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DIKTAT :

INFEKSI KUMAN PYOGENUS INFEKSI BASIL HEMOFILUS RADANG GRANULOMATIK

Oleh :

Soebarkah Basoeki !r" S#"PA M$!%i&i'o(o Ha(!ar$ Eko !r" MS S#PA

Untuk kalangan sendiri

Laboratorium Patologi Anatomi PROGRAM PENDIDIKAN DOKTER UNIVERSITAS MULAWARMAN SAMARINDA 2003/2004

PENGANTAR

De()a( $#a'a *e*#ela%ari !a( *e()$asi lebih *e(!ala* +e(+a() Il*$ Pa+olo)i A(a+o*i !ala* To#ik Pe('aki+ I(,eksi i(i *aka Mahasis&a !ihara#ka( !a#a+ *e*aha*i Ar+i !a( Pera(a( Il*$ Pa+olo)i !ala* bi!a() Il*$ Ke!ok+era( sehi())a !a#a+ *e()$raika( ko(se# !asar #e('aki+ !a( *e(%elaska( : Pera(a( Il*$ Pa+olo)i A(a+o*ik #a!a !ia)(osa +era#i #ro)(osa !a( #e(-e)aha(" Pe()olaha( se!iaa( Pa+olo)i A(a+o*i" Pe()iri*a( se!iaa( his+o#a+olo)ik !a( si+o#a+olo)ik" H$b$()a( Il*$ Pa+olo)i A(a+o*ik !e()a( bi!a() kli(ik"

Pa!a To#ik Pe('aki+ I(,eksi 'a() !isa*#aika( #a!a Pokok Perk$liaha( Pa+olo)i A(a+o*ik !e()a( +$%$a( : a" T$%$a( I(s+r$ksi U*$* .TIU/ 0 Me*aha*i #er$baha( %ari()a( akiba+ i(,eksi"

b" T$%$a( Perilak$ Kh$s$s .TPK/ 0 Me('eb$+ka( #a+o)e(esa : 0 0 0 0 I(,eksi !e()a( k$*a( #'o)e( I(,eksi !e()a( basil he*o,il$s Ra!a() )ra($lo*a+ik Mor,olo)i *asi()0*asi() ra!a()" #e('ebab *e(%elaska( as#ek kli(is sosial !a(

PENYAKIT IN EKSI

Pe('aki+ i(,eksi !a#a+ !isebabka( oleh berba)ai *a-a* a)e( biolo)is se#er+i bak+eri 1ir$s %a*$r !a( seba)ai('a" Disi(i aka( !ibi-araka( bebera#a #e('aki+ i(,eksi 'a() seri() !i!a#a+ka( 'ai+$ : I. Infeksi dengan kuman pyogen : II. III. Staphylococcus. Streptococcus. Pneumococcus. Gonococcus. Meningococcus.

Infeksi dengan Hemophyllus basil. Radang granulomatik. uberculosis. !epra Syphilis.

I! IN EKSI DENGAN KUMAN PYOGEN Staphylococcal Infection. Me('ebabka( i(,eksi s$##$ra+i1e 'a() lo-al" Lokalisasi : Ter$+a*a #a!a k$li+ se#er+i : 0 Par$0#ar$ 0 Gi(%al" +e+a#i !a#a+ #$la *e()e(ai ba)ia( +$b$h 'a() lai( 0 T$la() 0 O+ak"

K$*a( 'a() #ali() #a+ho)e( : Staphylococcus aureus" S+a#h'lo-o--$s *a*#$ *e*#ro!$ksi berba)ai +o2i( !a( e(3i* a"l" : 0 Ne-ro+i3i() e2o+o2i( 0 Hae*ol'si( 0 Le$-osi!i( 0 E(+ero+o2i( 0 Fibri(ol'si( !a( h'al$ro(i!ase" 0 S+a#h'loki(ase" 5ara #e('ebara( : 3 4 -'+olisis lo-al" 4 he*ol'sis" 4 *er$sak lekosi+" 4 *e*berika( )e%ala se#er+i GEA"

S+a#h'lo-o--$s !i!a#a+ka( !i*a(a0*a(a" Por+ !6e(+re : #! k$li+" Pathogenesis : K$*a( *e(e*b$s )l!"-eba-ea a+a$ ,ollikel ra*b$+ !a( *e(i*b$lka( i(,eksi0 i(,eksi ke-il !a( (ekrosis %ari()a(" Dari si+$ ke*$!ia( k$*a( *e('ebar ke +e*#a+0 +e*#a+ lai(" 7e(is 0 %e(is i(,eksi 'a() !isebabka( k$*a( +erseb$+ : "uruncle dan #arbuncle $ Os+eo*'eli+is E(!o-ar!i+is Me(i()i+is To(sili+is Si($si+is O+i+is *e!ia E(+eri+is 5oli+is Lo-ali3e! abs-ess #a!a se+ia# %ari()a( a+a$ or)a( +$b$h"

urun"l# $an %arbun"l#! "uruncle : Mer$#aka( kera!a(a)a( s$##$ra+i, lo-al #a!a k$li+ !a( %ari()a( s$b-$+a(" Da#a+ si()le 8 *$l+i#le" #arbuncle : Mer$#aka( #roses kera!a()a( s$##$ra+i, 'a() lebih !ala* !a( *e('ebar kearah la+eral !iba&ah ,as-ia #ro,$(!a !a( *e*be(+$k ba('ak si($s0si($s !ik$li+ $(+$k sal$ra( kel$ar('a" Lokalisasi : "uruncle. Da#a+ #a!a se+ia# +e*#a+ +e+a#i +er$+a*a !i!a#a+ka( #a!a : - K$li+ 'a() bera*b$+" - Daerah 0 !aerah 'a() le*bab se#er+i 4 0 *$ka 0 leher 0 a2illa #arbuncle. 0 Pa!a #$())$() ba)ia( belaka() leher" Pathogenesis : 0 i()$i(al 0 !iba&ah *a**a

M$la0*$la +er%a!i #a!a ,olli-le ra*b$+ . follikulitis / ke*$!ia( *e(e*b$s lebih !ala* *e*be(+$k s$b-$+a(eo$s abs-ess" Da( bila *e(e*b$s lebih !ala* la)i +erbe(+$k -arb$(-le" Makroskopis : Ber$#a be(+$ka( abs-ess 'ak(i %ari()a( !e()a( kera!a()a( ak$+ 'a() !i+e()ah('a *e()ala*i (ekrosis #a(-aira(" Mikroskopik : Di(!i() abs-ess +er!iri !ari %ari()a( ,ibrosis !a( %ari()a( )ra($lasi bera!a() *e(ah$(" Isi abs-ess %ari()a( ekro+ik !a( sel 0 sel ra!a()"

Streptococcoal Infection. Me('ebabka( i(,eksi 'a() s$##$ra+i," Ga*bara( kli(is !a( *or,olo)is

ber*a-a*0*a-a*" E(3'*0e(3'* 'a() !i#ro!$ksi oleh k$*a( s+re#+o-o--$s : 0 S+re#+ol'sis 0 S+re#+oki(ase 0 S+re#+o!or(ase 5ara Pe('ebara( : 9" Se-ara la()s$() !ari #e(!eri+a !e()a( i(,eksi k$*a( s+re#+o-o--$s a+a$ -arrier" :" Se-ara +i!ak la()s$() *elal$i !eb$ *aka(a( air" Pa+ho)e(esis : 9" Da#a+ ber$#a i(,eksi lokal 'a() +er!a#a+ seki+ar #or+ !6e(+re *isal : #har'()i+is a-$+a +o(silli+is a-$+a" :" Da#a+ ber$#a i(,eksi l$as !e()a( si,a+ sa()a+ -e#a+ *e('ebar *isal : -ell$li+es" ;" Da#a+ ber$#a #e('ebara( he*a+o)e( 'a() berasal !ari i(,eksi lo-al a+a$ i(,eksi 'a() l$as" <" Da#a+ ber$#a e2a(+he*a+o$s !isease *isal('a s-arie+ ,e1er" =" Da#a+ ber$#a #os+ s+re#+o-o--al h'#erse(si+i3a+io( *isal('a: rhe$*a+i,e1er )lo*er$lo(e#hri+is !a( lai(0lai(" Ma-a*0*a-a* s+re#+o-o--al i(,e-+io( : 9" U##er res#ira+or' +ra-+ i(,e-+io(" :" I(,eksi k$li+ : 0 i*#e+i)o -o(+a)iosa" 0 er'si#elas" ;" I(,eksi ,ollikel ra*b$+ !a( l$ka" <" S-arie+ ,e1er" =" S+re#+o-o--al i(+ra-+io( 'a() lai(" Impetigo cantagiosa : Mer$#aka( i(,eksi k$li+ 'a() ak$+" 5 0 He*ol'sis 0 Er'+hro)e(i- +o2i( 0 H'al$ro(i!ase

