MOLLE ULCER

MOLLE ULCER

Definition :

Molle Ulcer is acute genital infections, local, auto-inoculable, caused by Haemophilus ducreyi, with clinical symptoms typical ® ulcer at the site of entry, often accompanied by suppuration regional KGB.

Etiology

1. H. ducreyi
2. is a gram-negative bacteria,
3. facultative anaerobic,
4. short rod shape, rounded edges, do not move, do not form spores
5. require hemin for growth.

Pathogenesis

Trauma / abrasion Germs infect ®Penetration of the epidermis ® Lymphadenitis ® Inflammatory ® Supurasi

Clinical Overview

• The incubation period is 1-5 days.
• Beginning: macula or papule ® pustules ® broke ® typical ulcer.
• Nature of ulcer: multiple, soft, tender, dirty and easy basically bleed, ulcer edge ReSound, red skin around the ulcer

Predilection

1. Men: in the prepuce, glans penis, penis shaft, frenulum and anus
2. Female: vulva, clitoris, cervix and anus.
3. Enlarged inguinal lymph nodes are not multiple, occurring in 30% of cases with acute inflammation. Gland softened ® broke ® sinus (very painful with febrile).

Clinical Forms of Variation

• Giant Chancroid: only a single ulcer, rapidly expanding, destructive.
• Transient chancroid: small ulcers, heal themselves after 4-6 days, followed by inguinal lymph node perlunakan 10-20 days later.
• Ulcers mole serpiginosum: going inoculation and spread of confluent lesions on the prepuce, scrotum and thighs. Ulcers persist for years.
• mole gangrenosum ulcers: variant caused by bacterial super infection fusosprikhetosis, causing ulcers fagedenik. Can cause rapid tissue destruction and the.
• folikularis mole ulcers (chancroid follicularis): the hair follicle, consisting of multiple small ulcers. Can occur on the vulva or in the genital area hair. These lesions are very superficial.
• papular mole ulcer (ulcus molle elevatum): papule ® and granulomatous ulcerated. DD /: Donovanosis or condyloma lata syphilis II.

Laboratory

1. Direct examination materials ulcer ® gram staining. If found positive bacillus group made up like a row of fish.
2. Culture on chocolate agar, Muller Hinton order or serum-containing media with vancomysin. Positive when bacteria grow within 2-4 days (can be up to 7 days).
3. Serologic tests Ito-Reenstierna (0.1 ml of antigen is injected intradermally forearm skin pd) Positive if after 24 hours or more raised induration 5 mm in diameter.
4. ELISA tests using whole lysed H. ducreyi.
5. Other tests that can choose the security complement fixation test, presipitin and agglutinin.

Diagnosis

• Diagnose
• Clinical symptoms typical
• Direct examination materials are given ulcer gram staining.

Diagnosis of Appeals

• Syphilis I

• Ulcers mikstum

• Genital Herpes

• aphthae

• Scabies

• Piodermi

• pediculosis pubis

• Tuberculosis cutis

• Amobeasis kutis

• Dermatitis

• EEM

• epidermoid Ca

Complications

- Inguinal adenitis

- Phimosis or paraphimosis

- Urethral fistula

- Fistula rektovagina

Management

• Systemic Treatment

- Azithromycin 1 g, oral, single dose

- Ciprofloxacin 2 x 500 mg for 3 days

- Erythromycin 4 x 500 mg for 7 days

- Amoxicillin klavunat acid + 3 x 125 mg for 7 days

- Cotrimoxazole 2 x 2 tablets for 7 days

Local Treatment

• Apply with normal saline solution,

2 times a day for 15 minutes

• bubo aspiration for abscess transcutaneous measuring ≥ 5 cm by fluctuations in the middle