chancroid

軟性下疳 　

WordNet

1. infectious venereal ulcer
2. of or relating to or having chancroids

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/05/06 21:39:15」(JST)

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Chancroid
Classification and external resources
A chancroid lesion on penis
ICD-10	A57
ICD-9	099.0
DiseasesDB	5563
MedlinePlus	000635
eMedicine	emerg/95
MeSH	D002602

Chancroid (also known as soft chancre and ulcus molle) is a bacterial sexually transmitted infection characterized by painful sores on the genitalia. Chancroid is known to spread from one individual to another solely through sexual contact.

Causes

Chancroid is a bacterial infection caused by the fastidious Gram-negative streptobacillus Haemophilus ducreyi. It is a disease found primarily in developing countries, most prevalent in low socioeconomic groups, associated with commercial sex workers.

Infection levels are very low in the Western world, typically around one case per two million of the population (Canada, France, Australia, UK and US).^{[citation needed]} Most individuals diagnosed with chancroid have visited countries or areas where the disease is known to occur frequently, although outbreaks have been observed in association with crack cocaine use and prostitution.^{[citation needed]}

Chancroid is a risk factor for contracting HIV, due to their ecological association or shared risk of exposure, and biologically facilitated transmission of one infection by the other.

Pathogenesis

H. ducreyi enters skin through microabrasions incurred during sexual intercourse. A local tissue reaction leads to development of erythomatous papule, which progresses to pustule in 4–7 days. It then undergoes central necrosis to ulcerate.

Symptoms and signs

Buboes in a male

These are only local and no systemic manifestations are present. The ulcer characteristically:

• Ranges in size dramatically from 3 to 50 mm (1/8 inch to two inches) across
• Is painful
• Has sharply defined, undermined borders
• Has irregular or ragged borders
• Has a base that is covered with a gray or yellowish-gray material
• Has a base that bleeds easily if traumatized or scraped
• painful lymphadenopathy occurs in 30 to 60% of patients.
• dysuria (pain with urination) and dyspareunia (pain with intercourse) in females

About half of infected men have only a single ulcer. Women frequently have four or more ulcers, with fewer symptoms.

The initial ulcer may be mistaken as a "hard" chancre, the typical sore of primary syphilis, as opposed to the "soft chancre" of chancroid.

Approximately one-third of the infected individuals will develop enlargements of the inguinal lymph nodes, the nodes located in the fold between the leg and the lower abdomen.

Half of those who develop swelling of the inguinal lymph nodes will progress to a point where the nodes rupture through the skin, producing draining abscesses. The swollen lymph nodes and abscesses are often referred to as buboes.

Sites

Males

• Internal and external surface of prepuce.
• Coronal sulcus
• Frenulum
• Shaft of penis
• Prepucial orifice
• Urethral meatus
• Glans penis

Females

• Labia majora is most common site. "Kissing ulcers" may develop. These are ulcers that occur on opposing surfaces of the labia.
• Labia minora
• Fourchette
• Vestibule
• Clitoris
• Perineal area
• Inner thighs

Diagnosis

Clinical variants

Some of clinical variants are as follows.

Variant	Characteristics
Dwarf chancroid	Small, superficial, relatively painless ulcer.
Giant chancroid	Large granulomatous ulcer at the site of a ruptured inguinal bubo, extending beyond its margins.
Follicular chancroid	Seen in females in association with hair follicles of the labia majora and pubis; initial follicular pustule evolves into a classic ulcer at the site.
Transient chancroid	Superficial ulcers that may heal rapidly,followed by a typical inguinal bubo.
Serpiginous chancroid	Multiple ulcers that coalesce to form a serpiginous pattern.
Mixed chancroid	Nonindurated tender ulcers of chancroid appearing together with an indurated nontender ulcer of syphilis having an incubation period of 10 to 90 days.
Phagedenic chancroid	Ulceration that causes extensive destruction of genitalia following secondary or superinfection by anaerobes such as Fusobacterium or Bacteroides.
Chancroidal ulcer	Most often a tender, nonindurated, single large ulcer caused by organisms other than Haemophilus ducreyi; lymphadenopathy is conspicuous by its absence.