Pe('ebab : Be+a he*ol'+i- s+re#+o-o--$s" Pa!a $*$*('a *e('era() a(ak0a(ak" Sa()a+ *$!ah *e(%alar !e()a( ko(+ak la()s$()"

Makroskopis : Ber$#a 1esikel !iba&ah s+ra+$* -or(e$* 'a() #e($h !e()a( PMN" E#i!er*is i(i !iseki+ar('a !i!a#a+ka( oe!e*a !a( i(,il+rasi sel0sel ra!a() ka!a()0ka!a() %$)a #a!a -ore$* ba)ia( a+as" A#abila +elah +er%a!i $l-erasi +erliha+ -r$s+a 'a() +er!iri !ari ,ibri( !a( sel0sel PMN #a!a #er*$kaa( la#isa( *al#hi)i" Pa!a #e('e*b$ha( +i!ak +er%a!i -i-a+ri2 oleh kare(a #roses('a s$#er,i-ial" %rysipelas : Ter$+a*a !isebabka( oleh kare(a be+a he*ol'+i- s+re#+o-o--$s )ro$# A ka!a() > ka!a() )ro$# 5" Pe('aki+ i(i -e#a+ *e('ebar er'+ho*a+o$s o!e*a+o$s 'a() *e()e(ai %ari()a( k$li+" Lokalisasi 'a() +erseri() #a!a *$ka +e+a#i !a#a+ #$la *e()e(ai ba)ia( +$b$h 'a() lai(" Ter$+a*a !i!eri+a oleh #e(!eri+a $sia #er+e()aha( !a( %ara() *e()e(ai #e(!eri+a !iba&ah $sia :? +ah$(" Makroskopis : K$li+ 'a() +erke(a er'+he*a+o$s berbe(+$k se#er+i #i+a 'a() berba+as %elas *e(ebal" Ka!a()0ka!a() !i!a#a+ka( l'*#ha()i+is 'a() ber$#a )aris ke*eraha( 'a() *e(%alar !ari +e#i lesi !a( *e($%$ ke kele(%ar l'*#he re)io(al" Kele(%ar l'*#he seri() *e*besar kare(a kera!a()a( ak$+" Mikroskopis : E!e*a #a!a !er*is !a( e#i!er*is !a( a!(e2a k$li+" Seri() +erbe(+$k *i-roabs-ess ka!a()0ka!a() !a#a+ #$la +er%a!i abs-ess 'a() besar" Oleh kare(a %ara() *e(i*b$lka( ker$saka( %ari()a( 'a() berar+i *aka biasa('a aka( se*b$h !e()a( se*#$r(a" ka!a()0ka!a() *e()e(ai %ari()a( s$b-$+a( 'a() lebih !ala*" I(,il+rasi sel0sel PMN +er$+a*a seki+ar #e*b$l$h !arah

Infeksi luka dan follicle rambut : I(,eksi !e()a( s+re#+o-o--$s !a#a+ *e('ebabka( reaksi ra!a() 'a() l$as !a(

!i,,$se #a!a %ari()a( s$b-$+a( 'a() !ala* !a( %ari()a( o+o+ 'a() !i+a(!ai !e()a( i(,il+ra+ s$##$ra+i, !a( !i,,$se" Ka!a()0ka!a() +erbe(+$k ka(+o()0ka(+o() #$s 'a() ke-il" Ga*bara( i(i !iseb$+ seba)ai cellulites a+a$ phlegmon. Scarlet fe&er : Pe('ebab : He*ol'+i- s+re#+o-o--$s )ro$# A"

Ber$#a s$a+$ (aso#har'()i+is !a( +o(silli+is ak$+a" 6

Morphologi : Naso#har'(2 !a( +o(sil ber&ar(a ke*eraha(" To(sil *e*besar ser+a +a*#ak e2$!a+ s$##$ra+i, #a!a -ri#+a('a" Li!ah ber&ar(a *erah !e()a( #a#illa 'a() e!e*a+o$s" Ter!a#a+ e2a(+he*a !a( e(a(+he*a #a!a sel$r$h +$b$h" Kelai(a( i(i aka( *e*baik #a!a akhir *i())$ I" Mikroskopis : Ter%a!i reaksi ra!a() ak$+ !a( e!e*a #a!a ba)ia( +$b$h 'a() +erke(a se#er+i oro#har'(2 k$li+ !a( kele(%ar l'*#he" Streptococcal infection yang lain : - Se#sis #$er#oralis" - E(!o-ar!i+is a-$+a" - Ba-+erial #(e$*o(ia" - Me(i()i+is" - Seba)ai sek$(!er i(,eksi #a!a #e('aki+ i(,eksi 'a() lai(" Pneumococcal Infection. P(e$*o-o--al *er$#aka( !i#lo-o--$s )ra* .@/" Me('ebabka( i(,eksi s$##$ra+i, !a( *er$#aka( #e('ebab $+a*a !ari#a!a lobar #(e$*o(ia +e+a#i !a#a+ #$la *e('ebabka( i(,eksi !ilai( +e*#a+ se#er+i : - +eli()a +e()ah" - *as+oi! - *e(i()e( !a( %ar" O+ak" Por+ !6e(+re : #!$"+r" res#ira+ori$s Pe($lara( berasal !ari : - #e(!eri+a !e()a( i(,eksi k$*a( +erseb$+" - 5arrier P(e$*o-o--$s !a#a+ *e('ebabka( #(e$*o(ia 'a() #ri*er +e+a#i !a#a+ #$la sek$(!er #a!a #e(!eri+a0#e(!eri+a !e()a( : - i(,eksi 1ir$s - kea!aa(0kea!aa( 'a() *e($r$(ka( !a'a +aha( +$b$h se#er+i : ke!i()i(a( kelelaha( iri+asi ,isis a+a$#$( ki*ia&i #a!a *$-osa +ra-+$s res#ira+ori$s" Al-oholis* 0 si($s #ara(asalis" 0 r$a() se(!i

Meningococcal Infection" Mer$#aka( !i#lo-o--$s )ra* .@/" Pa!a $*$*('a *e()e(ai ba)ia(0ba)ia(

lai( se#er+i : e(!o-ar! #eri-ar! #erse(!ia( !a( +eli()a +e()ah" Por+ !6e(+re : (aso#har'(2 7

