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1.
Int J STD AIDS ; 27(8): 605-7, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26882914

RESUMO

Donovanosis is a rare sexually transmitted infection now mainly seen in sporadic cases in Papua New Guinea, South Africa, India, Brazil and Australia. The causative organism is Calymmatobacterium granulomatis, though a proposal has been put forward that the organism be reclassified as Klebsiella granulomatis comb nov The incubation period is approximately 50 days with genital papules developing into ulcers that increase in size. Four types of lesions are described - ulcerogranulomatous, hypertrophic, necrotic and sclerotic. The diagnosis is usually confirmed by microscopic identification of characteristic Donovan bodies on stained tissue smears. More recently, polymerase chain reaction methods have been developed. The recommended treatment is azithromycin 1 g weekly until complete healing is achieved.


Assuntos
Antibacterianos/urina , Calymmatobacterium , Granuloma Inguinal/diagnóstico , Granuloma Inguinal/tratamento farmacológico , Guias de Prática Clínica como Assunto , Busca de Comunicante , Humanos , Reação em Cadeia da Polimerase , Parceiros Sexuais , Infecções Sexualmente Transmissíveis
2.
Int J STD AIDS ; 27(1): 72-4, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25614521

RESUMO

Although atypical presentations of herpetic infection in immunocompetent individuals are common, they very rarely have the extensive, chronic and verrucous appearances seen in the immunocompromised host. We report a case of genital herpes manifesting as painless chronic non-healing genital ulcers with exuberant granulation tissue in an immunocompetent man. Owing to this morphology, the ulcers were initially mistaken for donovanosis. To the best of our knowledge, such a presentation of genital herpes in an immunocompetent individual has not been described previously.


Assuntos
Herpes Genital/diagnóstico , Herpesvirus Humano 2/isolamento & purificação , Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Calymmatobacterium/isolamento & purificação , Diagnóstico Diferencial , Granuloma Inguinal/diagnóstico , HIV-1 , Herpes Genital/tratamento farmacológico , Herpes Genital/virologia , Herpesvirus Humano 1 , Herpesvirus Humano 2/efeitos dos fármacos , Humanos , Imunocompetência , Masculino , Reação em Cadeia da Polimerase , Simplexvirus , Resultado do Tratamento , Úlcera/tratamento farmacológico
3.
Intern Med ; 51(17): 2479-81, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22975572

RESUMO

A 46-year-old man complained of ulcerovegetative lesions in the anogenital region, which he had noted one month prior to presentation. The patient had a history of travel to African countries. Therefore, the ulcerovegetative lesions of the patient were suspected to be granuloma inguinale (GI). Calymmatobacterium granulomatis was not observed in the direct examination of scrapings collected from the base of the ulcerovegetative lesion. Instead, a histological examination revealed cutaneous metastasis of mucinous adenocarcinoma of the rectum. Therefore, a diagnosis of GI was eliminated. As the patient did not report his history of rectal cancer and had travelled to African countries, we had primarily focused on the diagnosis of GI.


Assuntos
Adenocarcinoma/diagnóstico , Adenocarcinoma/secundário , Granuloma Inguinal/diagnóstico , Neoplasias Retais/diagnóstico , Neoplasias Retais/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/secundário , África , Calymmatobacterium , Quimioterapia Adjuvante , Colostomia , Diagnóstico Diferencial , Granuloma Inguinal/microbiologia , Granuloma Inguinal/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Retais/cirurgia , Pele/microbiologia , Pele/patologia , Recusa do Paciente ao Tratamento
4.
An Bras Dermatol ; 86(3): 585-6, 2011.
Artigo em Inglês, Português | MEDLINE | ID: mdl-21738983

RESUMO

The authors present images of two of the most common clinical forms of granuloma inguinale (donovanosis) in males and females. Donovanosis is considered a sexually transmitted disease that is endemic in tropical and subtropical regions of the world. Two microscopic images are also shown, one of a direct smear (the presence of Donovan bodies within large mononuclear cells identified using Giemsa stain) and the other of typical histological findings (rod-shaped Donovan bodies within a mononuclear histiocyte).