Laboratory findings

From bubo pus or ulcer secretions, H. ducreyi can be identified. PCR-based identification of organisms is available. Simple, rapid, sensitive and inexpensive antigen detection methods for H. ducreyi identification are also popular. Serologic detection of H. ducreyi is and uses outer membrane protein and lipooligosaccharide.

Differential diagnosis

CDC's standard clinical definition for a probable case of chancroid

1. Patient has one or more painful genital ulcers. The combination of a painful ulcer with tender adenopathy is suggestive of chancroid; the presence of suppurative adenopathy is almost pathognomonic.
2. No evidence of Treponema pallidum infection by darkfield microscopic examination of ulcer exudate or by a serologic test for syphilis performed greater than or equal to 7 days after onset of ulcers and
3. Either a clinical presentation of the ulcer(s) not typical of disease caused by herpes simplex virus (HSV) or a culture negative for HSV.

Despite many distinguishing features, the clinical spectrums of following diseases may overlap with chancroid:

• Primary syphilis
• Genital herpes

Comparison with syphilis

There are many differences and similarities between the conditions syphilitic chancre and chancroid.

Similarities

• Both originate as pustules at the site of inoculation, and progress to ulcerated lesions
• Both lesions are typically 1–2 cm in diameter
• Both lesions are caused by sexually transmissible organisms
• Both lesions typically appear on the genitals of infected individuals
• Both lesions can be present at multiple sites and with multiple lesions

Differences

• Chancre is a lesion typical of infection with the bacterium that causes syphilis, Treponema pallidum
• Chancroid is a lesion typical of infection with the bacterium Haemophilus ducreyi
• Chancres are typically painless, whereas chancroid are typically painful
• Chancres are typically non-exudative, whereas chancroid typically have a grey or yellow purulent exudate
• Chancres have a hard (indurated) edge, whereas chancroid have a soft edge
• Chancres heal spontaneously within three to six weeks, even in the absence of treatment
• Chancres can occur in the pharynx as well as on the genitals

Treatment

The CDC recommendation for chancroid is a single oral dose (1 gram) of Azithromycin, or a single IM dose of Ceftriaxone, or oral Erythromycin for seven days.

Abscesses are drained.

H. ducreyi is resistant to sulfonamides, tetracyclines, penicillins, chloramphenicol, ciprofloxacin, ofloxacin, trimethoprim and aminoglycosides. Recently, several erythromycin resistant isolates have been reported.

Treatment failure is possible with HIV co-infection and extended therapy is sometimes required.

Complications

• Extensive adenitis may develop.
• Large inguinal abscesses may develop and rupture to form draining sinus or giant ulcer.
• Superinfection by Fusarium and Bacteroides. These later require debridement and may result in disfiguring scars.
• Phimosis can develop in long standing lesion by scarring and thickening of foreskin, which may subsequently require circumcision.

Prevention

Chancroid spreads in populations with high sexual activity, such as prostitutes. Use of condom, prophylaxis by azithromycin, syndromic management of genital ulcers, treating patients with reactive syphilis serology are some of the strategies successfully tried in Thailand.

Prognosis

Prognosis is excellent with proper treatment. Treating sexual contacts of affected individual helps break cycle of infection.

History

Chancroid has been known to humans since time of ancient Greeks. Some of important events on historical timeline of chancre are:

Year	Event
1852	Leon Bassereau distinguished chancroid from syphilis (i.e. soft chancre from hard chancre)
1890s	Augusto Ducrey identified H. ducreyi
1900	Benzacon and colleagues isolated H. ducreyi
1970s	Hammond and colleagues developed selective media

External links

• Vaccine Shown Effective Against Chancroid in Medical News Today (May 9, 2006). Retrieved on May 1, 2008.