Pathogenesis : A!a ; s+a!i$* : Stadium I : Nasopharyngitis. - Ge%ala +i!ak *e(o(%ol" - M$-osa (aso#har'(2 *e()ala*i h'#er#lasia e!e*a !a( +er!a#a+ e2$!a+ *$-o#$r$le(+" Stadium II : Bacteriemia ( kuman masuk dan beredar dalam darah ) . A!a : be(+$k : 9/" :/" 5hro(i- *e(i()o-o--e*ia" 0 Ge%ala0)e%ala('a berla()s$() !ala* bebera#a b$la( sa*#ai +ah$(" A2$+a *e(i()o-o--e*ia" Ge%ala kli(is : Pe(!eri+a #a(as *e(!a!ak *e())i)il *alaise ('eri o+o+ *$al !a( *$(+ah" Dala* hari I a+a$ II +i*b$l #e+e-hia" P$r#$ra a+a$ e-h'*osis 'a() +ersebar !isel$r$h +$b$h" Ka!a() +er%a!i (ekrosis #a!a ba)ia( +e()ah !ari !aerah 'a() *e()ala*i #er!araha(" Da#a+ #$la +er%a!i 1esikel a+a$ b$lla" Seri() #$la +er%a!i #er!araha( #a!a *e!$lla a!re(al" Me(i()o-o--e*ia 'a() !iser+ai !e()a( #er!araha( *e!$lla a!re(al !iseb$+ seba)ai : Aa+erho$se0 Fri!eri-hse( s'(!ro*e" S'(!ro*e i(i !a#a+ #$la +er%a!i #a!a i(,eksi !e()a( bebera#a k$*a( 'a() lai(" Mikroskopis : Ber$#a a-$+a 1as-$li+is #a!a #e*b$l$h !arah ke-il 'a() !iik$+i !e()a( s$##$ra+i1e (ekrosis !a( #er!araha( ke!ala* !er*is" Ter!a#a+ i(,il+rasi sel0sel ra!a() +er$+a*a PMN !a( *a-ro#ha)e ka!a()0 ka!a() l'*#hosi+ !iseki+ar #e*b$l$h !arah 'a() +erke(a" Seri() !i!a#a+ka( +hro*bosis #a!a #e*b$l$h !arah 'a() +erke(a" Stadium III : M e n i n g i t i s. - S+a!i$* III i(i +i!ak selal$ +er%a!i" Gonococcal Infection. Mer$#aka( !i#lo-o--$s )ra* .0/" 5ara #e($lara( : Ha*#ir selal$ +er%a!i akiba+ ko(+ak se2$al +e+a#i !a#a+ #$la +er%a!i +a(#a ko(+ak se2$al 'ak(i : 9" Go(o-o--al o#h+hal*ia (eo(a+or$*" :" E#i!e*i- 1$l1o1a)i(i+is" 9" Go(o-o--al o#h+al*ia (eo(a+or$*"

Ter%a!i i(,eksi !e()a( )o(o-o--$s #a!a *a+a ba'i !i*a(a ib$ *e(!eri+a )o(o-o--al i(,e-+io( .)o(orrhoe /" :" E#i!e*i- 1$l1o1a)i(i+is" Me()e(ai &a(i+a $sia B b$la( > #$ber+as oleh kare(a #a!a $sia i(i e#i+hel 1a)i(a bel$* *e()ala*i kera+i(isasi oleh kare(a bel$* a!a #ro!$ksies+ro)e( se!a()ka( es+ro)e( !ari ib$ ha('a sa*#ai B b$la( sehi())a e#i+hel i(i *$!ah !ii(1asi oleh k$*a( )o(o-o--$s" Pathogenesis : Sebe(ar('a e#i+hel ber+a+ah 1a)i(a 8 )e(e+alia e2+er(a ora() !e&asa sa()a+ +aha( +erha!a# i(,eksi )o(orrhoe" Oleh kare(a('a bar$ bias +er%a!i a#abila e#i+hel ber+a+ah +erseb$+ r$sak" Daerah0!aerah 'a() seri() +erke(a : P r i a : 0 *$kosa $re+hra a(+erior" 0 #ros+a+e 0 1esi-$lar se*i(alis 0 e#i!i!'*is 0 kele(%ar #ara$re+hra Aa(i+a :0 $re+hra 0 kel" Bar+holi( !a( ske(e 0 -er1i2 0 +$ba ,allo#ii Ge%ala Kli(is : Masa i(k$basi : : > C hari Pada !aki-laki. Di!a#a+ka( e2$!a+ #$r$le(+ #a!a *ea+$s $re+hra !a( $re+hra #ars a(+erior" I(,eksi i(i +erba+as #a!a *$-osa !a( kel" Para$re+hra" Mea+$s *e(%a!i h'#ere*i e!e*a+$s !a( se-ara *ikrosko#is +a*#ak i(,il+rasi sel0sel PMN" A#abila +i!ak !ioba+i a+a$ #e()oba+a( +i!ak a!ek$a+" Proses aka( *e(%alar ke $re+hra #ars #os+erior #ros+a+e e#i!i!'*is +es+is" Kea!aa( i(i !a#a+ *e('ebabka( +er%a!i('a s+erili+as .a#abila +er%a!i s+ri-+$re $re+hra a+a$ ker$saka( +es+is/" Pada 'anita : Mea+$s $re+hra h'#ere*ia !a( e!e*a+o$s" Ter%a!i kera!a()a( s$##$ra+i, !a( #e*be(+$ka( abs-ess #a!a kel" Bar+holi( !a( ske(e" I(,eksi i(i !a#a+ la()s$() *e()e(ai -er1i2 !a( !a#a+ berla(%$+ ke +$ba !a( +erbe(+$k #'osal#i(2"

A#abila +er%a!i #erleka+a( !e()a( o1ari$* s+erili+as"

!a#a+ +erbe(+$k +$bo0o1arial

abs-ess" Akiba+ kera!a()a( !a( #erleka+a( #a!a +$ba i(i !a#a+ *e('ebabka(

II! &EMOP&YLLUS 'A%ILLI IN E%TION" He*o#h'll$s ba-illi *er$#aka( k$*a( )ra* .0/" Ya() #a+ho)e( $(+$k *a($sia : 9" He*o#h'll$s i(,l$e(3ae :" He*o#h'll$s #ar+$ssis ;" He*o#h'll$s !$-re'i (. Hemophillus influen)ae infection. Da#a+ *e('ebabka( ber*a-a*0*a-a* i(,eksi s$##$ra+i, se#er+i : 0 *e(i()i+is 0 lar'()o+ra-heobro(-hi+is 0 (aso#har'()i+is 0 o+i+is *e!ia 0 si($si+is 0 #(e$*o(ia

Pali() seri() *e()e(ai #e(!eri+a !ari $sia : > ; b$la( sa*#ai D +ah$( sebel$* $sia : > ; b$la( ba'i *asih *e(!a#a+ kekebala( se-ara #asi, !ari ib$('a se!a()ka( sa*#ai $sia D +ah$( kekebala( bel$* -$k$# $(+$k *e()a+asi i(,eksi +erseb$+" Pathogenesa : I(,eksi ber*$la #a!a (aso#har'(2 'a() ke*$!ia( *e(%alar keba)ia( +$b$h 'a() lai(" *. Hemophillus partusis infection +,hooping cough-. S$a+$ #e('aki+ ak$+ 'a() berba+as #a!a a(ak0a(ak !a( !i+a(!ai !e()a( ba+$k 'a() heba+ !a( *e(!a!ak !a( *e()akiba+ka( as#h'2ia" 5ara #e('ebara( : He*o#h'll$s Par+$ssis sa()a+ #eka +erha!a# kekeri()a( kare(a('a #e('aki+ i(i #!$" Ter%a!i kare(a ko(+ak la()s$() !e()a( #e(!eri+a ak+i," Pathogenesa : As#irasi !e()a( baha( 'a() +erko(+a*i(ir k$*a( +erseb$+ !iik$+i !e()a( +erlokalisir('a k$*a( +erseb$+ #a!a +e*#a+ 'a() baik $(+$k #er+$*b$ha( k$*a( +erseb$+ #a!a e#i+hel ber-ilia !ari sal$ra( (a,as ba)ia( a+as" Par+$ssis i(i *e*berika( )e%ala kli(is seba)ai berik$+ : - s+a!" I(k$basi sela*a : *i())$" - s+a!" 5a+arrhalis sela*a : *i())$ - s+a!" De()a( be(+$k #aro2's*al 'a() ('a+a sela*a : *i())$" 10