Assuntos
Calymmatobacterium , Granuloma Inguinal/patologia , Corantes Azur , Feminino , Humanos , Masculino , Coloração e Rotulagem
5.
Int J STD AIDS ; 21(9): 609-10, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21097731

RESUMO

Donovanosis is a rare sexually transmitted infection now mainly seen in sporadic cases in Papua New Guinea, South Africa, India, Brazil and Australia. The causative organism is Calymmatobacterium granulomatis though a proposal has been put forward that the organism be reclassified as Klebsiella granulomatis comb. nov. The incubation period is approximately 50 days with genital papules developing into ulcers that increase in size. Four types of lesions are described - ulcerogranulomatous, hypertrophic, necrotic and sclerotic. The diagnosis is usually confirmed by microscopic identification of characteristic Donovan bodies on stained tissue smears. More recently, polymerase chain reaction (PCR) methods have been developed. The recommended treatment is azithromycin 1 g weekly until complete healing is achieved.


Assuntos
Calymmatobacterium/isolamento & purificação , Granuloma Inguinal/diagnóstico , Granuloma Inguinal/tratamento farmacológico , Antibacterianos/administração & dosagem , Azitromicina/administração & dosagem , Europa (Continente) , Granuloma Inguinal/patologia , Histocitoquímica , Microscopia , Reação em Cadeia da Polimerase
7.
Clin Infect Dis ; 42(10): 1431-8, 2006 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-16619156

RESUMO

BACKGROUND: Genital ulcer disease (GUD) is commonly caused by pathogens for which suitable therapies exist, but clinical and laboratory diagnoses may be problematic. This collaborative project was undertaken to address the need for a rapid, economical, and sensitive approach to the detection and diagnosis of GUD using noninvasive techniques to sample genital ulcers. METHODS: The genital ulcer disease multiplex polymerase chain reaction (GUMP) was developed as an inhouse nucleic acid amplification technique targeting serious causes of GUD, namely, herpes simplex viruses (HSVs), H. ducreyi, Treponema pallidum, and Klebsiella species. In addition, the GUMP assay included an endogenous internal control. Amplification products from GUMP were detected by enzyme linked amplicon hybridization assay (ELAHA). RESULTS: GUMP-ELAHA was sensitive and specific in detecting a target microbe in 34.3% of specimens, including 1 detection of HSV-1, three detections of HSV-2, and 18 detections of T. pallidum. No H. ducreyi has been detected in Australia since 1998, and none was detected here. No Calymmatobacterium (Klebsiella) granulomatis was detected in the study, but there were 3 detections during ongoing diagnostic use of GUMP-ELAHA in 2004 and 2005. The presence of C. granulomatis was confirmed by restriction enzyme digestion and nucleotide sequencing of the 16S rRNA gene for phylogenetic analysis. CONCLUSIONS: GUMP-ELAHA permitted comprehensive detection of common and rare causes of GUD and incorporated noninvasive sampling techniques. Data obtained by using GUMP-ELAHA will aid specific treatment of GUD and better define the prevalence of each microbe among at-risk populations with a view to the eradication of chancroid and donovanosis in Australia.


Assuntos
Calymmatobacterium/isolamento & purificação , Cancroide/diagnóstico , Infecções por Enterobacteriaceae/diagnóstico , Haemophilus ducreyi/isolamento & purificação , Herpes Simples/diagnóstico , Reação em Cadeia da Polimerase/métodos , Infecções Sexualmente Transmissíveis/diagnóstico , Simplexvirus/isolamento & purificação , Treponema pallidum/isolamento & purificação , Primers do DNA , Diagnóstico Diferencial , Feminino , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/microbiologia , Doenças dos Genitais Femininos/virologia , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/microbiologia , Doenças dos Genitais Masculinos/virologia , Granuloma/diagnóstico , Humanos , Masculino , Estudos Prospectivos , Sensibilidade e Especificidade , Sífilis/diagnóstico , Úlcera/diagnóstico
8.
Int J STD AIDS ; 12(7): 423-7, 2001 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-11394976

