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LYMPHOGRANULOMA
VENEREUM
Synonyms
Tropical or Climatic bubo
Durand-Nicholas-Favre disease
Lymphogranuloma inguinale
Poradenitis inguinalis
Strumous bubo
History
•

Walkee in 1833 first identified

•

Caddy 1902 “Climatic bubo” India

•

Durand-Nicolas-Favre 1913 “LGI”

•

Frei 1925 – Intradermal Test

•

1927  Chlamydia Trachomatis causal agent
DEFINITION
•

•

•
•

•
•

Sexually transmitted disease
A disease affecting the Lymphatic System
Caused by Chlamydia Trachomatis Serovars
L1-L2-L3
Regional Suppurative LAN preceded by a
small transient inconspicuous lesion at
Inoculation Site
EPIDEMIOLOGY
•

6% Prevalence Rate in Clinics

•

Endemic to India

•

20 - 40 yrs.

•

Male : female = 5 :1

•

Urban, sexual promiscuity, low socio- economic
status.
AETIOLOGY
•

Chlamydia Biovar LGV Serovar L1/L2/L3

•

Obligate intracellular, Gram negative bacillus with
humans as Natural Hosts by Sexual Transmission /
Perinatal infection

•

Intracytoplasmic inclusion bodies

•

Controls the organelles of host cells for own growth
and protein synth

•

Cell cycle – 48 to 72 hrs


sss
PATHOGENESIS
•

•

•

•
•
•

Entry into cell as Metabolically inactive
elementary body (Eb) by receptor mediated
endocytosis.
Conversion to Active Reticulate Bodies which
multiply , condense and form Eb  burst out of
host cells
Lymphangitis, perilymphangitis, necrosis of
lymph nodes
PMN stellate abscess- bubo
Healing by fibrosis - esthiomene, adhesions
Dissemination rare


sas
CLINICAL FEATURES
Primary stage
Incubation period : 3-12 days.
Single, painless, evanescent, inconspicuous
Papule / vesicle / Erosion / Ulcer ?herpetiform
Male – coronal sulcus, prepuce, glans,
urethra
Female - endocervix, post vaginal wall
Oral / Rectal localization
NSU
BUBONULUS – Lymphangitic nodules over
dorsal penis  Chord-like swelling
PRIMARY LESION
BUBONULUS
Secondary ‘INGUINAL’ stage
•

02-06 wk after primary lesion

Inflammatory swelling of Inguinal nodes in males
perirectal and iliac nodes in females  ‘BUBOES’ 
Fluctuant if untreated  Multilocular Suppuration (70%)
•

•

Unilateral 2/3rd cases

•

Constitutional symptoms with bubo

Blue ball sign / Livid colour of overlying skin over
Bubo predicts rupture
•

•

Groove sign of Greenblat (20%)
GROOVE’S SIGN
‘BLUE-BALL’ SIGN
SECONDARY STAGE
•

‘Stage of Diagnosis’

? Women

Dissemination (Rare, hematogenous)
•
Arthritis
•
Ocular inflammatory disease
•
Pneumonitis
•
Hepatitis
•
EN / EM
TERTIARY STAGE
•
•

Develops in 25% of untreated
GENITO-ANO-RECTAL syndrome, more common in
women / MSM

Clinical features
•
•

Hyperplastic Ulcerative lesions
Proctocolitis
• Bloody purulent discharge
• Pruritis Ani
• Tenessemus
TERTIARY STAGE
•

Lymphatic tissue hyperplasia (LYMPHORROIDS /
PERI-ANAL CONDYLOMAS)

•
•

Chronic Ulceration / Scarring
Fistulae / Strictures

Mechanisms
Peno-Anal Intercourse
Posterior Urethral spread
Direct Spread from Vaginal Secretions
Lymphatic Dissemination by Cx
PROCTO-COLITIS
COMPLICATIONS
•

Genital Elephantiasis

•

Ram-rod / Ram-horn / Saxophone Penis
COMPLICATIONS
•

ESTHIOMENE / Vulval Elephantiasis
COMPLICATIONS
•

CA RECTUM (2-5%)

•

EPIDIDYMO-ORCHITIS

•

PROSTATITIS

•

SEMINAL VESICULITIS
Extragenital manifestations


Ocular manifestations

•

Can occur at any stage
common with L2
Conjunctivitis, Episcleritis, Keratitis, Iritis
Submaxillary, post auricular LN

•
•
•



Cutaneous manifestations
Id eruptions
Ilio-Psoas Abscess
Differential diagnosis
Primary stage






Genital herpes
Primary syphilis
Chancroid
Traumatic ulcer
NGU

Secondary stage







Chancroid
Syphilis
Genital herpes
Bubonic Plague
Tuberculosis
Septic LAN
Investigations







Leucocytosis
Raised ESR
Hyperproteinemia with raised globulin
False positive VDRL
Microscopy with giemsa stain
Frei’s test
Investigations









Microscopy / Identification
Gram stain, Giemsa stain, Warthin Starry, Machiavello
Isolation
Culture on McCoy / HeLa Cell Line (Brown Inclusion
bodies)
Histopathology – Stellate Abscesses / Gran Infiltrate
Serological tests: CFT, PCR, NAAT,
IMMUNOFLUORESCENCE
CT / MRI, Lymphography
Management


General measures



Medical Cap Doxycycline 100 mg bd
Tab Erythromycin 500 mg qid
Tab Azithro 1gm/wk



21days

Erythromycin 7.5- 12.5 mg/kg qid for 2-3wk for
children and pregnant patients


Surgical
Bubo aspiration preferred over I & D
Sx - elephantiasis, esthiomene, sinus,
fistulae,
stricture dilatation



Partner management (All contacts in 60
days)
azithromycin 1 gm orally single dose or
doxycycline 100 mg BD X 07 days
Lgv by aseem

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