The microscopic analysis provides the best result. The key is to observe adequately stained Donovan bodies (intracellular bacteria) .
Classical approach is a slow overnight staining by Giemsa method, Leishman’s stain or Wright’s stain. Before that the specimen has to be obtained by means of a forceps, currette, or the edge of a safety razor blade, and then crushed between two slides.
A modified Giemsa stain also called as RapiDiff is known to give rapid results. The organisms stained in this way are ovoid and pleomorphic with pink capsule and bluish or purplr body. Donovan bodies have also been observed in papanicoulau smears.
In advanced laboraties, a transmitting electron microscopy may be used for the evaluation of the ultrastructural features of klebsiella granulomatis comb. In endemic areas indirect immunofluorescence also plays a role, albeit the evidence for firm diagnosis lacking.
Culture and Histopathology:
Modified chlamydia culture was also used for this process. For lesions that are small, sclerotic, dry or necrotic then the biopsy is must and subsequent histological examination is also very important. Giemsa and silver staining are most efficient for visualizing the micro organisms in tissue sections. The characteristics histological finding reveals chromic inflammation with a preponderance of polymorphonuclears and plasma cells which can also be found in epidermis.
Although the use of polymerase chain reaction (PCR), which is a molecular diagnostic tool, in diagnosing granuloma inguinale has been reported, the technique is still mostly available as a research tool. Amplification of Klebsiella-like sequences was initially achieved by using primers that target the phoE gene.
Later a diagnostic PCR tool was developed from the observation that two unique base changes in the aforementioned gene eliminate HaeIII restriction sites, which enables clear distinction from closely related Klebsiella species. This method was then further refined into a colorimetric PCR test that is becoming ever-more pervasive in diagnostic microbiology laboratories.
Recently introduced was also a multiplex PCR that targets genital ulcers, and hence includes Klebsiella granulomatis comb. nov. alongside Treponema pallidum (causative agent of syphilis), Haemophilus ducreyi (causative agent of chancroid) and herpes simplex viruses.
The skin lesions consists of 3 stages:
Initially small pimple will begin to spread and eat away the surrounding tissue. As the tissue begins to wear away, it turns pink or a faint red. The bumps then turn into raised red nodules with a velvety texture. This can take place around the anus and genitalis. Although the bumps are painless, they can blees if they are injured.
In the second stage the bacteria begin to erode the skin. Once this occurs you will develop shallow ulcers that will spread from the genitals and anus to the thighs and lower abdomen or inguinal area. You will notice that the perimeters of the ulcer are lined with the granulated tissue. A foul smell may accompany the ulcers.
When granuloma inguinale advances to the third stage the ulcers become deep and mask into scar tissue