RESUMO

Donovanosis has been ignored for many years until recently. The condition still has a limited geographical distribution. A significant epidemic of donovanosis has been identified in KwaZulu/Natal, South Africa where it may be a risk factor for acquiring HIV in men. After a gap of more than 30 years, the organism was cultured by researchers in Durban, South Africa and Darwin, Australia. Polymerase chain reaction (PCR) techniques for donovanosis were developed soon after, most recently using a colorimetric detection system. Similarities between the causative organism, Calymmatobacterium granulomatis and Klebsiella spp. were confirmed. A proposal that the organism be reclassified under the genus Klebsiella has been put forward. Azithromycin has been confirmed as the drug of choice but is yet to be accepted universally because of cost issues. Treatment in patients with significant HIV induced immune deficiency may need to be prolonged. A donovanosis eradication programme is underway amongst the aboriginal community in Australia. Elsewhere, management through current syndromic guidelines for genital ulcers are yet to be validated in areas where donovanosis is endemic. PCR testing should enable further recognition of donovanosis and lead to more concerted efforts in disease control and possible eradication.


Assuntos
Calymmatobacterium , Granuloma Inguinal/microbiologia , Antibacterianos/uso terapêutico , Austrália/epidemiologia , Azitromicina/uso terapêutico , Calymmatobacterium/classificação , Controle de Doenças Transmissíveis , Feminino , Granuloma Inguinal/tratamento farmacológico , Granuloma Inguinal/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Klebsiella/classificação , Masculino , Reação em Cadeia da Polimerase , Fatores de Risco , África do Sul/epidemiologia
9.
Sex Transm Infect ; 76(2): 134-6, 2000 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-10858717

RESUMO

OBJECTIVE: To incorporate the first polymerase chain reaction (PCR) assay for Calymmatobacterium granulomatis into a colorimetric detection system for use in routine diagnostic laboratories. METHODS: A capture oligonucleotide specific for the Klebsiella phoE gene was covalently linked to tosyl activated magnetic beads. Biotinylated phoE PCR products obtained from 14 positive specimens from patients with donovanosis and isolates of Klebsiella pneumoniae, K rhinoscleromatis, and K ozaenae were cleaved with HaeIII for the purpose of differentiation, captured by the prepared beads, and subjected to standard EIA detection methodology. Eight samples from unrelated genital conditions underwent the same procedure. It was anticipated from the sequence data that the biotinylated fragment would be cleaved from the capture oligonucleotide target region in the three Klebsiella phoE products (that is, a negative colorimetric result) while the entire fragment of interest would remain intact in the positive C granulomatis phoE products (that is, a positive colorimetric result). RESULTS: All 14 positive specimens from patients with donovanosis gave strong colorimetric readings with this detection system. Isolates of K pneumoniae, K rhinoscleromatis, K ozaenae, and the eight specimens from unrelated genital conditions were negative. CONCLUSION: The successful development of a colorimetric detection system for C granulomatis incorporating two levels of specificity enables the molecular diagnosis of this condition to be undertaken by routine diagnostic laboratories. This should have an important role in the Australian government's campaign to eradicate donovanosis by 2003 though the test still needs to undergo trials and be validated using a larger number of samples from geographically diverse parts of the world in order to ascertain the generalisability of the methodology.


Assuntos
Calymmatobacterium/isolamento & purificação , Colorimetria/métodos , Granuloma Inguinal/diagnóstico , Reação em Cadeia da Polimerase/métodos , Humanos
11.
Int J Syst Bacteriol ; 49 Pt 4: 1695-700, 1999 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-10555350

RESUMO

By sequencing a total of 2089 bp of the 16S rRNA and phoE genes it was demonstrated that Calymmatobacterium granulomatis (the causative organism of donovanosis) shows a high level of identity with Klebsiella species pathogenic to humans (Klebsiella pneumoniae, Klebsiella rhinoscleromatis). It is proposed that C. granulomatis should be reclassified as Klebsiella granulomatis comb. nov. An emended description of the genus Klebsiella is given.


