Started off with an LP (lumbar puncture) of patient with suspected meningitis. Then to the womens ward for full rounds with Dr. Clara, Cavanaugh and me. Then back to the theatre for another LP and then a couple of outpatients.
My patient with the suprapubic cath came back for re-assessment of his condition. He is to go to Dreifontein (another mission hospital) to be evaluated by a surgeon for a prostatectomy.

This afternoon we saw an elderly woman whose history is interesting. Three months ago Dr. Stoughton saw her after she had been gorged by a bull in her rectum. It tore through to her vagina which Dr. S tried to stitch up. Now she is back because of pain and pus and bleeding from the area. Dr. Clara did the initial exam and found friable, fungating vaginal mucosa. Dr. Clara thinks she has cervical CA but Dr. Brown thinks is donovanosis or Granuloma Inguinale.

Granuloma Inguinale: This is not to be confused with LGV/Lymphogranuloma venereum (a painless genital chancre caused by a Chlamydia trachomatis that causes buboes/large nodes in the inguinal and femoral chains 3-30 days or so after exposure). Granuloma inguinale is caused by Calymmatobacterium granulomatis which causes chronic ulceration of the genitalia and surrounding tissues. It is described in the Oxford Handbook of Tropical Medicine as a beefy granulomatous ulcer with characteristic rolled edges. The lesion is elevated, well defined and bleeds easily with trauma. Usual sites are the anogenital region, thighs and perineum. Healing is uncommon without treatment and secondary infection can follow. This is the ‘pseudobubo’ disease in that the inguinal nodes are not involved BUT the granulomas may be mistaken for enlarged lymph nodes. Diagnosis is by Giemsa or Gram stain. Large mononuclear cells filled with cytoplasmic gram negative rods (Donovan bodies) look like closed safety pins. Treatment is with CTX (Cotrimoxazole or Trimpethaprim Sulfamethoxazole) 960 mg PO BD for 14 days or until lesions are healed. May also treat with tetracycline or doxycycline. We are starting her on CTX and will biopsy the lesion and look for Donvan bodies.
The afternoon I spent with the Cavanaughs taking Shona lessons.