- s+a!" 5o(1ales-e(+ sela*a : *i())$" Morfologis : Se+elah +er%a!i i(,eksi +er%a!i i(,il+rasi sel0sel PMN !a( e#i+hel !a( %ari()a( ika+ s$b e#i+hel" Pa!a s+a! !e()a( ba+$k #aro2'*al +er%a!i (ekrosis %ari()a( !i ser+ai !e()a( #e*be(+$ka( e2$!a+ *$-o#$r$la(+ +er$+a*a #a!a ba)ia( basal !a( +e()ah !ari#a!a e#i+hel" Bila #roses ber%ala( +er$s aka( *e('ebar ke +ra-hea bro(-h$s #eribro(-hial !a( akhir('a aka( *e('ebar ke %ar i(+ers+i+i$* !a( +er%a!i #(e$*o(i+is i(+ers+i+ialis !e()a( e2$!a+ *$-o#$r$le(+ 'a() sa()a+ ba('ak !a( +erk$*#$l #a!a sal" Na#as akiba+ ba+$k 'a() heba+ !a( ber$la()0$la() +er%a!i as#h'2ia kare(a +er%a!i s#as*e !ari #e*b$l$h !arah"selai( i+$ %$)a +er%a!i #er!araha( !a( e!e*a al1eoli" Sekre+ 'a() ba('ak *e('ebabka( obs+r$ksi sal"(a#as !a( a#abila obs+r$ksi +o+al aka( +er%a!i a+ele-+asisi" Ka!a()0ka!a() akiba+ ba+$k 'a() heba+ !a#a+ +er%a!i r$#+$re #are(-h'*a #ar$0#ar$ !a( +er%a!i i(+ers+i+ial e*#h'se*a" .. Hemophyllus ducroyi infection + chancroid/soft chancre/ ulcus molle -. Mer$#aka( 1e(eral !isease a-$+ 'a() !i+a(!ai !e()a( a!a('a $l-$s (ekro+ik #a!a +e*#a+ i(ok$lasi k$*a( +erseb$+ 'a() biasa('a #a!a )e(e+alia" #ara penularan : #!$ 0 laki0laki : #a!a #e(is 0 &a(i+a Per0alanan penyakit : M$la0*$la ber$#a *a-$la a+a$ 1esi-$lar ke*$!ia( *e(%a!i *el$as !a( +erbe(+$k $l-$s" Sifat-sifat ulcus : M$la0*$la !$()k$l !a( ber!ia*e+er k$ra() !ari 9 -* +e+a#i !a#a+ *el$as sa*#ai !ia*e+er : > ; -*" Ter+$+$# oleh %ari()a( (ekro+ik #$r$le(+ !a( ('eri" Dala* 9 > : *i())$ #er*$kaa( k$li+" Mikroskopis : Ter!a#a+ ; 3o(a : 9" Per*$kaa( $lk$s 'a() +er!iri !ari e2$!a+ #ro+ei(o$s baha( (ekro+ik sisa0 sisa lekosi+ !a( eri+hrosi+ 'a() r$sak" :" Eo(a %ari()a( )ra($lasi" ;" Eo(a !e()a( reaksi ra!a() 'a() lebih kro(is !e()a( #roli,erasi ,ibroblas+" 1linis: #roses aka( *e(%alar ke k)b"re)io(al !a( *e()akiba+ka( ra!a() s$##$ra+i, !a( (ekrosis !e()a( #e*be(+$ka( ,is+$la ke #a#$lla !a( : labia *a'or !a( *i(or"

akhir('a *e(%a!i i(+ra!er*al abs-ess !e()a( ,is+el0,is+el 'a() ke*$!ia( !a#a+

11

Ma-$la !a( #a#$lla +i*b$l : *i())$ ses$!ah i(,eksi" ; hari ke*$!ia( +i*b$l $lk$s 'a() ('eri !iser+ai #e*be()kaka( kel" Ge+ah be(i() re)io(al" Pe('aki+ i(i #!$"+erlokilisir #a!a +ra-+$s )e(e+alis !a( bel$* #er(ah !ila#orka( a!a('a #e('ebara( 'a() l$as" 2iagnosa : !e()a( isolasi k$*a(" Bio#si %ari()a(

Ski( +es+ .@/ sela*a ber+ah$(0+ah$( se+elah i(,eksi" Penyembuhan : S#o(+a( !e()a( a+a$ +a(#a #e()oba+a( !e()a( #e*be(+$ka( -i-a+ri-"

III! RADANG GRANULOMATIK T u b e r k u l o s a. Mer$#aka( #e('aki+ ak$+ a+a$#$( kro(is 'a() !isebabka( oleh k$*a( Mi-oba-+eri$* +$ber-$losis" Da#a+ *e('era() se*$a or)a( 'a() +erseri() #a!a #ar$0#ar$" Pe*ba)ia( k$*a( Mi-oba-+eri$* 4 9" Pa+ho)a( : 0 Mi-oba-+eri$* +$ber-$losis" F +'#e h$*a($s F +'#e bo1i(es F +'#e a1i$s 0 Mi-oba-+eri$* le#rae :" No( #a+ho)e( Reaksi 0aringan akibat infeksi dengan kuman tuberkulosa $ Aka( +erbe(+$k +$ber-le 'a() +er!iri !ari : %e(is 9" Har! +$ber-le" :" So,+ +$ber-le" 9" Har! +$ber-le" Terbe(+$k bila 1ir$le(si k$*a( TB5 #e(!eri+a baik" Mikroskopik : Diba)ia( +e()ah +er!iri !ari kelo*#ok sel0sel *o(o($-lear 'a() *iri# sel0sel e#i+hel !a( !iseb$+ sel0sel e#i+heloi!" Sel0sel i(i !i!$)a berasal !ari his+iosi+ a+a$ *a-ro#ha)e 'a() *e*,a)osi+ir k$*a( +b- a+a$ ba)ia( !ari k$*a( TB5" Diba)ia( +e#i a+a$ ka!a()0ka!a() !i+e()ah kelo*#ok sel0sel e#i+hel +erseb$+ !i!a#a+ka( sel !a+ia %e(is la()ha(s !e()a( i(+i 'a() ba('ak !a( khas +ers$s$( se#er+i +a#al k$!a !a( si+o#las*a ber&ar(a *erah *$!a" Gia(+ -ell i(i *e(-er(aka( re(!ah !a( !a'a +aha( +$b$h

12

!a( *ele('a#ka( ba)ia( 'a() (ekro+ik sel0sel e#i+heloi! i(i !il$ar('a !ikelili()i oleh sel0sel l'*#hosi+" :" So,+ +$ber-le" Ter%a!i #a!a #e(!eri+a !e()a( !a'a +aha( +$b$h 'a() re(!ah !a( 1ir$le(si k$*a( 'a() +i())i" Mikroskopik : Di+e()ah !ari be(+$ka( +$ber-le !ia+as *e()ala*i (ekrosis #e()e%$a(" Perkembangan tubercle : 9" Bila hos+ *e(a() *akro#ha) !a#a+ *er$sak k$*a( +$berk$losa Pa!a kea!aa( i(i +er%a!i #e(i*b$(a( ,ibroblas+ !a( ,ibrosi+ !iseki+ar +$ber-le . 'alling off reaction / !a( !iik$+i !e()a( #e*be(+$ka( %ari()a( #ar$+ !a( kalsi,ikasi" Fibro$s -a#s$le i(i *e(-e)ah #e('ebara( k$*a( +$berk$losa" :" Bila hos+ +ak !a#a+ *e()$asai i(,eksi *aka : Masi()0*asi() +$ber-le a+a$ bebera#a +$ber-le *e()a!aka( ,$si sehi())a +erbe(+$k +$ber-le 'a() besar !iseb$+ -o()lo*era+e +$ber-le 'a() !a#a+ *e(-a#ai $k$ra( G 0 9 -* ba)ia( +e()ah *e()ala*i (ekrosis #e()e%$a(" Se-ara !e()a( !i+e()ah('a

*akrosko#is +a*#ak +$ber-le +erseb$+ ber(a*a ab$0ab$ #ara Penularan :

+a*#ak ba)ia( 'a() *e()ala*i (ekrosis #e()e%$a( +erseb$+ ber&ar(a kek$(i()a(" 9" Ter$+a*a se-ara airbo(e i(,e-+io( .!ro#le+ 8 !$s+bor(e i(,"/ :" Melal$i *aka(a( 8 *i($*a( . biasa('a +'#e bo1i(es /" ;" Melal$i k$li+ . +b- k$li+ /" <" Melal$i ,a-es !a( $ri(e" Por+ !6e(+re : 9" :" ;" <" Par$ > #ar$" 7ari()a( l'*#hoi! oro#har'(2" Us$s K$li+"