References

UpToDate Contents

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• 1. 軟性下疳 chancroid
• 2. 性器潰瘍患者へのアプローチ approach to the patient with genital ulcers
• 3. 外陰部病変：形態に基づく鑑別診断 vulvar lesions differential diagnosis based on morphology
• 4. 性感染症の予防 prevention of sexually transmitted infections
• 5. リンパ肉芽腫性病 lymphogranuloma venereum

English Journal

• Chancroid, lymphogranuloma venereum, granuloma inguinale, genital herpes simplex infection, and molluscum contagiosum.

• Basta-Juzbašić A1, Ceović R2.Author information 1University Hospital Center Zagreb, Department of Dermatology and Venereology, School of Medicine University of Zagreb, HR-10000 Zagreb, Croatia.2University Hospital Center Zagreb, Department of Dermatology and Venereology, School of Medicine University of Zagreb, HR-10000 Zagreb, Croatia. Electronic address: romana.ceovic@zg.htnet.hr.AbstractChancroid, lymphogranuloma venereum, and granuloma inguinale may be considered as tropical venereal diseases. These diseases were a major diagnostic and therapeutic challenge in past centuries. Currently, patients with these bacterial infections that are endemic to the tropics occasionally consult with dermatologists in temperate climates. Due to the increasing frequency of travel to the tropics for tourism and work, as well as the increasing number of immigrants from these areas, it is important for dermatologists practicing in temperate climates to be familiar with the dermatologic manifestations of such infections, to be prepared to diagnose these diseases, and to treat these patients. All three "tropical" infections respond well to prompt and appropriate antimicrobial treatment, although herpes progenitalis still cannot be cured, and the number of people infected keeps growing; moreover, genital herpes can be transmitted by viral shedding before and after the visual signs or symptoms. Acyclovir, valacyclovir, and famciclovir can shorten outbreaks and make them less severe or even stop them from happening. There is currently no etiologic treatment for molluscum contagiosum, and the majority of treatment options are mechanical, causing a certain degree of discomfort. The molluscum contagiosum virus, unlike the other infectious agents mentioned, does not invade the skin.
• Clinics in dermatology.Clin Dermatol.2014 Mar-Apr;32(2):290-8. doi: 10.1016/j.clindermatol.2013.08.013.
• Chancroid, lymphogranuloma venereum, and granuloma inguinale may be considered as tropical venereal diseases. These diseases were a major diagnostic and therapeutic challenge in past centuries. Currently, patients with these bacterial infections that are endemic to the tropics occasionally consult w
• PMID 24559566

• Chancroid - desperate patient makes own diagnosis.

• Barnes P1, Chauhan M.Author information 1New Croft Centre for Sexual Health, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.AbstractWe report a case of chancroid in a white heterosexual man. This patient was seen by four separate health services over a period of five weeks with excruciatingly painful penile ulcers. Despite several negative herpes simplex virus polymerase chain reaction tests and a self-diagnosis of chancroid, he was repeatedly offered multiple courses of aciclovir. This case highlights the need for awareness of alternative diagnoses in persistent cases of genital ulcer disease.
• International journal of STD & AIDS.Int J STD AIDS.2014 Feb 17. [Epub ahead of print]
• We report a case of chancroid in a white heterosexual man. This patient was seen by four separate health services over a period of five weeks with excruciatingly painful penile ulcers. Despite several negative herpes simplex virus polymerase chain reaction tests and a self-diagnosis of chancroid, he
• PMID 24535694

• Haemophilus ducreyi Hfq contributes to virulence gene regulation as cells enter stationary phase.

