Granuloma Inguinale Research Articles

Lymphogranuloma of the Colon

THE voluminous literature recently accumulated on the subject of venereal lymphogranuloma contains no specific reference to involvement of the supra-anal portions of the colon by this condition. It is the purpose of this paper to describe three such cases complicating known rectal involvement: two in the transverse colon and one extensively in the descending and sigmoid. History.—Copeland, as early as 1811, suspected the venereal origin of stricture of the rectum. The condition was established as a definite pathological entity by the publication, in 1913, of a monograph by the Frenchmen, Nicolas, Durand, and Favre. It remained for Frei, in 1925, to introduce a diagnostic skin test based on a specific skin reaction which immediately placed the differential diagnosis on a sound basis. In 1930, the disease was transmitted to animals (monkeys) by intracerebral inoculations by the Swedish scientists, Hellerström and Wassen. Levaditi later substituted the mouse as a more suitable animal for experimentation. In 1932, Wolf, Sulzberger, and Wise introduced the cutaneous test in this country. Etiology.—The disease is due to an unknown filtrable virus and its frequency varies directly with the degreee of sex hygiene rather than racial susceptibility. Venereal lymphogranuloma is not related to granuloma inguinale, another venereal disease consisting of chronic, luxuriant ulcers produced by Donovan's bodies. The disease produces definite systemic reactions such as fever, headaches, secondary anemia, hyperglobulinemia, high sedimentation rate, and anti-complementary Wassermann reactions, in addition to the long described local acute and chronic tissue responses. Pathology.—Involvement of the colon grossly occurs by the formation of a granuloma and microscopically by the usual picture seen in a chronic non-specific granulomatous reaction, there being no pathognomonic pathological picture in this disease. Pathogenesis.—The anatomical basis for the sequelæ of venereal lymphogranuloma of the rectum is mostly stasis due to the occlusion of the lymphatics by destruction of the lymph glands, resulting in ulceration, elephantiasis, and fistulæ formation which is responsible for the spread to the buttocks and other extensions upward, such as parametritis and peritonitis. Roentgen Diagnosis.—The disease is manifested roentgenographically in the rectum by the demonstration of either extensive exudative inflammation, stricture, or fistulæ formation, depending on the stage of the disease. The changes higher in the colon are similar, and when found associated with known rectal involvement, must be considered as due to the same etiology. It is not the province of this paper to enumerate the clinical diagnostic criteria for the rectal diagnosis (history, controlled Frei tests, biopsy, etc.) but, whenever a case so labelled clinically shows an associated colon lesion and further shows reactions to the Frei therapeutic antigen, the etiology is self-evident.

EXPERIMENTAL AND CLINICAL GRANULOMA INGUINALE

Many investigators have asserted that they have cultured an organism comparable to the Donovan body on a variety of mediums, particularly Sabouraud's. 1 However, the types of organisms cultivated by the various investigators have not been identical. Moreover, subcutaneous inoculation of such organisms into human beings has failed in every instance to reproduce the typical lesions of granuloma inguinale. 2 It is therefore doubtful that the etiologic agent of this disease has ever been cultivated. On the other hand we have on several occasions aspirated material from unruptured inguinal abscesses (pseudobuboes) of granuloma inguinale in which the sole micro-organism present was the Donovan body. In attempting to corroborate the observations of previous investigators we met with utter failure to cultivate the Donovan body or any other organism from this material. 3 Since a pure culture of Donovan bodies was contained in the aspirated pus, we felt that some light might

The Attempted Cultivation of Donovan Bodies from Granuloma Inguinale

The Attempted Cultivation of Donovan Bodies from Granuloma Inguinale

Granuloma Venereum of Cervix Uteri: A Statistical Study

<h2>Summary</h2> From a study of 830 biopsies of diseased cervices of the uterus, the lesion was due to granuloma venereum in 9 cases, an incidence of 1.1 per cent. In biopsies from negro patients the incidence was 6.6 per cent. In biopsies from negro patients without carcinoma of the cervix, the incidence was 13.4 per cent. We have never observed granuloma venereum of the cervix in a biopsy from a white patient. Nine cases of granuloma venereum of the cervix have been found since 1934. No cases were observed six years prior to 1934. The cervix uteri may be the primary site of granuloma venereum, and is often a complication of other venereal diseases. The symptoms suggest carcinoma.