Fak+or > ,ak+or 'a() *e*#e()ar$hi #e($lara( : 3. "aktor 1uman : 9" 7$*lah k$*a( +b- 'a() *as$k" :" Hir$le(si k$*a(" 4. "aktor Host : 9" Kekebala( :" U*$r !a( %e(is kela*i(" ;" Sosial eko(o*i" <" Peker%aa(" =" Pe('aki+0#e('aki+ 'a() a!a sebel$*('a : 0 Diabe+es *elli+$s" 0 H'#er+h'roi!" Be(+$k +$ber-$losis : 13

9" Pri*ar' +$ber-$losis8-hil!hoo! +$ber-$losis" :" Se-o(!ar'8a!$l+ +'#e8rei(,e-+io( +$ber-$losis" Primary tuberculosis. Mer$#aka( i(,eksi !e()a( k$*a( TB5 'a() #er+a*a kali" P!$" Me()e(ai ba'i !a( a(ak0a(ak +e+a#i !a#a+ #$la *e()e(ai ora() !e&asa 'a() sebel$*('a +i!ak #er(ah +eri(,ek+ir !e()a( k$*a( TB5" K$*a( TB5 'a() *as$k ke*$!ia( bera!a #a!a !i(!i() al1eoli !a( *e(i*b$lka( reaksi kera!a()a( !isi+$" Reaksi 'a() +i*b$l #a!a ,o-$s #ri*er i(i seba)ai berik$+ : Dala* :< %a* +er%a!i i(,il+rasi sel0sel ra!a() PMN 'a() se)era *a+i !a( !i)a(+i oleh sel0sel MN" K$*a(0k$*a( TB5 ke*$!ia( !i+a()ka# oleh sel0sel MN hi!$# !ala* sel0sel +erseb$+ ka!a()0ka!a() sel0sel MN 'a() !i+e*#a+i *a+i" Pa!a *i())$ II ses$!ah +i*b$l aller)i !a( kekebala( sel0sel *o(osi+ !a#a+ *er$sak 8 *e*aka( basil0basil TB5 sel0sel !a+ia sehi())a +erbe(+$k +$ber-le" !esi primer ini disebut Ghon "ocus 5 !esion. 0 0 0 0 0 Lokalisasi +erseri() !i s$b#le$ral #a!a ba)ia( ba&ah lob$s *e!i$s a+a$ ba)ia( a+as lob$s i(,erior" Ber&ar(a ab$0ab$ #$+ih ber$k$ra( 9 > 9 = -* berba+as %elas !e()a( #are(-h'*a seki+ar" 7ara() bila+eral" Fok$s i(i I?J *e()ala*i ,ibrosis ka!a()0ka!a() #erka#$ra( *alah !a#a+ +er%a!i #e*be(+$k( +$la()" 9?J ,o-$s #e()e%$a( *el$as !ala* #are(-h'*a #ar$0#ar$ aka( !iba+$kka(" Kare(a +er%a!i !rai(a)e ke kele(%ar )e+ah be(i() #eribro(-hial .k)b" Re)io(al/ *e(i*b$lka( #roses TB5 #a!a kele(%ar )e+ah be(i()" Ko*bi(asi Gho( ,o-$s !a( #e*besara( k)b" Re)io(al i(i !iseb$+ Ghoncomple6" Secondary tuberculosis. A!alah ,ase !#"i(,eksi TB5 'a() +er%a!i kare(a reak+i1asi !ari TB5 #ri*er a+a$ rei(,eksi #a!a i(!i1i!$ 'a() sebel$*('a #er(ah +erke(a i(,eksi" 7adi kuman 4# ini dapat berasal dari : E(!o)e( :Oleh kare(a reak+i1asi k$*a(0k$*a( TB5 'a() *asih hi!$# !ala* ,o-$s #ri*er 'a() +elah *e()ala*i ,ibrosis8kalsi,ikasi" I(,eksi e(!o)e( i(i *e(%a!i +$ber-$lo$s #(e$*o(ia" Bila #e()e%$a( i(i *e(e*b$s bro(-h$s baha( i(i ,raksi li#i! +erbesar !ala* si+o#las*a *e('ebabka( +ra(s,or*asi sel0sel *o(osi+ *e(%a!i sel0sel e#i+heloi! !a( +erbe(+$k

14

*er$#aka( #e('ebab $+a*a !ari seba)ia( besar a!$l+ TB5 #a!a #e(!eri+a !iba&ah $sia <? +ah$(" E2o)e( : K$*a( TB5 berasal !ari l$ar +$b$h" Seri() #a!a #e(!eri+a 'a() ber$sia lebih !ari <? +ah$(" Tb- sek$(!er i(i #!$ ber$#a TB5 #ar$0#ar$" Sifat 4# sekunder : Se%ak #er*$laa( s$!ah a!a reaksi aller)i !a( kekebala(" La()s$() +i*b$l reaksi #e*be(+$ka( +$ber-le" Lokalisasi ha*#er selal$ #a!a sa+$8ke!$a a#e2 #ar$0#ar$" Sa()+ %ara()8+i!ak +er%a!i #e*besara( k)b" re)io(al" Be(+$k +$ber-le se#er+i i(,eksi #ri*er"

Per%ala(a( #e('aki+ sela(%$+('a : 9" Me('e*b$h !a( +er%a!i ,ibrosis !a( #e()a#$ra(" :" Ter%a!i #e('ebara( lo-al8#ro)resi, .#(e$*o(ia alba/" Kali i(i +er%a!i kare(a i**$(i+e+ 'a() +erbe(+$k #a!a i(,eksi #ri*er +elah le('a# sehi())a si,a+ rei(,eksi sa*a !e()a( i(,eksi #ri*er" ;" Me('ebar ke #le$ra +er%a!i #le$ral e,,$sio( #le$ral ,ibrosis ,o-al #le$ral a!hesio(" <" Bila *e()a!aka( erosi ke bro(-h$s k$*a(0k$*a( +erseb$+ !a#a+ !iba+$kka( !a( *e($lari *$-osa bro(-h$s bro(-hiol$s !a( +ra-hea +er%a!i e(!o+ra-heobro(-hial TB5" Bila *e()a!aka( i(#la(+asi ke lar'(2 +er%a!i lar'()i+is TB5" =" S#$+$* 'a() *e()a(!$() k$*a( !i+ela( +er%a!i i(+es+i(al TB5" B" Pe('ebara( k$*a( *elal$i sel )e+ah be(i() sa*#ai kealira( !arah !a( *e('ebar kesel$r$h +$b$h +er%a!i *illiar' TB5" Or)a(0or)a( 'a() *$!ah +erke(a TB5 *illier : 0 l'*#ho(o!$le 0 li1er 0 lie( 0 )i(%al 0 kel" A!re(al C" Isola+e! or)a( TB5" Seri() +er%a!i #a!a *e(i()e( )i(%al +$la() +$ba ,allo#i !a( e#i!i!'*is" 0 #ros+a+e 0 1esi-$lar se*i(alis 0 +$ba ,allo#ii 0 e(!o*e+ri$* 0 *e(i()e( !a( +er%a!i +$ber-$lo$s #(e$*o(ia

!P"# ( M$"B%S &#NS!N ).

