Chancroid is most common in developing countries, especially in Africa and Asia,

where the causative organism, Haemophilusducreyi was isolated from over 50

percent of genital ulcers in patients until the 1990s. these endemic regions also
have some of the highest rates of human immunodeficiency virus (HIV) infection in
the world, and chancroid is common in all 18 countries in which adult HIV
prevalence surpasses 8 percent.
Recent epidemics in the industrialized countries have usually been associated with
commercial sex work, the use of crack cocaine, syphilis, and an increased risk of HIV
infection. Lower-class prostitutes appear to be a reservoir in all reported outbreaks
of the disease. Men have a markedly higher incidence of chancroid than woman.
Several studies in Africa showed that chancroid ulcer is an important risk factor for
the heterosexual spread of HIV-1. It is still not clear whether there is an
asymptomatic reservoir of H. ducreyi carriers and what the risk of transmission are.
The duration of infectivity in the absence of treatment was estimated to be 45 days
for woman. The transmission rate from females to males is not known, but a
transmission rate from males to female of 70 percent per sex act has been reported.
ETIOLOGY AND PATHOGENESIS
Historical Aspects
H. ducreyi is a gram-negative, facultative anaerobic coccobacilus that requires
hemin (X factor) for growth. The organism is small, nonmotile, and nonsporeforming and shows tipicallystreptobacillary chaining, especially in cultures. The
exact taxonomy is still controversial. The current classifications list H. ducreyi as a
true Haemophilus sp. However, studies of DNA homology and chemotaxonomy
demonstrate substantial differences between H. ducreyi and Haemophilus sp. H.
ducreyi will likely be reclassified in the future, but this issue awaits further studies.
Biochemistry:
Growth Requirements:
Genetic and virulence:
Three major factors seem to be important in the pathogenesis of H. ducreyi
infection: the adherence to the epithelial surface, the rate of production of exotoxins
(e.g., cytolethal distending toxin), and the resistance of the host defense
mechanism. Many details about pathogenesis are still unclear. Because of the lack
of appropriate experimental model systems, attachment factors, in particular, are
not well understood.
CLINICAL FINDINGS
The incubation period is between 3 and 7 days, rarely more than 10 days. No
prodromal symptoms are known. The chancre begins as a soft pzpule surrounded by

erythema. After 24 to 48 hours it becomes pustular, eroded, and ulcerated. Vesicle

are not seen. The edges of the ulcers are often ragged and undermined. The ulcer is
usually covered by a necrotic yellowish gray exudate, and its ground is composed of
granulation tissue that bleeds readily on manipulation. In contrast to those of
syphilis, chancroid ulcer are usually tender, not indurated (soft chancre), and
painful. The diameter varies from 1 mm to 2 cm. half of males have a single ulcer,
and most lessions are found on the external or internal surface of the prepuce, on
the frenulum, and on the glans. The meatus and shaft of the penis and the anus are
involved less frequently. Edema of the prepuce is often seen. Rarely, if the chancre
is localized in the urethra H. ducreyi causes purulent urethritis.
In females the lesions are mostly localized on the vulva, especially on the
fourchette, the labia minora, and the vestibule, vaginal, cervical, and perianal ulcers
have also been describe. Extragenital lesions of chancroid have been reported on
the breasts, fingers, thighs, and inside of the mouth. Trauma and abrasion may be
important for such extragenital manifestations.
Painful inguinal adenitis (bubo) occurs in up to 50 percent of patients within a few
days to 2 weeks (average, 1 week) after onset of the primary lesion. The adenitis is
unilateral in most patients, and erythema of the overlying skin is typical. Buboes
can become fluctuant and may rupture spontaneously. The pusof a buboes are less
common in female patients. In addition to the common types of chancroid describe
thus far, a number of clinical variants have been reported. Mild systemic symptoms
can accompany chancroid in rare cases, but systemic infection by H. ducreyi has
never been observed. Recently chronic skin infection due to H. ducreyi was
reported, affecting the lower limb of children visiting samoa, suggesting that this
may be a previously unrecognized from of infection.
LABORATORY TEST
Bacterial culture of H. ducreyi currently remains the primary tool for the diagnosis of
chancroid in the clinical setting. However, the advent of more sensitive DNA
amplification techniques has demonstrated that the sensitivity of H. ducreyi culture
is only 75 percent at best. The bacillus will survive only 2 to 4 hours on a swab
unless refrigerated. Swabbed material from the purulent, ulcer base should be
inoculated directly onto an appropriate culture medium, because no satisfactory
transport system is available.
As noted earlier (see Growth Requirements), the simultaneous use of two primary
isolation media from a nutritionally rich agar base supplemented with hemoglobin
and serum is recommended for high culture sensitivity. Small, non mucoid, yellowgray, translucent colonies. Typically, these colonies remain intact when they are
pushed across the agar surface. The identification of H. ducreyi is performed
following the recommendations of lubwama. Demonstration of hemin requirement,
oxidase and catalase test, beta lactamase test, and hydrogen sulfide and inhole

