Image Library (PHIL). [5]
-
![This image depicts the penis of a male with its foreskin retracted, revealing a suppurative lesion involving the glans and prepuce. From Public Health Image Library (PHIL). [5]](/images/1/10/Granuloma_inguinale05.jpeg)
This image depicts the penis of a male with its foreskin retracted, revealing a suppurative lesion involving the glans and prepuce. From Public Health Image Library (PHIL). [5]
-
![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. From Public Health Image Library (PHIL). [5]](/images/2/2a/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. From Public Health Image Library (PHIL). [5]
-
![This patient showed manifestations of granuloma inguinale, also known as Donovanosis, involving swelling and subcutaneous granulomas of the inguinal lymph nodes, bilaterally. From Public Health Image Library (PHIL). [5]](/images/8/82/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. From Public Health Image Library (PHIL). [5]
-
![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. From Public Health Image Library (PHIL). [5]](/images/6/6d/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. From Public Health Image Library (PHIL). [5]
![Genital ulcer in a male patient with Donovanosis.Adapted from Dermatology Atlas.[4]](/index.php/File:SOA-Donovanosis-male.jpg)
![Genital ulcer in a female patient with Donovanosis.Adapted from Dermatology Atlas.[4]](/index.php/File:SOA-Donovanosis-female.jpg)
![Donovanosis. Adapted from Dermatology Atlas.[4]](/index.php/File:Donovanosis01.jpg)
![Granuloma inguinale, or Donovanosis, accompanied by perianal skin ulceration due to the bacterium, Klebsiella granulomatis. Adapted from Dermatology Atlas.[4]](/index.php/File:Enterobacteria62.jpeg)
![Donovanosis of penis. Adapted from Dermatology Atlas.[4]](/index.php/File:Enterobacteria54.jpeg)
![Donovanosis of penis. Adapted from Dermatology Atlas.[4]](/index.php/File:Enterobacteria53.jpeg)
![Preputial granulomatous lesion due to Donovanosis. Adapted from Dermatology Atlas.[4]](/index.php/File:Enterobacteria51.jpeg)
![Bilaterally infected inguinal lymph nodes due to a Calymmatobacterium granulomatis bacteria. Adapted from Dermatology Atlas.[4]](/index.php/File:Enterobacteria49.jpeg)
![This patient presented with a case of systemically disseminated Donovanosis of the ankle due to C. granulomatis bacteria. From Public Health Image Library (PHIL). [5]](/index.php/File:Granuloma_inguinale11.jpeg)
![This male presented with a penile lesion that was found to be granuloma inguinale, also called “genital ulcerative disease”. From Public Health Image Library (PHIL). [5]](/index.php/File:Granuloma_inguinale10.jpeg)
![This male presented with a penile lesion of roughly 40 days duration that was determined to be granuloma inguinale. From Public Health Image Library (PHIL). [5]](/index.php/File:Granuloma_inguinale09.jpeg)
![This 19 year old woman presented with an perianal granuloma inguinale lesion of about 8 months duration. From Public Health Image Library (PHIL). [5]](/index.php/File:Granuloma_inguinale08.jpeg)
![This patient presented with an ulcerated glans penis due to Donovanosis, or granuloma inguinale. From Public Health Image Library (PHIL). [5]](/index.php/File:Granuloma_inguinale07.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. From Public Health Image Library (PHIL). [5]](/index.php/File:Granuloma_inguinale06.jpeg)
![This image depicts the penis of a male with its foreskin retracted, revealing a suppurative lesion involving the glans and prepuce. From Public Health Image Library (PHIL). [5]](/index.php/File:Granuloma_inguinale05.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. From Public Health Image Library (PHIL). [5]](/index.php/File:Granuloma_inguinale03.jpeg)
![This patient showed manifestations of granuloma inguinale, also known as Donovanosis, involving swelling and subcutaneous granulomas of the inguinal lymph nodes, bilaterally. From Public Health Image Library (PHIL). [5]](/index.php/File:Granuloma_inguinale02.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. From Public Health Image Library (PHIL). [5]](/index.php/File:Granuloma_inguinale01.jpeg)
References
- ↑ 1.0 1.1 1.2 1.3 O'Farrell N (2002). "Donovanosis". Sex Transm Infect. 78 (6): 452–7. PMC 1758360. PMID 12473810.
- ↑ 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.
- ↑ 3.0 3.1 Richens J (1991). "The diagnosis and treatment of donovanosis (granuloma inguinale)". Genitourin Med. 67 (6): 441–52. PMC 1194766. PMID 1774048.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 "Dermatology Atlas".
- ↑ 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)".