Assuntos
Calymmatobacterium/classificação , Granuloma Inguinal/microbiologia , Klebsiella/classificação , Calymmatobacterium/citologia , Calymmatobacterium/genética , Calymmatobacterium/fisiologia , Proteínas de Escherichia coli , Genes de RNAr , Humanos , Klebsiella/citologia , Klebsiella/genética , Klebsiella/fisiologia , Dados de Sequência Molecular , Filogenia , Porinas/genética , RNA Ribossômico 16S/genética , Análise de Sequência de DNA
12.
J Med Microbiol ; 48(9): 841-847, 1999 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-10482295

RESUMO

Calymmatobacterium granulomatis is the aetiological agent of granuloma inguinale - a chronic granulomatous genital infection - and is morphologically similar to members of the genus Klebsiella. This study determined the 16S rRNA gene sequence of C. granulomatis and the taxonomic position of the organism in relation to the genus Klebsiella. Genomic DNA was extracted from C. granulomatis-infected monocytes and from frozen and formalin-fixed paraffin wax-embedded tissue biopsy specimens from patients with histologically proven granuloma inguinale. The 16S rDNA was amplified by PCR with broad range oligonucleotide primers. The amplified DNA fragments were cloned into pMOS vector, digested with Bam HI and Pst1 restriction endonucleases, hybridised with a gram-negative bacterial probe (DL04), sequenced in both directions by the automated ALF DNA sequencer, verified on an ABI Prism 377 automated sequencer and analysed with DNASIS and MEGA software packages. Sequence analysis revealed DNA homology of 99% in C. granulomatis from the different sources, supporting the belief that the bacteria in the culture and the biopsy specimens belonged to the same species, although there was some diversity within the species. Phylogenetically, the strains were closely related to the genera Klebsiella and Enterobacter with similarities of 95% and 94% respectively. C. granulomatis is a unique species, distinct from other related organisms belonging to the gamma subclass of Proteobacteria.


Assuntos
Calymmatobacterium/classificação , Genes de RNAr , Filogenia , RNA Ribossômico 16S/genética , Calymmatobacterium/genética , DNA Ribossômico/genética , Genes Bacterianos , Granuloma Inguinal/microbiologia , Humanos , Klebsiella/classificação , Dados de Sequência Molecular , Análise de Sequência de DNA
15.
J Med Microbiol ; 47(12): 1069-73, 1998 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-9856642

RESUMO

The ultrastructural features of cells of Calymmatobacterium granulomatis from monocyte co-cultures and tissue biopsy specimens were compared. In cultures the bacteria were mainly extracellular, i.e., not within membrane-bound vacuoles. The bacterial body was surrounded by a uniformly extensive homogeneous layer with a relatively high electron density. This layer varied considerably in tissue biopsy specimens, having either homogeneously electron-dense or delicate web-like structures with varying density and thickness. In tissue specimens the bacteria were located predominantly within vacuoles of varying sizes in the cytoplasm of the macrophages and, occasionally, extracellularly within the intercellular spaces of the stroma. The bacterial cytoplasm contained ribosomes scattered throughout with electron-dense granules located peripherally. The trilaminar cell-wall structure was typical of a gram-negative organism, comprising an outer membrane, a middle electron-opaque layer and an inner plasma membrane. Surface structures such as fimbriae, flagella and bacteriophages were not identified in specimens from either source.


