TAILIEUCHUNG - Chapter 139. Haemophilus Infections (Kỳ 5)

Clinical Manifestations Infection is acquired as the result of a break in the epithelium during sexual contact with an infected individual. After an incubation period of 4–7 days, the initial lesion—a papule with surrounding erythema—appears. In 2 or 3 days, the papule evolves into a pustule, which spontaneously ruptures and forms a sharply circumscribed ulcer that is generally not indurated (Fig. 139-2). The ulcers are painful and bleed easily; little or no inflammation of the surrounding skin is evident. Approximately half of patients develop enlarged, tender inguinal lymph nodes, which frequently become fluctuant and spontaneously rupture. Patients usually seek medical. | Chapter 139. Haemophilus Infections Kỳ 5 Clinical Manifestations Infection is acquired as the result of a break in the epithelium during sexual contact with an infected individual. After an incubation period of 4-7 days the initial lesion a papule with surrounding erythema appears. In 2 or 3 days the papule evolves into a pustule which spontaneously ruptures and forms a sharply circumscribed ulcer that is generally not indurated Fig. 139-2 . The ulcers are painful and bleed easily little or no inflammation of the surrounding skin is evident. Approximately half of patients develop enlarged tender inguinal lymph nodes which frequently become fluctuant and spontaneously rupture. Patients usually seek medical care after 1-3 weeks of painful symptoms. The presentation of chancroid does not usually include all of the typical clinical features and is sometimes atypical. Multiple ulcers can coalesce to form giant ulcers. Ulcers can appear and then resolve with inguinal adenitis Fig. 139- 2 and suppuration following 1-3 weeks later this clinical picture can be confused with that of lymphogranuloma venereum Chap. 169 . Multiple small ulcers can resemble folliculitis. Other differential diagnostic considerations include the various infections causing genital ulceration such as primary syphilis condyloma latum of secondary syphilis genital herpes and donovanosis. In rare cases chancroid lesions become secondarily infected with bacteria the result is extensive inflammation. Diagnosis Clinical diagnosis of chancroid is often inaccurate and laboratory confirmation should be attempted in suspected cases. Gram s staining of a swab of the lesion may reveal a predominance of characteristic gram-negative coccobacilli but the presence of other bacteria often makes it difficult to interpret this result. An accurate diagnosis of chancroid relies on culture of H. ducreyi from the lesion. In addition aspiration and culture of suppurative lymph nodes should be considered. Since the organism

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