15

Mer$#aka( s$a+$ #e('aki+ kro(is 'a() !isebabka( oleh M'-oba-+eri$* le#rae" Di!$)a !a'a i(1asi !a( 1ir$le(si k$*a( +erseb$+ re(!ah sehi())a $(+$k #e($lara( !ib$+$hka( &ak+$ ber+ah$(0+ah$( !a( h$b$()a( 'a() sa()a+ i(+i*" Le#ra i(i +i!ak !i+$larka( i($+ero 8 here!i+er" Masa i(k$basi : = > 9? +ah$(" Pe('aki+ i(i +er$+a*a *e()e(ai k$li+ *$-osa !a( sara, #eri,er" Oleh kare(a kelai(a( i(i +er%a!i #a!a k$li+ !a( *$-osa !a( e2$!a+ !ari !aerah i(i ka'a k$*a( *aka !a#a+ !i+$larka(" Kelai(a( i(i +er!a#a+ %$)a !ala* oro#har'(2 sehi())a se-re+ hi!$() !a( *$l$+ !a#a+ i(,e-+io$s ke sel$r$h ba!a(" Di!$)a *as$k('a k$*a( !ala* +$b$h *elal$i lesi #a!a k$li+ 8 *$-osa !a( !i!$)a #e('ebara(('a *elal$i l'*#ho)e( !a( he*a+o)e( sehi())a +er%a!i i(,eksi sis+e*ik" A!a : be(+$k : 9" T'#e +$ber-$loi! :" T'#e le#ro*a+o$s (. ype tuberculoid : Ti*b$l #a!a hos+ 'a() rela+i1e lebih resis+e(" 1elainan yang ter0adi : Ber$#a *a-$lo#a#$lar #a!a k$li+ : Ba)ia( +e()ah ber&ar(a *erah -okla+ !a( +ak *e(i())i" Ba)ia( +e#i h'#ere*is *e(i())i !a( a)ak keras" Ber$k$ra( 9-* bila %$*lah ba('ak !a#a+ *er$#aka( ber-ak0ber-ak 'a() lebar kare(a ber)ab$()" Ta(!a khas ber-ak i(i : F" +i!ak )a+al F" a(aes+hesia F" a(h'!ro Mikroskopis : Ba)ia( +e()ah : ber$#a ra!a() (o( s#esi,ik !e()a( serb$ka( sel0sel MN +er$+a*a seki+ar a!(e2a !a( #e*b$l$h !arah" Ba)ia( +e#i : Se#er+i har! +$ber-le -aseosa +i!ak +er%a!i" Pa!a lesi i(i %ara() 8 sa()a+ se!iki+ !i!a#a+ka( k$*a( le#ra" Kelai(a( his+olo)ik i(i %$)a +er!a#a+ #a!a sera+0sera+ sara, #eri,er se+e*#a+ !a( aka( +er$s *e(%alar ke sera+0sera+ sara, 'a() lebih besar" Gra($lo*a +$ber-$loi! i(i +er!a#a+ !i!ala* a+a$ seki+ar sab$+ sera, sara, +erseb$+ !a( la*a0la* *e(%a!i ,ibrosis !a(k eras sehi())a sera+ sara, +eraba +ebal !a( se#er+i +ali" Kele(%ar )e+ah be(i() se+e*#a+ ka!a()0ka!a() %$)a +erke(a" *. ype lepromatous : +er!iri !ari sel e#i+heloi! !ikelili()i oleh l'*#hosi+ !a( sel #las*a seri()kali !e()a( sel0sel !a+ia" Nekrosis

16

Ti*b$l #a!a #e(!eri+a 'a() lebih #eka" Di*$lai !e()a( *$-$la 'a() s'*e+ris *iri# !e()a( +'#e +$ber-$loi!" Mak$la se)era ber$bah *e(%a!i lesi 'a() (o!$lar !ala* !er*is .Kle#ro*a/ ber$k$ra( 9 -* a+a$ !a#a+ lebih l$as la)i" Rash +er$+a*a #a!a *$ka !a( !aerah e2+e(sor e2+re*i+as le#ro*a #a!a !ahi #i#i hi!$() !a( bibir !a#a+ *e*beri )a*bara( se#er+i si()a . "acies leonina/" No!$le 'a() ber&ar(a k$(i() ab$0ab$ i(i +er!a#a+ !ala* !er*i( +e#a+ !iba&ah e#i!er*is" K$li+ !ia+as('a !a#a+ +erle#as sehi())a +erbe(+$k se*a-a* $lk$s" Mikroskopis : Ter!iri !ari +i*b$(a( *a-ro#ha)e !a( sel !a+ia 'a() *e()a(!$() li#i! !a( bak+eri . lepra cell /" Bak+eri +ers$s$( !ala* b$(!le a+a$ )lobi 'a() ka!a()0ka!a() !a#a+ *e(-a#ai =? *ikro(" K$*a(0k$*a( i(i !a#a+ !i!a#a+ka( !ala* %ari()a( 8 sal" Ge+ah be(i()8)ia(+ -ell" Dia(+ara le#ra sel !i!a#a+ka( l'*#hosi+ !a( sel #las*a kele(%ar )e+ah be(i() %$)a +erke(a .ha*#ir selal$/ !a( %$)a *e()a(!$() ,o-i !#"le#ra -ell se#er+i !i a+as" Le#ra -ell %$)a +er!a#a+ !ia(+ara berkas0berkas sara, !i!aerah 'a() +erke(a +er%a!i reaksi ra!a() !a( +er%a!i -i-a+ri2 'a() !i,,$se !i!ala* !a( seki+ar sara, *e('ebabka( #e(ebala( sara, +erseb$+" Le#ro*a %$)a +er%a!i #a!a *$-osa hi!$() oro#har'(2 e#i)lo++is lar'(2 !a( +ra-hea ka!a()0ka!a() %$)a !i li1er lie( s$*s$* +$la() #ar$0#ar$ !a( )o(a!" 1linis: Ga())$a( sara, #eri,er 'a() +er%a!i *e()akiba+ka( )a())$a( se(soris +er%a!i a(aes+hesia 'a() seri() !iser+ai !e()a( +er%a!i('a $lk$s !a( i(,eksi k$li+ 'a() +er%a!i oleh kare(a )a())$a( +ro#hies *a$#$( oleh kare(a +ra$*a" Ga())$a( sara, *o+oris *e('ebabka( a+ro,i o+o+0o+o+ skele+ : Ma(i,es+asi 'a() lai( : a" T$ber-$loi! +'#e" 0 0 0 0 b" 0 0 0 0 ko(+rak+$r #a!a o+o+ +a()a( *e()akiba+ka( -la& ha(! ,a-ial #aral'sis a+ro#h' e2+re*i+as a$+o a*#$+asi #a!a %ari0%ari +a()a( !a( kaki *a-$lo#a#$llar lesio( !a( +er%a!i s$b-$+a( (o!$le ,a-ias leo(i(e +erke(a('a *$-osa hi!$() !a( (aso#har'(2 *e()akiba+ka( #er!araha( !isi+$" +erke(a('a lar'(2 *e()akiba+ka( s$ara serak !a( ba+$k0ba+$k" Dia)(osa !i+e)akka( !e()a( : #e*eriksaa( kli(is 17

Le#ro*a+o$s +'#e"

bio#s' s-ra#i() le#ro*i( +es+ .*e())$(aka( e2+ra-+ k$*a( le#ra/" .@/ #a!a i(!i1i!$ (or*al !a( #e(!eri+a +'#e T" .0/ #a!a #e(!eri+a +'#e L"

Mor+ali+as Pro)(osis

: Ti!ak +i())i : T'#e T lebih baik"

S y p h y l i s ( %!S ). Pe('aki+ 'a() !isebabka( Tre#o(e*a #alli!a . +er)olo() s#iro-hae+a /" Kelai(a( 'a() !isebabka( oleh )olo()a( s#iro-hae+a i(i sa*a 'ai+$ : 9" Kera!a()a( i(+ers+i+ial 'a() +ersebar l$as !iser+ai !e()a( #er$baha( #roli,era+i, #a!a #e*b$l$h !arah !a( i(,il+rasi 'a() #ro*i(e( !ari l'*#hosi+ !a( sel #las*a !i !aerah #eri1ask$ler" :" Ka!a()0ka!a() +erbe(+$k ,o-al (ekrosisi +e+a#i biasa('a +i!ak +er%a!i s$##$rasi" ;" Pa!a !aerah lesi sa()a+ se!iki+ !i+e*$ka( *ikro or)a(is*e" <" Sa()a+ s$kar *e()i!e(+i,ikasika( k$*a( se-ara k$l+$r" =" K$*a( +i!ak !a#a+ !i+$(%$kka( !e()a( #e()e-a+a( biasa har$s !e()a( !ark ,iel! e2a*i(a+io(" S'#hilis *er$#aka( #e('aki+ kela*i( 'a() #ali() berbaha'a kare(a : 9" Lesi #ri*er !a( #e('ebara( sis+e*ik 'a() +er%a!i ke*$!ia( seri()kali +i!ak !iser+ai !e()a( kel$ha( a+a$ )e%ala0)e%ala kli(ik 'a() ('a+a" :" Pa!a ,ase akhir *e()akiba+ka( )a())$a( sis+e*ik 'a() l$as" D?J #e(!eri+a !a+i() beroba+ !ala* kea!aa( +erla*ba+ oleh kare(a : 0 Mer$#aka( #e('aki+ 'a() *e*#$('ai *a(i,es+asi 'a() bera(eka ra)a* *iri# !e()a( #e('aki+ " 0 A(+ara s+a!i$* I !e()a( s+a!i$* lai(('a +er!a#a+ ,ase la+e(+ +a(#a )e%ala kli(is" #ara Penularan : : 0 0 :" 5o()e(i+al : 0 ha*#er selal$ se-ara ko(+ak se2$al" +ra(s,$se !arah" +ra(s#la-e(+a #a!a ib$0ib$ 'a() *e(!eri+a s'#hilis +er%a!i ses$!ah keha*ila( = b$la(" Tre#o(e*a #alli!a +i!ak !a#a+ *e(e*b$s k$li+8*$kosa 'a() i(+ak bahka( *$kosa 'a() #ali() +i#is#$( %a!i $(+$k i(1asi('a !i#erl$ka( a!a('a l$ka8lesi" empat infeksi pertama : biasa('a #a!a #e(is 1$l1a !a( -er1i2 9?J e2+ra)e(i+al : li!ah %ari oro#har'(2" 9" A-L$ire!

