CHANCROID

Muna Munirah Binti Zamry Norfaizah binti Che Mat Amin

C11110842 C11110859

Advisor dr. Regina Mihardja

Supervisor dr. St. Nur Rahmah, Sp. KK

DEFINITION
Synonym : Ulcus molle, soft chancre, soft sore Chancroid is a sexually transmitted, acute ulcerative disease usually localized at the anogenital area and often associated with inguinal adenitis or buboes

EPIDEMIOLOGY
Endemic in developing countries : Africa, Asia, America Latin This endemic regions also have highest rates of human immunodeficiency virus (HIV) infection Associated with commercial sex worker, the use of crack cocaine, and syphillis Incidence men > women

ETIOLOGY
Haemophilus ducreyi Basil gram negative, facultative anaerobic, non motile, non spore forming Requires hemin (X factor) for growth

PATHOGENESIS
Factors in H. ducreyi infection : Adherence to the epithelial surface Rate production of exotoxins Resistence of the host defence mechanism Trauma or microabrasion to the skin or mucosa is necessary for the penetration of the organism into the epidermis.

CLINICAL MANIFESTATION
Incubation period : 3-7 days No prodromal symptoms Soft papule surrounded erythema After 24-48 hours pustular, eroded, and ulcerated Vesicles are not seen at any stage

The ulcer : Ragged undermined edge, sharply demarcated and without induration Covered by a necrotic yellowish gray exudate Granulomatous base often bleeds on scraping Tender, not indurated, and painful

Predilection area Men : preputium, sulcus coronarius, frenulum, glans penis, urethra, scrotum, perineum, anal Women : labium, clitoris, fourchette, vestibule, anal, cervix Extragenital : tongue, lips, finger, breast, umbilical, thigh, conjunctiva

 Clinical variant : - Giant chancroid - Large serpiginous ulcer - Phagedenic chancroid - Transient chancroid - Follicular chancroid - Papular chancroid

 Painful inguinal adenitis (bubo) unilateral and erythema of the overlying skin Occurs within few days to 2 weeks after onset of primary lesion

DIAGNOSIS
Culture Gram/ Giemsa staining. Imunofluoresens technique. Biopsy

GRAM STAINING

Gram-stained smear of exudate from a genital ulcer showing the characteristic chaining pattern of H.ducreyi.

GIEMSA STAINING

Smear from soft ulcer showing a school of fish pattern.

DIFFERENTIAL DIAGNOSIS
Herpes genitalis Sifilis stadium I Limfogranuloma venerium (L.G.V) Granuloma inguinale

Herpes genitalis

Sifilis stadium I

Limfogranuloma venerium (L.G.V)

Granuloma inguinale

TREATMENT

COMPLICATION
Mixed chancre. Abscess of inguinal gland. Scarring leading to phimosis. Bacterial superinfection. Painful inguinal adenitis. Fistula uretra (rare)

PROGNOSIS
This disease is self-limited and systemic spread does not occur. Occaisonally, without treatment, genital ulcer and inguinal abscess have been reported to persist for years. Local pain is the most frequent complaint. Antibiotic treatment usually clears up the lesions quickly with very little scarring. To avoid reinfections, patients must be instructed to use condom properly.

Immunoassay (IA)

Fluorescent trepodermal antibody absorption (FTA-ABS) TREPONERMAL

Treponemapallidum particle agglutination (TP-PA)

Western blot SYPHILIS TEST Venereal research disease laboratory (VDRL)

Rapid plasma reagin (USR) NON- TREPONERMAL Unheated serum reagin (USR)

Toludine red unheated serum test (TRUST)