This page includes the following topics and synonyms: Granuloma Inguinale, da Calymmatobacterium granulomatis, Donovanosi, Granuloma venereo. Basta-Juzbasic A, Ceovic R. Chancroid, lymphogranuloma venereum, granuloma inguinale, genital herpes simplex infection, and molluscum. The diagnosis and treatment of donovanosis (granuloma inguinale). .. Guariento A, Delascio D, de Macedo OB, Luisi A. Granuloma venéreo e gestaço. Matern.
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Proctitis as the clinical presentation of lymphogranuloma venereum, a re-emerging disease in developed countries. Departments of 1 Gastroenterology and 2 Infectious Diseases. Madrid, Spain 3 Department of Microbiology. The initial presentation is usually a painless ulcerated papule on the genitalia or distal proctitis. The progression of the infection can lead to major complications: We present five cases of LGV proctitis as the initial presentation of the disease.
All patients were male, mean age The initial diagnosis was made by rectosigmoidoscopy indicated for pain and anal discharge. All cases were confirmed by polymerase chain reaction technique in rectal tissue. Endoscopic images obtained showed a great variety of rectal lesions, from mild erythema of the mucosa and ulcers to deep ulcers with elevated borders grankloma purulent exudate.
All cases were resolved after treatment with doxycycline for 3 weeks.
Granuloma venéreo – Heraclides Cesar de Souza Araujo – Google Books
It emphasizes the importance of suspecting this re-emerging disease in patients with risk factors HIV and MSMwith the aim of early treatment and to avoid major complications. Men who have sex with men. Se presentan cinco casos de LGV con proctitis como signo inicial cenereo la enfermedad. Tras tratamiento con doxiciclina, durante 3 semanas, todos los casos se resolvieron de forma satisfactoria. Virus de la inmunodeficiencia humana.
Beforeit was considered a rare disease in industrialised countries but it was endemic in parts of Africa, Asia, South America, and Caribbean countries. The first European case was detected in Rotterdam, the Netherlands, in February and since then there have been clusters of cases in European countries, North America and Australia. The first case in Spain was reported in in Barcelona 1.
Lymphogranuloma venereum: diagnostic and treatment challenges
The clinical course vehereo the disease includes three stages. First, after an incubation period of 3 to 30 days, it is characterized by the appearance of small painless ulcerated papule in the site of inoculation prepuce or glans in males and vulva or vaginal wall in women. This lesion is self-limiting and may pass unnoticed by most patients. In the second stage which begins a few weeks or even months after the primary lesion, loco-regional lymphatic chains in the site of inoculation are affected and painful inguinal lymphadenopathy usually appears.
Anal ulcers or proctitis may also arise by direct inoculation of the bacteria in the rectal mucosa, a more common presentation in women or men who have sex with men MSM. At rectosigmoidoscopy several lesions can be seen in distal rectum, from a nodular mucosal erythema to ulcers with mucopurulent exudate. In the third stage, which occurs when the disease progresses untreated, lymph node necroinflammation leads to obstruction of lymphatic drainage and genital elephantiasis.
In this context, rectal involvement may be complicated by fistulae and rectal strictures 2. The current standard method for diagnosing LGV is the direct identification of Chlamydia trachomatis in tissue or fluids from the patient.
Initially laboratory diagnosis was based on cultures, today used only in specific cases, or in the nucleic acid amplification test followed by genotyping with polymerase chain reaction PCR. Sincemolecular biological techniques based on high specificity detection of the membrane protein H gene by PCR are used 3. Serology has also been replaced by direct detection tests, but still may have some utility in selected cases e. The treatment of choice is doxycycline mg orally twice daily for 3 weeks.
Other alternatives are erythromycin mg orally four times daily for 3 weeks or a single oral dose of azithromycin 1 g once weekly for 3 weeks.
Response to antibiotic treatment is usually complete after 3 or 6 weeks and all lesions disappear in most patients. In case of complicated disease with fistulas or anal strictures, and after antibiotic treatment, surgery or aspiration and drainage of lymph nodes may be needed. Up to now, and in our knowledge, there has been no reported case of endoscopic dilation in anal strictures, although it could be an alternative procedure to consider.
We report 5 cases of LGV in white men with proctitis as the initial presentation lesion who were diagnosed between February and February The mean age was Four were receiving antiretroviral treatment and had undetectable viral load at the time of infection with Chlamydia trachomatis.
All of them were MSM and had multiple sexual partners in the last months.
The symptoms that led to gdanuloma request of a rectosigmoidoscopy were anal pain in three of them and anal rectal discharge associated with rectal tranuloma in the others. Endoscopic involvement was limited to the distal rectum in the first three cases and to the middle and distal rectum in the last two. The lesions ranged from mild and nonspecific hyperemic mucosa case 5, figure 1 to a circumferential ulceration with elevated geographical borders and mucopurulent exudate case 3; figures 2 and 3.