Pathogenesa :

18

Pa!a a-L$ire! s'#hilis se+elah k$*a( *as$k ke!ala* %ari()a( se)era +er%a!i #e*biaka( *e(e*b$s sal$ra( l'*#he !a( !ialirka( ke kele(%ar l'*#he re)io(al" Dala* :< %a* +er%a!i s's+e*i- s#iro-hae+a*ia karea( !rai(a)e *elal$i alira( l'*#he a+a$ la()s$() *e()a!aka( i(1asi ke 1e(a01e(a sehi())a k$*a( !a#a+ sa*#ai !ise*$a ba)ia( +$b$h" S#iro-hae+a*ia i(i !a#a+ berla()s$() sa*#ai ber*i())$0*i())$ berb$la(0b$la( a+a$ bahka( ber+ah$(0+ah$( sa*#ai !ir$sak oleh a(+ibo!' .TPI/" 3c8uired syphilis A!a ; s+a!i$* : I. Primary stage. Lesi +i*b$l a(+ara C hari > ; b$la( ses$!ah ko(+ak ber$#a !$()k$l 'a() *e()ala*i erosi sehi())a +erbe(+$k $l-$s !$r$* 'a() +ak ('eri !a( sa()a+ i(,e-+io$s" Mor,olo)i $l-$s !$r$* : Makroskopis : bebera#a *a-$la 'a() soli+er *e(i())i" : bebera#a ** > -*" !ala*('a ber1ariasi !ari erosi ke-il sa*#ai $lk$s 'a() !ala*" Dasar $lk$s ber&ar(a *erah se#er+i lak !a( !i!a#a+ka( e2$!a+ 'a() %er(ih" Mikroskopis : I(,il+rasi sel0sel MN 'a() ba('ak sel #las*a ser+a serb$ka( l'*#hosi+ !a( *a-ro#ha)e" Pa!a +e#i $l-$s +a*#ak i(,il+ra+e ra!a() !e()a( #roli,era+i1e 1aso,ibroblas+ik" Pe*b$l$h !arah ke-il8ka#iler !i+e*#a+ +erseb$+ *e()ala*i e(!ar+eri+is obli+era(s 'ak(i #e(ebala( #roli,era+i, !ari e(!o+hel !a( ,ibroblas+" Pa!a #er*$kaa( $lk$s !i!a#a+ka( il,il+rasi sel0sel ra!a() +er$+a*a (e$+ro,il" De()a( i*#re)(asi #erak +erliha+ ba('ak s#iro-hae+a !ala* %ari()a(" Dala* < > B *i())$ $lk$s aka( se*b$h se(!iri ree#i+helialisasi" KGB"re)io(al biasa('a *e*besar !e()a( )a*bara( s$a+$ l'*#ha!e(i+is (o( s#esi,ik ak$+ !a( kro(is" Rea)i( +es+8TPI +es+ .0/" 2iagnosa : 19 !is$s$l !e()a( keras berba+as %elas !a( +e#i a)ak

De()a( !i+e*$ka(('a k$*a( !ari $lk$s 8 as#irasi k)b"re)io(al" II. Secondary stage. Ter%a!i 9 > ; b$la( se+elah s+a! I" Ma(i,es+asi : ber$#a rash 'a() *a-$lo#a#$ler 'a() +ersebar l$as #a!a k$li+ !a#a+ #$la *e()e(ai *$kosa *$l$+ +ela#ak +a()a( !a( kaki !a( #a!a lesi0lesi +erseb$+ !i!a#a+ka( k$*a(('a" Ter%a!i l'*#ha!e(o#ha+' )e(eralisa+a .#e*besara( kele(%ar l'*#he !isel$r$h +$b$h/ " Mak$la #a!a k$li+ : 0 0 0 ber&ar(a *erah -okla+ #!$" k$ra() !ari = -*" !a#a+ #$la berbe(+$k ,ollik$ler a(($lar #$s+$lar" ber$#a $lk$s 'a() s$#er,i-ial !a( *e()a(!$() ba('ak s#iro-hae+a" Ga*bara(('a k$ra() lebih sa*a !e()a( lesi #ri*er +e+a#i i(,il+rasi sel0sel MN lebih ri()a( !a( +er$+a*a !iseki+ar #e*b$l$h !arah sa%a" Ker$saka( ka#iler lebih heba+ !a( !iik$+i #roli,erasi ka#iler" #ondyloma lata + &enereal 'ars Mer$#aka( salah sa+$ *a(i,es+asi !ari l$es s+a! II 'a() ber$#a lesi #a#$ler #a!a !aerah #e(is a!a( 1$l1a" Ka!a()0ka!a() !i!a#a+ka( #a!a bibir !a( !aerah #eria(al" Makrosko#is : ber$#a #a#$la 'a() ber&ar(a *erah -okla+ 'a() *e(i())i !e()a( #er*$kaa( 'a() lebar !a( !a+ar" : > ; -*" h'#er#lasia e#i!er*is !e()a( h'#erkera+osis !a( a-a(+hosis" Khas : !i!a#a+ka( i(,il+rasi sel0sel MN !a( sel #las*a ser+a e(!ar+eri+is obli+era(s" Pa!a s+a!" II i(i ka!a()0ka!a() !iser+ai !e()a( kelai(a( #a!a *a+a ber$#a iri+asi re+i(i+is (e$ri+is" Reaksi serolo)is .@/" III. ertiary stage.

Pa!a *$kosa : Mikrosko#is :

Mikrosko#is :

Ter%a!i 9 > bebera#a +ah$( ke*$!ia(" 20

Ter%a!i #a!a k$ra() lebih ;?J #e(!eri+a +e+a#i ha('a G ('a 'a() *e($(%$kka( )e%ala0)e%ala kli(is 'a() ber$#a : D? > D=J = > 9?J Sisa('a : : : -ar!io1as-$lar s'#hilis -e(+ral (er1o$s s's+e* s'#hilis" ber$#a )a**a #a!a he#ar a+a$ !i+e*#a+0+e*#a+ lai("

