Lymphogranuloma
venereum, a sexually transmitted disease of men caused by Chlamydia trachomatis, subgroups L1, L2, or L3, is characterized by
transient primary cutaneous or mucosal lesion and regional
lymphadenitis.
Visit :
Psittacosis (Ornithosis, Parrot Fever)
;
Trachoma ;
Chlamydial Infection
;
Chlamydial Conjunctivitis (Inclusion
Conjunctivitis).
;
Chlamydial Infection of the Genital Tract
;
Lymphogranuloma Venereum
.
Although the
disease is present worldwide, the highest prevalence is in the tropics
and subtropics; it accounts for up to 6% of sexually transmitted
disease in Africa, Southeast Asia, and India.
Lymphogranuloma
venereum is diagnosed more frequently in men than women, a situation
that probably reflects underdiagnosis and asymptomatic disease in
women.
In north America
and Europe, lymphogranuloma venereum is now primarily a disease of
homosexual men.
After an incubation period of 4 to 21
days, a primary lesion develops at the site of infection.
The painless, herpetiform lesion,
varying in diameter from 1 to 6 mm, usually occurs on the penis,
vagina, cervix, but lips, tongue, and fingers are other primary sites.
Before the primary lesion appears, C.
trachomatis is carried in the lymphatics to regional lymph nodes.
Here after a latent period of 1 to 4
weeks, the nodes enlarge.
Any group may be involved and
enlargement may be unilateral or bilateral.
Over the next few weeks, the nodes
become tender and fluctuant, and frequently ulcerate and discharge
pus.
Lympadenopathy and drainage may persist
for several weeks or months.
Involvement of the inguinal and femoral
nodes may produce the ”groove sign”, in which the enlarged lymph nodes
are visibly separated by the inguinal ligament.
Primary anorectal lymphogranuloma
venereum, usually in homosexual men, causes severe proctocolitis,
accompanied by tenesmus, diarrhea, bleeding, fever, and weight loss.
Patients with lymphogranuloma venereum
usually present with lymphadenopathy, with or without systemic signs
and symptoms, such as fever, chills, myalgias, arthralgias, headache,
anorexia, and meningismus.
Increased serum immunoglobulins,
leukocytosis, and elevated erythrocyte sedimentation rate, and
abnormal liver function are common.
False-positive reagin tests for
syphilis are a feature, but concurrent syphilis always must be
considered.
The diagnosis in most cases are made on
clinical grounds, supported by serologic tests and
is usually
confirmed by polymerase chain reaction.
Most infections resolve completely with
or without antimicrobial therapy, but there may be serious sequelae.
Progressive ulceration of the penis,
urethra, or scrotum, with fistulas and urethral stricture develop in
5% of men with lymphogranuloma venereum.
Chronic ulcers of vulva and smooth,
pedunculated, perianal growths are occasional complications.
Lymphatic obstruction develops in 10%
to 20%of untreated patients and can cause genital elephantiasis in
women.
Rarely, the infection may disseminate
to the lungs, kidneys, bones, joints, and brain system, in which case
it may be fatal.
Primary cutaneous lesion is a
superficial ulcer without specific features.
The lymph nodes contain
characteristic multiple, coalescing abscesses, which have the
appearance of granulomas.Image
Link
There are neutrophils and necrotic
debris in the center, surrounded by a zone of palisaded epithelioid
cells, macrophages, and occasional giant cells.
Image Link1
;
Image Link2.
In turn, this zone is surrounded by
lymphocytes, plasma cells, and fibrous tissue.
Healing is by fibrosis with effacement
of the normal architecture of the node.
Lesions outside lymphnodes tend to be
dominated by fibrous scarring.
Granulomas in the nodes are identical
to cat scratch disease but the bacilli of cat scratch disease, when
present in the granulomas, are diagnostic.
Confirmation of a
diagnosis of LGV requires showing C. trachomatis
serovars L1–3 by serological tests or PCR on genitourinary specimens.
Lymph node resection is not favoured because of the possibility of
sinus formation.
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