Granuloma venereum of uterus, tubes, and ovaries: Pund and Gotcher: Surgery 3: 34, 1938

Granuloma venereum of uterus, tubes, and ovaries: Pund and Gotcher: Surgery 3: 34, 1938

EXTRAGENITAL GRANULOMA INGUINALE

Granuloma inguinale, as the name implies, is a granulomatous process which usually occupies the inguinal region. The well known proclivity of the disease for the external genitalia has earned for it a place in the category of venereal diseases. Its venereal origin, however, has never been absolutely proved. The development of granuloma inguinale is not confined to the external genitalia, the vagina, the perineum, the buttocks and the groin. It may occur primarily on the cervix. The recognition of this fact is of utmost importance in the differentiation of carcinoma of the cervix uteri, which it closely simulates. 1 Recently there was recorded a case of granuloma inguinale of the uterus, tubes and ovaries. 2 EXTRAGENITAL SITES It has long been known that extragenital lesions occur. In 1905 Donovan 3 was struck by the granuloma-like appearance of the lesions in the mouth of a boy in a ward. Scrapings

GRANULOMA INGUINALE

It is now well recognized that granuloma inguinale is not limited to the tropics. Fox, 1 in reporting a number of cases in the middle part of the temperate zone, has called attention to the wide distribution of this disease. The present case is reported because of some unusual features. REPORT OF CASE M. S., an unmarried Negress aged 25, who was born and had lived all her life in Missouri, was first admitted to the Kansas City General Hospital on June 19, 1935. Her condition had started two years before as bumps around the vaginal opening, which gradually spread as running sores. Although she stated that she had not had syphilis and serologic tests gave no evidence of the disease, she was given injections of neoarsphenamine and a bismuth preparation for several months. These had no effect on the ulceration. There were no apparent abnormalities aside from the pudendal

Granuloma Inguinale 1

Summary and Conclusion 1. A series of 294 cases of granuloma inguinale observed in New Orleans during the years 1931 to 1935 is reported. 2. The analysis of the clinical symptoms suggests that the disease is a strictly local infection with no dissemination of the infectious agent and no general toxicity. Secondary infections have to be regarded as serious complications of the disease. 3. An attempt has been made to divide the lesions, according to their appearance, into five principal groups, the most common one being the serpiginous ulcer of the pudenda. 4. The genital organs must be regarded as the site of predilection for the disease, followed by the inguinal and perineal regions. The extragenital lesions are rare and usually secondary to pudendal lesions. 5. The histopathology of the five principal types of lesions is described. A brief stage of exudative inflammation is followed by a chronic productive inflammatory process leading to the formation of the serpiginous ulcer, the hypertrophic and cicatricial lesions. 6. Certain cicatricial lesions which have been interpreted as the scar tissue of healing ulcers represent an active and progressive manifestation of the disease.

Immunological Relationships of Encapsulated Gram-Negative Rods.

The difficulties encountered in the past, in the differentiation of the bacteria exemplified by the organisms of Friedlander, rhinoscleroma, ozaena, granuloma inguinale and Bad. aero genes, have more recently been increased, rather than diminished, by the discovery that members of the different species possess common immunological characteristics by virtue of similarities in the capsular carbohydrate. Studies on the immunological reactions of the unencapsulated cell supplied the hypothesis that the different organisms, once deprived of the ability to elaborate capsular polysaccharide, might be more readily amenable to systematization. Accordingly, unencapsulated, or “R”, strains have been derived from the encapsulated “S” strains by continued cultivation of the ”S“ form in homologous anti-S serum. Usually, 6 to 12 transplants in broth containing 10% immune serum sufficed for the conversion. Rabbits were then injected intravenously with suspensions of heat-killed (30 min. at 56°C.) R forms until the sera contained sufficient antibody for serological study. For this purpose, anti-sera were obtained with R cells derived from Friedlander's bacillus, Types A and B and Group X; ozaena bacillus, Types I and II and Group III; three immunologically different strains of Bact. aerogenes; and a single strain of rhinoscleroma and granuloma bacillus. Agglutinations were then conducted employing each R strain and each anti-serum. In order to illustrate the reactions observed, a summary protocol has been arranged of all the reactions. The titres of the different anti-sera were close to 1:5000, and the agglutination was composed of large, coarse granules readily disrupted on agitation. This is, of course, in contradistinction to the agglutination of S cells, which is characterized by a compact, tenacious disc. Examination of the data reveals 2 large groups disclosed by the agglutination reaction.

The variety and distribution of gross lesions in lymphopathia venerea

In summing up, we simply call attention to the immense variety of gross lesions encountered and the difficulty of diagnosis. The confusion between granuloma inguinale and lymphogranuloma inguinale, or lymphopathia venerea is possibly due to the fact that many of these cases of lymphopathia venerea do improve somewhat under injections of tartar emetic. That leaves us with only two points for a differential diagnosis: first, the presence of Donovon bodies in tissues removed, and second, the presence or absence of a reaction to the Frei antigen. We believe that the antigen is specific. We also believe the Donovon bodies to be diagnostic; therefore, should we find both, the patient must have two diseases.