Pathological examination of rectal biopsies showed granulation tissue, increase in polymorphonuclear leucocytes, fibrin exudate associated with fibrosis and stromal congestion. There were no granulomas or viral inclusions in the samples. Periodic acid-Schiff and Ziehl-Nielsen stains were negative. Case 3 showed inguinal lymphadenopathy in pelvic computed tomography. All patients were treated with doxycycline, mg orally twice daily for 3 weeks, with complete resolution of all lesions.
Mucosal healing was confirmed by sigmoidoscopy within 2 to 4 weeks after the treatment. In both cases with more severe mucosal injury cases 3 and 4 distal rectal scarring remained, without stenosis or other complications. After a mean follow up of There has been a resurgence of LGV in the last ten years in urban areas of developed countries, particularly among MSM.
It has been observed also a co-infection with other sexually transmitted diseases such as syphilis, gonorrhea or hepatitis C virus 5. It seems that these individuals do not represent a reservoir of the disease. The co-existence of both infections is not only the result of high sexual risk behavior but it could be a synergistic effect between HIV branuloma LGV 6. Furthermore, it is not considered an opportunistic infection as most of the cases described were under antiretroviral treatment and with normal CD4 lymphocyte count.
Some authors suggest that the increase of cases reported in recent decades is due to the development of diagnostic tests for serotypes L1, L2 and L3 of Chlamydia sincewhich have emerged these infections previously undiagnosed. Other authors speculate that a change in antibiotics prescribing practices for urethritis and other genital infections in the 90’s, with a decrease in the use of doxycycline and an increase in azithromycin, would have re-emerged Chlamydia endemic infections 7.
In the reappearance of this disease its presentation has changed and, today, proctitis is the most common initial clinical manifestation. Then differential diagnosis of LGV includes other sexually transmitted diseases such as syphilis, gonorrhea or proctitis caused by herpes simplex virus or cytomegalovirus. In severe rectal lesions, endoscopic images can mimic an inflammatory bowel disease 11a rectal carcinoma or a lymphoma.
In this series of five cases, all patients were promiscuous MSM. Despite HIV infection there was no immune deficiency as in all patients CD4 lymphocytes count was in normal range. The route of inoculation of the microorganism was the anal sexual activity, but the presenting symptoms ranged from mild discomfort to rectal anal suppuration and rectal bleeding, perhaps related to the severity of proctitis or to the time from infection.
GRANULOMA VENEREO by mishell jaramillo on Prezi
Also notable is the variety of rectal mucosal lesions induced by Chlamydia trachomatis and that are showed in the pictures. Two of the patients had full circumference rectal ulcers and mucopurulent exudate that mimicked anal carcinoma or Crohn’s disease, particularly when those graunloma were detected on the digital rectal exploration.
By contrast, in two other patients, one of whom was diagnosed of HIV infection in that episode, the rectal findings were minimal showing mild mucosa erythema and some aphthas, so the infection could be passed unnoticed.
LGV is a public health problem. Case detection and study of contacts to prevent the spread granulomw the disease is a challenge for all health professionals. It is necessary to define the diagnostic targets and the monitoring of veneeo populations to prevent the increase in cases and the concomitant infections.
Gastroenterologists are beholden to suspect this emerging disease when compatible symptoms are present, especially in MSM, and not ignore an endoscopic examination and granuloja this disease with trivial anal problems. The endoscopist, due to the large spectrum of possible rectal lesions, should take biopsies routinely for LGV and other sexual transmitted disease and request the laboratory for PCR in tissue of Chlamydia trachomatis serovars L when suspecting this disease.
A silent endemic disease in men who have sex with men in industrialized countries. Mabey D, Peeling RW. Sex Transm Infect ; From culture to realtime quadriplex polymerase chain reaction. Van de Laar MJW. What do we know, what can we do? Euro Surveill ; A cluster of acute hepatitis C virus infection among men who have sex with men: Results from contact tracing and public health implications. The association between Lymphogranuloma venereum and HIV among men who have sex with men: Schachter J, Moncada J.
How to turn an endemic disease into an outbreak of a new disease? Sex Transm Dis ; Update on lymphogranuloma venereum in the United Kingdom. Sex Transm Inf ; Rectal lymphogranuloma venereum surveillance in France Lymphogranuloma venereum in the United kingdom. Clin infect Dis ; Lymphogranuloma venereum proctosigmoiditis is a mimicker of inflammatory bowel disease. World J Gastroenterol ; Case reports We report 5 cases of LGV in white men with proctitis as the initial presentation lesion who were diagnosed between February and February