frambusia revisi
TRANSCRIPT
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FRAMBUSIAFRAMBUSIA
Dr. Subakir, SpKK (K)
FK UNDIP / RSDK
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FRAMBUSIAFRAMBUSIASinonim :Sinonim : patek, puru, pian, jaw, dll
Yaitu : penyakit treponematosis menahun, hilang timbul, mengenai kulit, tulang.
Sifat :Sifat : infeksiosa & kontagiosa
Etiologi :Etiologi : Treponema pertenue (Castellani,1905)– Morfologi & serologi tidak bisa dibedakan dg T. pallida
– Ada perbedaan kecil secara molekuler, yaitu susunan asam amino pada 1 rantai gene homolog : tpf1 glutamin dan arginin pada tyf1
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Epidemiologi :Epidemiologi :– Tropis, lembab, negara berkembang– Higine kurang– Pedesaan– Anak-anak >– Pria >– Indonesia : Sumatra Barat, Indonesia Timur.
Patogenitas :Patogenitas :
T. pertenue masuk tubuh lewat inokulasi di kulit (kontak langsung) yg terbuka multiplikasi reaksi peradangan
Waktu Inkubasi :Waktu Inkubasi : 3 - 6 minggu
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Imunitas :Imunitas :
• Pada frambusia yg belum sembuh terdapat imunitas tidak sempurna terhadap Treponema Bisa reinfeksi
• Penderita sembuh Kebal terhadap inokulasi Treponema baru.
• Penderita frambusia ada kekebalan parsial terhadap sifilis, Sebaliknya penderita sifilis sukar terkena frambusia.
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Klinis :Klinis :
• Stadium I
• Stadium II
• Stadium III
Laten
Dini - menular
Lanjut - tidak menular
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Stadium IStadium I• Gejala (-) / Asimtomatis,
Sakit (-), gatal (-)
• UKK :– papula 3-4 cm– eritema– kulit bagian atas mengelupas
serum kering - krusta - kuning, tebal 1 - 5 mm
– permukaan kasar, papilomatosa (“frambos”)
– ulkus, dasar papilomatosa, serum bau amis banyak treponema
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* Lesi inisial
= primer papiloma
= babon
= mother jaw
* Lokasi :– Tempat terbuka : kaki, tangan– Mulut, hidung– Bokong, anus
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2 - 3 bulan tanpa pengobatan :2 - 3 bulan tanpa pengobatan : ## Sembuh (palsu !)
* kulit atrofi, cekung, hipo / hiperpigmentasi
## T. pertenue - limfogen - hematogen / bakterimia
bersarang ke kulit• febris
• sakit kepala
• sakit sendi
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Stadium IIStadium II
• Papiloma sekunder
papula kecil + 1 cm• Tersebar pada kulit, ukuran sama milier,
koribriformis, anuler, bergerombol
(Liken frambosiacus = Plandetre )• Lokasi : badan, bagian yg berlipat,
lubang tubuh
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Stadium IIStadium II
• Pada telapak kaki, tangan = bubul = crabs
Hiperkeratosis, tidak ulserasi sakit
• Periungual
= planic onychia
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Stadium IIStadium II• Periosteum periostitis
sakit tulang, linu.
Tulang panjang
~ tibia pedang
Tulang maksila
~ gondow
Tulang jari-jari
~ mutilasi
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Stadium IIStadium II
• 2 - 3 bulan sembuh ( palsu ) kulit atrofi, hiperpigmentasi
• 2 - 3 tahun Laten lesi hilang timbul
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Stadium IIIStadium III
• Gumata : pertumbuhan jaringan akibat reaksi peradangan.
ulkus sembuh
sikatrik.
• Pada usia dewasa.
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Stadium IIIStadium III
• Nodus / guma :
- Soliter
- Tulang Osis
- Multipel
- Kutis, Subkutis
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Stadium IIIStadium III
Bentuk kalainan yg lain :• Ulkus serpiginosum.• Keratoma plantaris
sulkatum = beld.• Nodositas junkta
artikularis.
• Gangosa
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Gambaran HistopatologisGambaran Histopatologis
Dermis :
• Infiltrat perivaskuler padat, sel plasma, netrofil, limfosit, histiosit, fibroblas
• Tidak ada kelainan pembuluh darah
(proliferasi endotel)
Epidermis :
• Hiperplasi, akantosis
• Udema
• Eksositosis netrofil
mikroabses
• Papilomatosis
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Diagnosis BandingDiagnosis Banding : Sifilis
DiagnosisDiagnosis
## Klinis : I. Buah frambos besar
II. Buah frambos kecil, milier
III. Tanda-tanda sisa / sikatrik
## Lab : STS - Non treponemal
- Treponemal
## Epidemiologi
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Pengobatan :Pengobatan :* Obat pilihan utama : penisilin
( Benzatin penisilin )< 10 th : 600.000 IU> 10 th : 1,2 juta IU
* Alergi Eritromisin, tertrasiklin
Pencegahan :Pencegahan : - dr. Kodijat : Magsaysay
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B E J E LB E J E LSifilis endemisSifilis endemis
Dr. Subakir, SpKK (K)
FK UNDIP / RSDK
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B E J E LB E J E L= Sifilis endemisSifilis endemis
Yaitu : penyakit treponematosis non venerik,
mengenai anak.
Etiologi :Etiologi : T. pallidum subspesies endemicum
= varian tipe N
Epidemiologi :Epidemiologi : - anak
- daerah bergurun
- Timur Tengah
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UKK :UKK :• Plakat, tertutup membran putih.
• Teraba lunak, nyeri (-)
• Sudut mulut vegetasi
perianal papilomatosis
kondilomatosa
hipertrofi
( lesi banyak treponema )
• Lama 1 - 2 bulan
• Timbul ulserasi, rambut kulit rontok
Terapi :Terapi : Penisilin 1,2 - 2,4 juta IU
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P I N T AP I N T APuru
Dr. Subakir, SpKK (K)
FK UNDIP / RSDK
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P I N T AP I N T A = PuruPuru
Yaitu : penyakit treponematosis non venerik,
kontagiosa, endemis.
Etiologi :Etiologi : T. carateum
Epidemiologi :Epidemiologi :
- mengenai semua umur terutama anak, pria
- ras kulit berwarna
- Pasifik, Amerika Tengah, Selatan
- Sosek - Higine kurang
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Penularan : Penularan : - Kontak langsung
- Vektor insekta
( Phlebotomus, Simulium, Ornithodorus )
Masa Inkubasi : Masa Inkubasi : 9 - 90 hari
UKK :UKK : Ada 4 Stadium
1. Primer
2. Sekunder
3. Lanjut
4. Laten
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1. Stadium Primer
• Papula berskuama, eritem plakat
• 3 - 12 bulan
Lesi satelit.• Badan, bokong,
ekstremitas terbuka.• Sembuh
hipopigmentasi
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2. Stadium Sekunder
• 5 - 12 bulan.
• Limfadenopati generalisata - nyeri (-).
• Papuloskuamosa, merah - ungu - hitam.
Daerah terbuka biru tua - abu abu - cokelat.
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3. Stadium Lanjut
• 3 bulan - 10 tahun
• Hiperkeratosis
manum & plantar warna-warni, atrofi
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4. Stadium Laten
• Klinis (-)• Daerah - daerah STS (+)
Terapi :Terapi : Penisilin 1,2 - 2,4 juta IU
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Karakter Epidemiologi Penyakit TreponemalKarakter Epidemiologi Penyakit Treponemal
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Karakter Klinik Penyakit TreponemalKarakter Klinik Penyakit Treponemal