SUBACUTE LYMPHOGRANULOMA INGUINALE

The purpose of this paper is to emphasize the incidence of lymphogranuloma inguinale on the Pacific Coast. Especially a of tropical regions, where it has been abundantly described as climatic bubo, the has recently been reported from many European maritime cities and from ports of the Great Lakes. In the confusion of names the should not be confounded with that termed lymphogranulomatosis, a term often applied to Hodgkin's disease, or with those termed ulcerative, pudendal disease and granuloma inguinale, presumably caused by protozoan infection. Complete and easily accessible descriptions of the are contained in the articles by De Wolf and Van Cleve, 1 Sulzberger and Wise 2 and, especially from the standpoint of pathology, Lillie. 3 Described briefly, the is a venereal infection caused by virus, showing a slight, transitory, mostly unobserved primary genital lesion of ulcerative or nodular type two or three weeks after

CARCINOMA OF BARTHOLIN'S GLAND

Primary carcinoma of Bartholin's gland is rare. A review of the world's literature by Harer in 1933 revealed only thirty cases recorded, not all of which in his opinion were authenticated. Nothing definite is known about the etiology. Falls says that chronic inflammation has been present in a considerable number of the cases reported. In only one case was there a definite history of gonorrhea and syphilis. Bilateral inflammation of the gland was described in only one case. The lesion has been found in unmarried women but not in virgins. The youngest patient was 28 and the oldest 91, while the average age was over 50 years. Diagnosis is usually made postoperatively. It is most frequently confused when associated with chronic infection with abscess formation. Syphilis, contrary to gonorrhea, rarely attacks this gland. Chancroid and granuloma inguinale affecting Bartholin's gland have not been reported. Primary tuberculosis is rare, there being

Further Studies on the Etiology of Granuloma Inguinale

Cases of granuloma inguinale are being encountered with greater frequency in the United States, and in view of an apparently increased incidence, particularly in the Gulf and South Atlantic seaboard states, this disease gives promise of becoming an important public health problem in the near future. The method of transmission of the infection remains uncertain, and acceptable proof of the cultivation of the etiological agent has not been forthcoming.In a previous report (1), based on cytologic and cultural studies of the lesions of granuloma inguinale, we expressed the opinion that the Donovan organism, generally regarded as the etiologic agent, is cytotropic, and that its multiplication takes place mainly, if not entirely, within the large mononuclear cells that occur so abundantly in the lesions. All of our previous attempts to cultivate the Donovan organism resulted in failure.Since these earlier studies numerous additional cases of the disease have been encountered in the clinics of the Vanderbilt University Hospital.

Granuloma inguinale, with report of a case with oral involvement

A LTHOUGH the disease known as granuloma inguinale, granuloma venereum, granuloma tropicum or ulcerating granuloma of the pudenda has been known since the latter part of the past century, l* 2 it was not until 1913s that any cases were recognized in this country, and it is only since 1920 that its frequency has been recognized. Although not common, its frequency is such that a brief description of the usual clinical appearance and course is justified. The disease is much more common in negroes than in white people, the ratio apparently being in the neighborhood of nine to one. The first lesion noticed is usually a small papule in the groin. This gradually increases in size, ulcerates and continues to spread superficially, leaving a red, exuding, granulating area that shows little tendency toward healing. Where folds of the skin approximate, the disease can spread by contact as well as by extension from the edges, and the extension tends to be somewhat greater downward. Enlargement of the regional lymph nodes, while frequently observed, appears to be the result of secondary infection of the granulating surface and not the result of the disease itself. The lesions, unless checked by treatment, will spread until death finally results. Although the disease usually is limited to the region of the groin, it can occur on other parts of the body, and lesions have been produced on the back by inoculation. Ectopic lesions are particularly likely to cause difficulty in diagnosis. Etiology.--The structures described by Donovan in 1905,4 and commonly known as “Donovan bodies” are usually thought to be living parasites of some nature and to be the etiologic agent of the disease. Donovan considered them to be protozoa, while Siebert5 who described the same structures in 190’7 without knowledge of Donovan’s observations, thought them to be capsulated bacteria. The disease was at first thought by some to be a form of syphilis,6 and some authors observed spirochetes, 6, ’ but these findings have been so infrequent as to make them seem incidental and not of significance in the etiology of the disease. Since the Donovan body is the only constant finding, and the one which has been most studied, the question of etiology will be discussed with particular reference to this structure.