• Gangaiah D, Labandeira-Rey M, Zhang X, Fortney KR, Ellinger S, Zwickl B, Baker B, Liu Y, Janowicz DM, Katz BP, Brautigam CA, Munson RS Jr, Hansen EJ, Spinola SM.AbstractTo adapt to stresses encountered in stationary phase, Gram-negative bacteria utilize the alternative sigma factor RpoS. However, some species lack RpoS; thus, it is unclear how stationary-phase adaptation is regulated in these organisms. Here we defined the growth-phase-dependent transcriptomes of Haemophilus ducreyi, which lacks an RpoS homolog. Compared to mid-log-phase organisms, cells harvested from the stationary phase upregulated genes encoding several virulence determinants and a homolog of hfq. Insertional inactivation of hfq altered the expression of ~16% of the H. ducreyi genes. Importantly, there were a significant overlap and an inverse correlation in the transcript levels of genes differentially expressed in the hfq inactivation mutant relative to its parent and the genes differentially expressed in stationary phase relative to mid-log phase in the parent. Inactivation of hfq downregulated genes in the flp-tad and lspB-lspA2 operons, which encode several virulence determinants. To comply with FDA guidelines for human inoculation experiments, an unmarked hfq deletion mutant was constructed and was fully attenuated for virulence in humans. Inactivation or deletion of hfq downregulated Flp1 and impaired the ability of H. ducreyi to form microcolonies, downregulated DsrA and rendered H. ducreyi serum susceptible, and downregulated LspB and LspA2, which allow H. ducreyi to resist phagocytosis. We propose that, in the absence of an RpoS homolog, Hfq serves as a major contributor of H. ducreyi stationary-phase and virulence gene regulation. The contribution of Hfq to stationary-phase gene regulation may have broad implications for other organisms that lack an RpoS homolog.
• mBio.MBio.2014 Feb 11;5(1):e01081-13. doi: 10.1128/mBio.01081-13.
• To adapt to stresses encountered in stationary phase, Gram-negative bacteria utilize the alternative sigma factor RpoS. However, some species lack RpoS; thus, it is unclear how stationary-phase adaptation is regulated in these organisms. Here we defined the growth-phase-dependent transcriptomes of H
• PMID 24520065

Japanese Journal

• The cytolethal distending toxin from the chancroid bacterium Haemophilus ducreyi induces cell-cycle arrest in the G2 phase

• CORTES-BRATTI X.
• J Clin Invest 103, 107-115, 1999
• NAID 30035043445

• In vitro activity of azithromycin and against organisms associate with bacterial vaginosis and chancroid

• JONES B M
• Eur J Clin Microbol Infect Dis 7, 551-553, 1988
• NAID 30002302208

• 岐阜市民病院における最近8年間の尿道炎患者の臨床的観察

• 土井 達朗,武田 明久,岡野 学,藤広 茂,波多野 紘一,加藤 直樹,坂 義人
• 泌尿器科紀要 33(5), 724-729, 1987-05-00
• … して,1979年以前では主にPCGの投与が,1980年以降ではMINOあるいはDOXYとSPCMの併用投与が最も多く行なわれ,治癒成績はそれぞれ94%,99%であった.7) NGUに対して,1979年以前にはMINOあるいはDOXYは7例(10%)に投与されたにすぎなかったが,1980年以降では152例(89%)に投与され,その成績はそれぞれ43%,97%の治癒率であったClinical observations were made on patients with urethritis, syphilis, chancroid, genital herpes and venereal warts for the last eight years at Gifu City …
• NAID 120002159558

Related Links

• Chancroid: MedlinePlus Medical Encyclopedia

Chancroid is caused by a bacteria called Haemophilus ducreyi. The infection is found in many parts of the world, such as Africa and southwest Asia. Very few people are diagnosed in the United States each year with this ...

• Chancroid | definition of chancroid by Medical dictionary

Chancroid Definition Chancroid is a sexually transmitted disease caused by a bacterial infection that is characterized by painful sores on the genitals. Description Chancroid is an infection of the genitals that is caused by the ...

Related Pictures

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★リンクテーブル★

リンク元	「Haemophilus ducreyi」「軟性下疳」「genital ulcer disease」
拡張検索	「chancroidal」

「Haemophilus ducreyi」

　　[★]

同

Hemophilus ducreyi

関

chancroid

[show details]

en

Haemophilus ducreyi : 約 356,000 件
Hemophilus ducreyi : 約 9,530 件

「軟性下疳」

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英

chancroid, soft chancre, soft sore, soft ulcer

ラ

ulcus molle

「genital ulcer disease」

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• 軟性下疳

関

chancroid、chancroidal

「chancroidal」

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• 軟性下疳の

関

chancroid、genital ulcer disease