Assuntos
Calymmatobacterium/ultraestrutura , Granuloma Inguinal/microbiologia , Monócitos/microbiologia , Pele/microbiologia , Biópsia , Técnicas de Cocultura , Epiderme/microbiologia , Granuloma Inguinal/patologia , Humanos , Microscopia Eletrônica , Pele/patologia
16.
Am J Clin Pathol ; 108(5): 510-4, 1997 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-9353089

RESUMO

Granuloma inguinale (donovanosis) is seen predominantly in adults (it rarely occurs in children) and mainly affects genital skin and mucosa. Infection occurs at other skin and mucosal sites, and hematogenous dissemination to bone also has been described. The infection responds dramatically to appropriate antibiotic treatment. We present two cases of granuloma inguinale occurring in children (8 months and 5 months of age) causing mastoiditis and external ear discharges. A temporal lobe abscess also developed in the 8-month-old child. Subsequent computed tomography scans showed marked improvement in the brain lesion after treatment. The second child had a polypoid mass in the middle ear that on biopsy showed the features of granuloma inguinale. The mother of this child had biopsy-proven granuloma inguinale of the uterine cervix. These cases indicate that granuloma inguinale can be transmitted during vaginal delivery, and careful cleansing of neonates born to infected mothers is recommended.


Assuntos
Granuloma Inguinal/diagnóstico , Mastoidite/diagnóstico , Otite Média/diagnóstico , Antibacterianos/uso terapêutico , Biópsia/métodos , Calymmatobacterium/isolamento & purificação , Colo do Útero/microbiologia , Cloranfenicol/uso terapêutico , Orelha Média/microbiologia , Orelha Média/patologia , Feminino , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Granuloma Inguinal/complicações , Granuloma Inguinal/patologia , Humanos , Lactente , Masculino , Processo Mastoide/microbiologia , Processo Mastoide/patologia , Mastoidite/etiologia , Mastoidite/patologia , Complicações do Trabalho de Parto/microbiologia , Otite Média/etiologia , Otite Média/patologia , Penicilinas/uso terapêutico , Gravidez , Tomografia Computadorizada por Raios X
17.
J Med Microbiol ; 46(7): 579-85, 1997 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-9236742

RESUMO

Granuloma inguinale is a chronic destructive granulomatous disease of the genitalia. The clinical diagnosis is often unreliable and the definitive diagnosis is based on the visualisation of 'Donovan bodies' in tissue smears or biopsy specimens. The organism implicated in its aetiology, Calymmatobacterium granulomatis, was reported to have been cultured > 30 years ago, but little is known about the organism because of its fastidious nature and the difficulty in culturing it. Twenty-two biopsy specimens from female patients with clinical and laboratory-confirmed granuloma inguinale were treated with amikacin 10 mg/L and inoculated in a monocyte co-culture system with peripheral blood mononuclear cells (PBMC) from a single donor and autologous sera. The method was subsequently modified by pretreatment of specimens with vancomycin 5 mg/L and metronidazole 10 mg/L in addition to amikacin 10 mg/L for the purpose of decontamination, pooled blood donor PBMC and by the use of heat-inactivated fetal calf serum instead of autologous serum for culture. This modified method was used to culture additional biopsy specimens and genital ulcer scrapings from female and male patients, respectively. All monocyte co-cultures were examined by a rapid Giemsa (RapiDiff) stain and by an indirect immunofluorescence test with immune sera. Representative cultures were examined by transmission electron microscopy. C. granulomatis was successfully isolated in pure culture by the monocyte co-culture system from four biopsy specimens and 14 genital ulcer scrapings. The cultured organisms were visible both intra- and extra-cellularly and were extremely pleomorphic, with characteristic single and biopolar condensation. The numbers of the organisms increased after each passage. All positive cultures showed bright fluorescence when tested with immune sera. Transmission electron microscopy of the cultured bacteria demonstrated a typical gram-negative cell wall consisting of an outer membrane, middle electron opaque layer and an inner plasma membrane. The capsule was thick and electron dense. Numerous electron dense granules were present within the cytoplasm.