The Treatment of Granuloma Inguinale by Diathermic Fulguration an Analysis of Twenty-Two Cases

(1) The method of treatment described in this paper is, I believe, a new one. (2) The treatment is easy to carry out, is not attended by shock, and, given general anaesthesia at the time of operation, causes practically no discomfort to the patient. (3) The average time taken to heal the ulcer in this series of cases is seventy days, the greater part of the ulcer being healed in most cases in about four or five weeks. This is a very much shorter period than that taken by the antimony tartrate treatment in most cases. There were no failures in the series. (4) Judging from the appearance of the scar and from the one follow-up case seen, it seems probable that the cure is lasting. (5) The fact that treatment of the edges of the ulcer only is sufficient goes to confirm the work of Castellani and Mendelson, referred to above, that the Leishman-Donovan body, found only in smears from the ulcer, is not the causative organism, but a nosoparasite. It also seems to indicate very strongly that the true causative orga...

Infection of Monkeys with Donovan Organisms by Injections of Tissue from Human Lesions of Granuloma Inguinale

Summary 1. Three Macacus rhesus monkeys inoculated with Donovan organisms from a case of granuloma inguinale showed evidence of an abortive infection with this pathogenic agent. 2. A biological method is thus afforded for testing any microorganism which might be cultivated from these lesions and suspected of being the etiological agent.

PREGNANCY AND LABOR COMPLICATED BY GRANULOMA INGUINALE

Granuloma inguinale is a disease found chiefly in the subtropics, but during the last ten years sporadic cases have been reported from many localities in this country, especially in the South. In Charleston, S. C., it is fairly common; the genito-urinary department of Roper Hospital informs me that it treats about twenty-five cases a year. Kenneth M. Lynch 1 of Charleston and Meredith F. Campbell 2 of New York are to be credited with the most comprehensive study of this condition that has been made in this country. The organisms that are supposed to be the cause of this disease were first described by Donovan in 1905 and are called Donovan bodies. The method for demonstrating this organism is as follows: A portion of ulceration is selected where the ulceration appears to be spreading, not healing. Wet dressings of physiologic solution of sodium chloride are applied to this area for

Supplementary Volume, The George Blumer Edition of Billings-Forcheimer's Therapeusis of Internal Diseases

This supplementary volume to the well-known System of Therapeusis of Internal Medicine of Billings and Forcheimer is intended to bring the system up-to-date, and well fulfills its object. No less than sixty authorities have united in its preparation and their contributions are uniformly excellent. Of special interest to physicians interested in tropical medicine may be mentioned the paper of Bunker upon the place of malaria in the treatment of general paralysis; that of Cowgill upon the vitamins; that of Craig upon the prophylaxis and treatment of amoebiasis; that of Hillsman and Zimmerman upon granuloma inguinale and lymphygranulomatosis inguinalis; and that of Strong upon recent advances in the treatment of leprosy. The volume is filled with the latest information concerning the prophylaxis and treatment of disease and furnishes an epitome of all recent advances along these lines. It can be cordially recommended to every physician as a most valuable addition to his reference library.

Recent Advances in Tropical Medicine

The first edition of this work was reviewed in this Journal in the issue of May, 1928, Page 259. That a second edition has been called for in a little over one year speaks well for it's popularity and usefulness, as well as for the evident interest of the medical profession in tropical medicine. The present edition contains new sections upon Oroya Fever and Veruga Peruana, new Helminthic Infections, Granuloma Inguinale and Climatic Bubo, and a few new illustrations. On the whole, it is an improvement over the first edition and is well up-to-date, containing references to papers published as late as the middle of 1929. The work can be recommended to all physicians interested in tropical medicine as a valuable summary of the more important recent discoveries in the etiology, epidemiology, diagnosis, prophylaxis, and treatment of the diseases of the tropics and subtropics, and the warmer portions of the temperate zones.

GRANULOMA INGUINALE

The etiology of granuloma inguinale has interested investigators in this field throughout the world since the disease was first adequately described by Conyers and Daniels in 1896. Donovan created widespread interest in the disease by describing cellular inclusions which were constantly found in smears obtained from cases of granuloma inguinale. The cellular inclusions discovered by Donovan were found in the cystoplasm of the mononuclear cells, which cell is the predominating one of the lesion. Donovan's discovery has been confirmed by all of those investigators who have interested themselves in the study of this disease. The cellular inclusions have been named after their discoverer, and are known as Donovan bodies. A disease that has been established as a definite clinical entity, being widespread in its geographic distribution, portraying the same clinical manifestations, the same pathologic change, the constant observation of the Donovan bodies in smears from the lesion and the organism