Limfogranuloma Venerium
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Transcript of Limfogranuloma Venerium
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Limfogranuloma Venerium
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Definisi
•Adalah penyakit menular seksual yang disebabkan oleh bakteri obligat intraseluler Chlamydia trachomatis sub tipe L1, L2 dan L3
•Memiliki masa tunas 1-4 minggu•Terdapat gejala konstitusi sebelum
muncul LGV, yaitu : demam, malese, nyeri kepala, artralgia, anoreksia, nausea.
•Lesi dapat mengenai KGB regional pada stadium selanjutnya
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•Yang membedakan dr infeksi genital non spesifik oleh Chlamydia trachomatis adalah kuman C.T memiliki tdd 2 biovars :▫Trachoma / Organisme TRIC▫Organisme LGV
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Epidemiologi
•Terutama terdapat di negara tropik dan sub tropik
•Penderita pria lebih banyak daripada wanita
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FASE 1
FASE 2
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Patogenesis
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Gambaran Klinis
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Gejala Klinis Limfogranuloma Venereum
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Stadium Primer Afek Primer•Setelah masa inkubasi 3-30 hari•Merupakan bentuk tak khas dan tak nyeri;
dapat berupa erosi dangkal, papul miliar, vesikel, pustul dan ulkus yg tak nyeri. Muncul pada tempat inokulasi bakteri
•Umunya soliter dan cepat hilang, penderita jarang datang saat fase ini.
•Pria : letaknya di sulcus coronarius, uretra (jarang)
•Wanita : vagina bagian dalam dan serviks
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St. Sekunder Sindrom Inguinal•Terjadi 2-6 minggu setelah infeksi primer.•Pada stadium ini yang terserang adalah
KGB inguinal medial. Terjadi limadenitis dan periadenitis.
•Terjadi perlunakan yg konsistensinya dapat keras, kenyal bahkan abses di dalam limfonodi yang meradang, disebut “Bubo”, yang dapat ruptur secara tiba-tiba, membentuk sinus dan akan mengalirkan eksudat.
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•Dapat terjadi 2-3 kelompok kelenjar berdekatan dan memanjang seperti sosi di bagian proksimal dan distal lig. Pouparti dan dipisahkan oleh sulkus, “Stigma of Groove”
•Kemudian abses tersebut dapat menjalar ke limfonodi daerah fosa iliaka dan femoralis, disebut Bubo bertingkat “Etage Bubonen”
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Gambar: Bubo yang Belum Ruptur (Kiri) dan Bubo yang Telah Ruptur (Kanan)
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Stadium Tersier
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Kelainan lain :•Kulit : Eksantema, berupa eritema
nodosum dan eritema multiformis.•Fotosensitivitas dapat terjadipada 10-30%
kasus pada bentuk dini dan 50% pada bentuk lanjut.
•Mata : Konjungtivitis, edema dan ulkus pada palpebra dengan pembesaran KGB regional dan demam. “Sindrom Okuloglandular PARINAUD”.
•SSP : meningoensefalitis.•Hepatosplenomegali, peritonitis, dan
uretritis.
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Penegakan Diagnosis Limfogranuloma Venereum
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Diagnosis Banding Limfogranuloma VenereumDiagnosis banding LGV sangat bervariasi tergantung pada stadiumnya:
•Stadium Primer▫Ulkus Durum▫Ulkus Mole
•Stadium Sekunder▫Skrofuloderma▫Limfadenitis piogenik▫Limfadenitis karena ulkus mole▫Limfoma maligna▫Hernia inguinalis
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Terapi
•Kotrimaksazol (Septrin®, Bactrim® )▫2 x 2 tab (480mg=960mg) / hari hingga
sembuh.▫Pada sindrom inguinal 1-5 minggu
•Obat gol. Sulfa▫3 x 1 gr / hari
•Tetracyclin▫3 x 500 mg / hari
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•Penatalaksanaan LGV tidak hanya terbatas pada pasien saja, tetapi juga pada partner hubungan seksual.
•Jika partner hubungan seksual tidak menunjukkan gejala atau asimtomatik, maka harus diobati dengan doksisiklin oral 100 mg 2 kali sehari selama 7 hari, atau dosis tunggal 1 gr azitromisin.
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