Ditambah tambah masuk untuk ref besarEpid dari fitzMore recent reports fromSoutheast Asia and Africa suggest that the incidence of chancroid may be declining in the face of a rapidly rising incidence ofgenital herpes.59 Chancroid outbreaks have been reported in a number of cities in industrialized countries during the last twodecades, predominantly in the United States.10 After an epidemic in California in 1981, the number of cases peaked in 1987 at5,035 cases. In a ten city study, chancroid was confirmed in 12% of genital ulcers in Chicago and 20% in Memphis.11 Incontrast, only 23 cases of chancroid were reported to the Centers for Disease Control and Prevention (CDC) in 20071.2 Thetrue incidence in most areas remains unclear and is probably vastly underreported because confirmatory culture media or DNAamplification methods are not commercially available.13 The global epidemiology of chancroid is so poorly documented that itis not included in WHO estimates of the global incidence of curable sexually transmitted diseases.4 Overall, chancroidaccounted for 8 cases (3%) of genital ulcers in a sexually transmitted infection (STI) clinic in Paris from 1995 to 2005.14

gejala klinis habifFemales may havemultiple, painful ulcers on the labia and fourchette and, less often, on the vaginal walls and cervix. Autoinoculation results in lesions on the thighs, buttocks, and analareas. Female carriers may have no detectable lesions and may be without symptoms.

gejala klinis rooks

Lesions are more common in uncircumcised men and areusually located in the coronal sulcus or on the inner aspect of theprepuce (Fig. 34.47). Perianal lesions occur in MSM. In women,lesions may be recognized at the vaginal introitus or on the labia;vaginal and cervical lesions may also occur but often go unnoticed.In one-third of cases, there is accompanying inguinal lymphadenitis,which may progress to suppurating bubo formation.Fluctuant inguinal abscesses will rupture and discharge (Figs34.48 & 34.49).Other complications are uncommon. Phagadenic ulceration andresulting genital deformity may occur with secondary infection.Extragenital lesions may occur via autoinoculation to the fi ngersor thighs. Lesions of the lips and oral cavity have been described.Systemic disease does not occur.Vertical transmission and neonatal disease is extremely rare.Recently, chronic skin ulceration of the legs caused by H. ducreyiin children visiting Samoa has been described [8].

Int j std aids 2011Non-sexual transmission has been reported.13,14 H. ducreyihas been demonstrated in asymptomatic individuals.15 Malecircumcision is associated with reduced risk of contractingchancroid.16

Lesi yang berdekatan pada pasien laki-laki atau perempuan biasanya bergabung dan membentuk lesi konfluens.

PEMERIKSAAN GRAM DARI ROOKS

H. ducreyi possesses agglutination properties that account for the clumping of organisms when colonies are dispersed in saline. Agglutination may be responsible forthe school-of-fish pattern seen on Gram staining. Smears taken from the surface areas are of little use. Material is obtained by drawing the flat surface of a toothpickunder the undermined border of the ulcer. The cellular debris is then smeared on a glass slide. Exudate is obtained from the base of a new ulcer with a cotton swab.The swab is rolled in one direction over the slide to preserve the characteristic arrangement of the organisms. The slide is gently fixed with heat and stained withGram stain. Gram-negative coccobacilli occur in parallel arrays (school-of-fish arrangement). This feature is infrequently seen and other gram-negative bacilli in the smear may result in a false-positive diagnosis ( Figure 10-18 ). Bacteria may be intracellular. H. ducreyi may also bedemonstrated with Wright, Giemsa, or Unna-Pappenheim stains.Herpes simplex genital ulcers can mimic chancroid. [21] A herpes culture and Tzanck smear to look for virus-induced multinucleated giant cells help to establish thediagnosis. The histologic nature of chancroid is specific, but the biopsy procedure is so painful that other means of confirming the diagnosis should be used first.

KULTUR DARI ROOKSAccurate diagnosis depends on the ability to culture H. ducreyi. The rate of isolation varies among laboratories. Most laboratories have little experience with thisdisease and their rates of isolation are low. A sterile swab or plastic loop is used to sample the base of the ulcers. All the newly formulated transport media maintainviability of H. ducreyi for more than 4 days at 4 C. More reliable results are obtained if the exudate from the ulcer is inoculated directly onto the plate, not ontotransport medium. Plates are incubated at 33 C in microaerophilic conditions and examined for growth in 48 hours.H. ducreyi cannot be cultured on routine medium. Nutritional requirements of H. ducreyi seem to be geographically defined. High cultural yield is obtained by usingMueller-Hinton agar base supplemented with chocolate horse blood and Isovitale X (MH-HBC).