activity. Testing of antibiotic suspectlbility is recommended, because clinically

significant antimicrobial resistance of H. ducreyi has become common.
Direct examination of clinical material by Gram or Giemsa stain may be helpful, but
reported sensitivity and specifity values are low-10 percent to 63 percent and 51
percent to 99 percent, respectively. The bacilli are usually found in small clusters or
parallel chains of two or three organism streaming along stands of mucus. This
pattern has been described as a school of fish or railroad track. This
arrangement, said to be characteristic of H. ducreyi, is nevertheless not
pathogonomic, because most genital ulcers have a polymicrobialflora. Cotton or
calcium-alginate swabs are recommended for specimen collection. Some authors do
not recommend direct microscopy in the routinediagnosis of chancroid
Many attempts have been made to develop serologic test for chancroid. Due to
limited sensitivity in the detection of circulating antibodies to H. ducreyi, serologic
testing currently has limited usefulness in the routine diagnosis of chancroid
infection but may be useful in population-based epidemiologic research as a method
of screening for past infection.

Chancroid adalah penyakit yang paling umum di negara-negara berkembang,

terutama di Afrika dan Asia, di mana organisme penyebabnya, adalahHaemophilus
ducreyi yang menginfeksi lebih dari 50 persen yang menyebabkan ulkus di kelamin
pada pasien sampai tahun 1990-an. Beberapa daerah-daerah endemic juga
memiliki resiko tertinggi penyakit human immunodeficiency virus (HIV) di seluruh
dunia, dan umumnya chancroid ada di 18 negara yang menginfeksi orang dewasa
HIVdengan pravelensi yang melebihi 8 persen.
Epidemi baru-baru ini di negara-negara industri biasanya dikaitkan dengan pekerja
seks komersial, penggunaan kokain, sifilis, dan peningkatan risiko infeksi HIV.
Pelacur kelas bawah tampak sebagai penampung di semua wabah penyakit yang
dilaporkan. Pria memiliki insiden yang lebih tinggi dari pada wanita. Beberapa
penelitian di Afrika menunjukkan bahwa ulkus chancroid merupakan faktor risiko
penting untuk penyebaran heteroseksual HIV-1. Hal ini masih belum jelas apakah
ada reservoir carier asimtomatik H. ducreyi dan apa risiko penularan ini. Durasi
infektivitas tanpa pengobatan diperkirakan 45 hari untuk wanita. Tingkat penularan
dari perempuan ke laki-laki tidak diketahui, tetapi tingkat transmisi dari laki-laki ke
perempuan adalah 70 persen per tindakan seks telah dilaporkan.
ETIOLOGI DAN PATOGENESIS
Aspekhistoris
H. ducreyi adalah bakteri gram negatif, fakultatif anaerob coccobacilus yang
membutuhkan hemin (faktor X) untuk pertumbuhannya. Organisme ini berukuran

kecil, nonmotile, dan non-sporeforming.taksonomi yang tepat masih kontroversial.

Saat klasifikasi dari H. ducreyi sebagai daftar kelompok dari Haemophilus sp.
Namun, penelitianhomologi DNA dan kemotaksonomi menunjukkan perbedaan
besar antara H. ducreyi danHaemophilus sp. H. ducreyi kemungkinan akan
dipindahkan pada masa depan, tapi masalah ini menanti studi lebih lanjut.
Biokimia:
Persyaratanpertumbuhan:
Genetikdanvirulensi:
Tiga factor utama yang penting dalam pathogenesis infeksi H. ducreyi: kepatuhan
terhadap permukaan epitel, tingkat produksi eksotoksin (misalnyac ytolethal
distending toksin), dan perlawanan dari mekanisme pertahanan tuan rumah.
Banyak rincian tentang pathogenesis masih belum jelas.Karena kurangnya sistem
model eksperimen yang tepat masih tidak dipahami dengan baik.
TEMUAN KLINIS
Masa inkubasi antara 3 dan 7 hari, jarang lebih dari 10 hari.Tidak ada gejala
prodromal yang dapat dikenali. Chancre diawali dengan papule kecil dikelilingi oleh
eritema. Setelah 24 sampai 48 jam menjadi berjerawat, terkikis, danulserasi.
Vesikel tidak terlihat. Tepi ulkus sering tidak teratur dan rusak. Ulkus biasanya
tertutup oleh jaringan yang sudah nekrotik bercampur eksudat berwarna abu-abu
kekuningan ,dan kulit yang terdiri dari jaringan granulasi yang berdarah mudah di
manipulasi. Berbeda dengan orang-orang yang mengidap sifilis,ulkus chancroid
biasanya halus, tidak indurated (chancre lunak), dan menyakitkan. Diameter
bervariasidari 1 mm sampai 2 cm. setengah darilaki-laki memiliki ulkus tunggal,
dan sebagian besar lesi ditemukan pada permukaan eksternal atau internal
preputium, di frenulum, dan pada glans penis. Meatus dan batang penis dan anus
terlibat lebih jarang.Edema preputium sering terlihat. Jarang, jika chancre
terlokalisir di H. ducreyi uretra menyebabkan purulen uretritis.
Pada wanita lesi sebagian besar terlokalisasi pada vulva, terutama pada fourchette,
labia minora, dan ruang depan, vagina, leher rahim, dan ulkus perianal juga telah
menjelaskan. Lesi ekstragenital dari chancroid telah dilaporkan yaitu padapayudara,
jari, paha, dan bagian dalam mulut. Trauma dan abrasi mungkin penting untuk
manifestasi ekstragenital tersebut.
Adenitis inguinal menyakitkan (bubo) terjadi pada hingga 50 persen pasien dalam
beberapa hari sampai 2 minggu (rata-rata, 1 minggu) setelah timbulnya lesi
primer.Adenitis biasanya unilateral pada sebagian besar pasien, dan eritema dari
kulit di atasnya khas.Buboes dapat menjadi berfluktuasi dan dapat mudah
pecah.Nanah dari buboes kurang umum pada pasien wanita. Selain jenis umum
chancroid menggambarkan sejauh ini, sejumlah varian klinis telah dilaporkan.

