Sinoni m Granuloma Venereum Granuloma Inguinale Tropicum Granuloma

Sinoni m  Granuloma Venereum  Granuloma Inguinale Tropicum  Granuloma

Sinoni m Granuloma Venereum Granuloma Inguinale Tropicum Granuloma Donovani Donovanosis Defini si Suatu penyakit kelamin dgn proses granulomatosa yg biasanya pd regio anogenital & inguinal Daya penularan relatif rendah, penularan secara auto-inokulasi, sifat kronis & progresif, biasanya pd kulit & kadang-kadang sistem limfatik Histor Histor ii

1882 1882 1905 1905 1917 1917 Mc McLeod Leod Donovan Donovan(di (diMadras) Madras) Donovan DonovanBodies Bodies --Sitanala Sitanala(di (diIrian IrianJaya) Jaya)

Th/ --Tim dokter Hindia-Belanda Tim dokter Hindia-Belanda Th/ Epidemiolo gi Tropis & subtropis Ras kulit hitam > kulit putih Frekuensi (endemik) di Papua New-Guineaendemik) di Papua New-Guinea Irian Jaya

Juga di: India (endemik) di Papua New-GuineaTimur, Barat & Selatan) Cina Selatan Afrika Tengah & Barat Australia Amerika Utara, Tengah, Selatan Usia dewasa muda(endemik) di Papua New-Guinea20 40 tahun) Sosial ekonomi & higiene :=2:1 Penularan veneris - primer lesi non veneris - anak-anak Etiolo gi Calymatobacterium granulomatis ( = Donovania granulomatis = ) Basil btk batang pendek & tebal (= peniti dg ujung bulat) Kadang-kadang pleomorfik kokus, dll Gram negatif ; spora - ; berkapsul Dapat dibiak yolk sac embrio ayam

Klini Klini ss Masa Masatunas tunas1112 12minggu minggu(variabel) (variabel)22bulan bulan Primer Primerlesi lesi:: Papel/ nodul merah & lembek (=bisul) Sekret amis + darah Sero-sanguinosa

Sero-sanguinosa Ulkus Ulkusmeluas meluaske ke bokong Per bokong kontinuitatum paha paha Oto-inokulasi Ulkus Granulomatous abdomen abdomenbawah bawah Ulserasi (+gatal)

Nyeri ? Klini Klini ss Lesi genital KGB inguinal > ulkus khas Lesi genital KGB inguinal > ulkus khas Predileksi Predileksi Disebut: Disebut:Pseudo-Bubo Pseudo-Bubo karena karenaGranuloma Granulomasubkutan subkutan : Lab.minora/ mayora, mons veneris : Lab.minora/ mayora, mons veneris

Fourchette Fourchette : Glans, preputium & skrotum : Glans, preputium & skrotum Ada Ada44tipe tipeklinis klinis: : a. a.Tipe TipeNodular Nodular nodus nodusmerah merah&&lunak lunak lunak lunak++granulasi granulasi b. b.Tipe TipeUlsero-vegetatif

Ulsero-vegetatif Ulkus Ulkusbesar besar melebar melebar c.c.Tipe TipeHipertrofik Hipertrofik Rx Rxproliferatif proliferatif masa masavegetatif vegetatif d. d.Tipe TipeSikatrisial Sikatrisial Sikatriks-sikatriks Sikatriks-sikatrikspada padajaringan

jaringangranulasi granulasi Klini s Lesi ekstra genital muka ; leher mulut & tenggorokan Complicatio n 1. Edema deformitas genital a.l stenosis uretra vagina (endemik) di Papua New-Guinea > ) anus Hiperplasia proses keganasan a.l B.C.C Sq. C. C Lesi metastatik:- tulang & sendi - visceral o.k fibrosis

2. 3. 1. 2. 3. Diagnosi s Anamnesa: yang baik Anamnesa: yang baik Gambaran klinis tergantung tipe ? Laboratorium: SA. Giemsa, Wright D. granulomatis dalam sel MN Biakan + yolk sac embrio ayam 4. Biopsi Epidermis: - akantosis tepi lesi - hiperplasia pseudokarsinomatosa Dermis: - Donovan Bodies dalam histiosit

- Infiltrat padat terdiri dari histiosit & sel plasma Diagnosis Banding 1. SIIII Kondiloma Lata 2. Amubiasis cutis lesi perianal 3. TBC cutis ekstra genital 4. Squamous Cell Ca 5. L.G.V 6. Ulkus molle Thera pi 1. Streptomycin 1 g/ hr 20 hr kadang 30 hr

4 g/ hr 50 hr 2. Gol. Tetracyclin (Chlor/ Oxytetracyclin); Doxycycline 4 x 500 mg/ hr 10 20 hr 2 x 100 mg/ hr 3. Gol. Sulfa 2 x 2 tab/ hr 10-20 hr (800 / 160 mg) Sulfamethoxazole Bactrim Trimethoprim Septrin 4. Erythromycin ; Ampicillin 5. Chloramphenicol MANAGEMENT ( Th.B. Fitzpatrick ) Prevention: Encourage use of condoms Most effective - Chloramphenicol, 500mg PO qid ) - Tetracycline, 500 mg PO qid

} 3-4 weeks - Gentamycin, 1 mg/kg IV bid ) Alternatives - Streptomycin, 1 g IM bid or - Ampicillin, 500 mg PO qid 12 weeks - Erythromycin, 500 mg PO qid or - Cotrimoxazole, 2 tab. PO bid 10 days - Quinolones oral (Ciprofloxacin, Ofloxacin, Levofloxacin) Management Sex Partners

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