Intracellular klebsiella infections (donovanosis and rhinoscleroma)

Two rare intracellular species of Klebsiella, a Gram-negative bacillus, cause granulomatous disease in humans that is found in small endemic foci in warm climates, linked to poverty and poor hygiene. Donovanosis is caused by Klebsiella granulomatis (previously named Calymmatobacterium granulomatis) and is presumed to be sexually transmitted. Presenting with genital ulcers or growths, often accompanied by an inguinal ‘pseudobubo’ (granuloma inguinale), it is diagnosed by demonstrating Donovan bodies (vacuoles containing capsulated coccoid bacteria) lying within histiocytes in material taken from a typical lesion. Treatment is with azithromycin; surgery may be needed for complications. Rhinoscleroma, caused by Klebsiella rhinoscleromatis, is believed to transfer from person to person; following a period of rhinitis it most typically manifests with bulky growths in the upper respiratory tract. It is diagnosed by demonstrating intracellular organisms in typical lesions, combined with culture. Treatment is with ciprofloxacin; surgical debulking of lesions and/or reconstruction may be required.