Gejala sistemik ringan dapat ditemui pada chancroid dalam kasus yang jarang,
tetapi infeksi sistemik oleh H. ducreyi belum pernah diamati. Baru-baru ini infeksi
kulit kronis akibat H. ducreyi dilaporkan, mempengaruhi ekstremitas bagian bawah
pada anak-anak mengunjungi samoa, hal ini menunjukkan bahwa kemungkinan
sebelumnya tidak dikenali gejala dari infeksi.
LABORATORIUM UJI
Kulturbakteri H. ducreyisaatinitetapsebagaialatutamauntukmenentukandiagnosis
chancroiddalamujiklinis.Namun, munculnyateknikamplifikasi DNA
lebihsensitiftelahmenunjukkanbahwasensitivitaskulturducreyi H. hanya 75 persen di
terbaik. Basil akanbertahanhanya 2 sampai 4 jam pada swab kecualididinginkan.
Bahandiusapdaripurulen, dasarulkusharusdiinokulasilangsungke media kultur yang
tepat, karenatidakadasistemtransportasi yang memuaskantersedia.
Sepertidisebutkansebelumnya, penggunaansimultandaridua media isolasi primer
daridasar agar nutrisi yang kaya dilengkapidengan hemoglobin dan serum
dianjurkanuntuksensitivitaskulturtinggi. Kecil, non berlendir, kuningabu-abu,
kolonitembus.Biasanya,
koloniinitetaputuhketikamerekamendorongseluruhpermukaan agar.Identifikasi H.
ducreyidilakukanmenyusulrekomendasidarilubwama.Demonstrasikebutuhanhemin,
oksidasedanujikatalase, ujilaktamase beta,
danhidrogensulfidadanaktivitasinhole.Pengujiansuspectlbilityantibiotikdianjurkan,
karenaresistensiantimikroba yang signifikansecaraklinis H.
ducreyitelahmenjadiumum.
Pemeriksaanlangsungdaribahanklinisoleh Gram atauGiemsa stain
mungkinmembantu, tapidilaporkansensitivitasdanspesifisitasnilai-nilai yang rendah
10 persenmenjadi 63 persendan 51 persenmenjadi 99 persen, masing-masing. Basil
biasanyaditemukandalamkelompokkecilataurantaiparaleldariduaatautigaorganisme
mengalir di sepanjangtribunlendir.Polainitelahdigambarkansebagai "sekolahikan"
atau "jalurkeretaapi". Pengaturanini, dikatakankarakteristik H. ducreyi,
adalahtetaptidakpathogonomic,
karenasebagianbesarulkuskelaminmemilikipolymicrobialflora a.
Kapasataukalsiumalginat-penyeka yang
direkomendasikanuntukkoleksispesimen.Beberapapenulistidakmenyarankanmikrosk
oplangsung di routinediagnosisdarichancroid
Banyakupayatelahdilakukanuntukmengembangkantesserologiuntukchancroid.Karen
asensitivitasterbatasdalammendeteksiantibodi H. ducreyi,
pengujianserologisaatinimemilikikegunaan yang terbatasdalam diagnosis
rutininfeksichancroidtetapimungkinbergunadalamberbasispopulasipenelitianepidemi
ologisebagaimetodeskrininguntukinfeksimasalalu.