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Epid dari fitz

More recent reports from


Southeast Asia and Africa suggest that the incidence of chancroid may be
declining in the face of a rapidly rising incidence of
genital herpes.59 Chancroid outbreaks have been reported in a number of
cities in industrialized countries during the last two
decades, predominantly in the United States.10 After an epidemic in
California in 1981, the number of cases peaked in 1987 at
5,035 cases. In a ten city study, chancroid was confirmed in 12% of genital
ulcers in Chicago and 20% in Memphis.11 In
contrast, only 23 cases of chancroid were reported to the Centers for Disease
Control and Prevention (CDC) in 20071.2 The
true incidence in most areas remains unclear and is probably vastly
underreported because confirmatory culture media or DNA
amplification methods are not commercially available.13 The global
epidemiology of chancroid is so poorly documented that it
is not included in WHO estimates of the global incidence of curable sexually
transmitted diseases.4 Overall, chancroid
accounted for 8 cases (3%) of genital ulcers in a sexually
transmitted infection (STI) clinic in Paris from 1995 to 2005.14

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Females may have


multiple, 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 anal
areas. Female carriers may have no detectable lesions and may be without symptoms.
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Lesions are more common in uncircumcised men and are


usually located in the coronal sulcus or on the inner aspect of the
prepuce (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 (Figs
34.48 & 34.49).
Other complications are uncommon. Phagadenic ulceration and
resulting genital deformity may occur with secondary infection.
Extragenital lesions may occur via autoinoculation to the fi ngers
or 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. ducreyi
in children visiting Samoa has been described [8].

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Non-sexual transmission has been reported.13,14 H. ducreyi
has been demonstrated in asymptomatic individuals.15 Male
circumcision is associated with reduced risk of contracting
chancroid.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 for
the 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 toothpick
under 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 with
Gram 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 be
demonstrated 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 the
diagnosis. 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 ROOKS


Accurate diagnosis depends on the ability to culture H. ducreyi. The rate of isolation varies
among laboratories. Most laboratories have little experience with this
disease 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 maintain

viability 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 onto
transport 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 using
Mueller-Hinton agar base supplemented with chocolate horse blood and
Isovitale X (MH-HBC).

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