Assuntos
Técnicas Bacteriológicas , Calymmatobacterium/crescimento & desenvolvimento , Granuloma Inguinal/microbiologia , Monócitos/microbiologia , Corantes Azur , Biópsia , Calymmatobacterium/isolamento & purificação , Calymmatobacterium/ultraestrutura , Membrana Celular/ultraestrutura , Parede Celular/ultraestrutura , Técnicas de Cocultura , Grânulos Citoplasmáticos/ultraestrutura , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Masculino , Microscopia Eletrônica
19.
Genitourin Med ; 68(4): 269-72, 1992 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-1398665

RESUMO

OBJECTIVES: An indirect immunofluorescence technique applied to paraffin embedded tissue sections of lesions containing Donovan bodies was evaluated as a serological test for the diagnosis of granuloma inguinale. METHODS: Sera from patients with proven granuloma inguinale, other sexually acquired genital ulcerations and blood donors from areas where granuloma inguinale is rarely encountered as well as from disease-endemic regions were tested. Sera were tested either unabsorbed or following absorption with whole Klebsiella pneumoniae bacteria. RESULTS: Using unabsorbed sera at a dilution of 1:160 the test was found to have a sensitivity of 100%, specificity of 98%, positive predictive value (PPV) of 89% and negative predictive value (NPV) of 100%. There proved to be no advantage in preabsorbing sera with K. pneumoniae antigen. CONCLUSIONS: In the absence of culture methods for Calymmatobacterium granulomatis, an indirect immunofluorescence technique may prove valuable for the diagnosis of individual cases of granuloma inguinale and as an epidemiological tool in studies of the disease.


Assuntos
Calymmatobacterium , Imunofluorescência , Granuloma Inguinal/diagnóstico , Anticorpos Antibacterianos/análise , Calymmatobacterium/imunologia , Reações Cruzadas , Humanos , Klebsiella pneumoniae , Inclusão em Parafina , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
20.
Genitourin Med ; 67(4): 322-6, 1991 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-1655626

RESUMO

OBJECTIVE: To study the microbial aetiology of genital ulcer disease (GUD) in women. DESIGN: Microbial and clinical assessment of genital ulcers in women. SETTING: City Health sexually transmitted diseases clinic, King Edward VIII Hospital, Durban, South Africa. PARTICIPANTS: 100 Zulu women with genital ulceration who had not received antibiotics in the previous two weeks. RESULTS: Syphilis was diagnosed in 40%, genital herpes in 18%, donovanosis (granuloma inguinale) in 16%, chancroid in 14%, lymphogranuloma venereum in 7% and scabies in 2%. No recognised cause was detected in 18%. Secondary syphilis was diagnosed in 21%, primary syphilis in 16% and mixed primary and secondary syphilis in 3%. Multiple infections were detected in 13 women, of whom 12 had syphilis. Bleeding was observed from the ulcers of 59 during swab collection. Three women had HIV-1 antibodies. Neisseria gonorrhoeae was isolated from the ulcers and endocervix of two women and from the endocervix alone in nine. Generalised scabies was diagnosed in 14. CONCLUSIONS: All the major causes of GUD are prevalent in Zulu women in Durban: secondary syphilis was the commonest diagnosis. Donovanosis, which often presents late with large ulcers, and genital herpes are now significant problems. Mixed infections with coexisting syphilis are common. All women in this population with GUD should be treated for syphilis and receive oral antibiotics effective for chancroid and donovanosis.


Assuntos
Calymmatobacterium/isolamento & purificação , Doenças dos Genitais Femininos/microbiologia , Haemophilus ducreyi/isolamento & purificação , Simplexvirus/isolamento & purificação , Treponema pallidum/isolamento & purificação , Úlcera/microbiologia , Adolescente , Adulto , Animais , Feminino , Doenças dos Genitais Femininos/epidemiologia , HIV/isolamento & purificação , Humanos , Pessoa de Meia-Idade , Neisseria gonorrhoeae/isolamento & purificação , Prevalência , Sarcoptes scabiei/isolamento & purificação , África do Sul/epidemiologia , Úlcera/epidemiologia
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