#ardio&asculer syphilis. Ti*b$l bebera#a +ah$( > bebera#a !e-a!e ses$!ah i(,eksi" Biasa('a #a!a $sia <? > == +ah$(" Laki > laki : &a(i+a K ; : 9" Di!$)a +re#o(e*a #alli!a +elah bera!a #a!a +e*#a+0+e*#a+ +erseb$+" Se%ak s+a! I a+a$ II !a( #roses('a ber%ala( sa()a+ la*ba+" Or)a( 'a() #ali() seri() +erke(a a!alah aor+a +er$+a*a aor+a as-e(!e(s !a( ar-$s aor+a" Aortitis luetica Mer$#aka( lesi 'a() #ali() seri() !a( #ali() seri$s #a!a l$es III kare(a *e('ebabka( aor+a i(s$,,i-ie(si !a( a(e$r's*a aor+a" Makroskopis : Terbe(+$k %ari()a( #ar$+ 'a() (a*#ak seba)ai ber-ak0ber-ak 'a() *e(i())i ber&ar(a ab$0ab$ #a!a #er*$kaa( aor+a" 5i-a+ri2 'a() +er%a!i +i!ak +era+$r !a( +er%a!i ker$+a(0ker$+a( lo()i+$!i(al 'a() *e*beri )a*bara( se#er+i -akar a'a* #a!a #er*$kaa( i(+i*a" Mikroskopik : Ter%a!i e(!ar+eri+is obli+era(s !ari 1asa 1asor$* *e()akiba+ka( (ekrosis !ari +$(i-a *e!ia" Serab$+0serab$+ ela+is #a!a +$(i-a *e!ia !i)a(+i %ari()a( )ra($lasi !a( i(i *e('ebabka( kele*aha( !i(!i() aor+a sehi())a +er%a!i aor+a i(s$,,i-ie(si !a( a(e$r's*a aor+a" #entral ner&ous system syphilis. 5NS s'#hilis (e$ros'#hilis !i!$)a akiba+ !ari i(1asi +re#o(e*a #alli!a ke!ala* 5NS !a( *e(i()a( 'a() +elah *$lai se%ak s+a!" I 8 II" Pa!a (e$ros'#hilis i(i &ala$#$( !a#a+ !i+e*$ka( s#iro-hae+a !ala* liL$or -erebro s#i(alis (a*$( ha('a 98; kas$s 'a() *e($(%$kka( kelai(a(0kelai(a( a(a+o*i- #a!a sara,('a" Ma(i,es+asi kli(is *e$ros'#hilis : 0 *e(i()o1as-$ler s'#hilis" - Tabes !orsalis Gumma: A!alah ,ak+or ker$saka( %ari()a( akiba+ ra!a() (o( s$##$ra+i, 'a() !i!$)a !isebabka( oleh a!a('a s#iro-hae+a !ala* %ari()a( +erseb$+ ber$#a %ari()a( (ekro+ik 'a() ber&ar(a ab$0ab$ #$+ih ko(sis+e(si #a!a+ ke('al se#er+i kare+ !iseb$+ )$**a+o$s (ekrosis" Lokalisasi 'a() +erseri() : 21 0 Paresis

%ari()a( k$li+ !a( *$kosa" Ha+i" T$la()" Tes+is"

7$)a !a#a+ !i+e*#a+0+e*#a+ lai(" Da#a+ si()le 8 *$l+i#le" Uk$ra( : !ari 'a() ha('a !a#a+ !iliha+ se-ara *ikrosko#ik sa*#ai ber$k$ra( besar .lebih !ari 9?-*/" Khas : G$**a !ili#$+i %ari()a( #ar$+ ,ibroblas+i-" Bila +er%a!i erosi #a!a #er*$kaa( k$li+8*$kosa +er%a!i $lk$s 'a() resis+e( +erha!a# se)ala #e()oba+a( lo-al" Pada Hepar : Da#a+ +er%a!i #e*besara( he#ar 'a() (o!$ler #a!a s+a!i$* (ekrosis ak$+ ke*$!ia( +er%a!i %ari()a( ak$+ *e('ebabka( -irrhosis he#a+i- !a( !iseb$+ he#ar loba+$*" Pada ulang : Ter%a!i ,o-$s0,ok$s !es+r$ksi +$la()" Da#a+ +er%a!i erosi !ari #er*$kaa( -or+e2 'a() *e('ebabka( ,rak+$ra #a+holo)is" Ka!a()0ka!a() *e('ebar ke #erse(!ia( *er$sak #er*$kaa( se(!i !a( *e('ebabka( )a())$a( ,$()si se(!i" Pada estis : M$la0*$la +es+is *e*besar +e+a#i ke*$!ia( +er%a!i %ari()a( ,ibrosis" Mikroskopik : Ba)ia( +e()ah" Baha( (ekrosis koa)$lasi .*asih +a*#ak sa*ara0sa*ar s+r$k+$r %ari()a(/" Ti!ak !i!a#a+ka( sel %ari()a( a+a$ lekosi+ 'a() *asih hi!$#" A1as-$ler" Ter!a#a+ +i*b$(a( ,ibroblas+ 'a() *iri# sel0sel e#i+heloi! #a!a +b-" I(,i(+rasi sel0sel MN +er$+a*a l'*#hosi+ !a( sel #las*a" Pe*b$l$h !arah ke-il *e()ala*i e(!ar+eri+is obli+era(s" Tre#o(e*a *$()ki( a!a +e+a#i sa()a+ s$li+ !i!a#a+ka("

Ba)ia( +e#i"

S()*ili+ %ong#nital! Pe('aki+ s'#hilis !a#a+ *e()e(ai %a(i( a#abila +er%a!i s#iro-hae+e*ia #a!a ib$" Pe($lara( ha('a +er%a!i ses$!ah b$la( ke = keha*ila( kare(a i+$ s'#hilis b$ka( #e('ebab 'a() $*$* !ari earl' abor+io(" Ter)a(+$() #a!a bera+('a i(,eksi !a#a+ +er%a!i la+e abor+io( lahir *a+i a+a$ lahir hi!$# +a(#a )e%ala0)e%ala s'#hilis +e+a#i ke*$!ia( *a(i,es+ se+elah a(ak besar" De()a( #e()oba+a( 'a() a!ek$a+ #a!a ib$ sebel$* keha*ila( b$la( I?J !ari a(ak0a(ak('a bebas s'#hilis" 22 ke0<

S'#hilis -o()e(i+al 'a() (a*#ak se%ak ba'i . !ues congita praeco6 /" 1elainan yang ter0adi biasanya khas : 9" Pa!a k$li+ !a( *$kosa" Bebera#a lesi *ak$lo#a#$ler 'a() !i,,$se !a( *e()ala*i !esk&a*asi" Lokalisasi : 0 0 0 +ela#ak +a()a( !a( kaki" seki+ar *$l$+ !a( a($s" !a#a+ %$)a #a!a sel$r$h #er*$kaa( +$b$h"

Makrosko#ik : 0 e(!ar+eri+is obli+era(s !a( i(,il+rasi MN .l'*#hosi+ !a( sel #las*a/" !a#a+ !i+e*$ka( s#iro-hae+a

:" Pa!a +$la()" Ber$#a os+eo-ho(!ri+is !a( #eri-ho(!ri+is )e(eralisa+a 'a() *e()e(ai se*$a +$la() +er$+a*a : 1o*er !es+r$ksi +$la() *e('ebabka( +er%a!i('a sa!!le (ose" Tibia #erios+i+is *e('ebabka( #er+$*b$ha( +$la() bar$ 'a() berlebiha( #a!a a(+erior +ibia +er%a!i saber shi(" Ga*bara( #a!a #e($la()a( e(!o-ho(!ral *e('ebabka( #er+$*b$ha( 'a() berlebiha( !ari +$la() ra&a( !a( *e()akiba+ka( e#i#h'sis *elebar" ;" Pa!a Ha+i" Ter%a!i reaksi ra!a() 'a() !i,,$se" M$la0*$la ha+i *e*besar +e+a#i ke*$!ia( +er%a!i -i-a+ri2 sehi())a he#ar *e()ker$+ !a( %ari()a( #ar$+ 'a() *$la0*$la ha('a !il$ar lob$l$s ke*$!ia( *as$k !ia(+ara sel0sel #are(-h'*a ha+i !a( *e*isah0 *isahka( #are(-h'*a he#ar !a( *e*beri )a*bara( s$a+$ -irrhosis he#a+i-" Ka!a()0ka!a() !a#a+ !i+e*$ka( )$**a !ala* ha+i" <" Par$0#ar$" Ter%a!i !i,,$se i(+ers+i+ial ,ibrosis sehi())a ko(sis+e(si #ar$0#ar$ lebih #a!a+" Bila heba+ #ar$0#ar$ (a*#ak #$-a+ ha*#er +a(#a $!ara !iseb$+ #(e$*o(ia alba" Mikroskopis : r$a() al1eoli se*#i+" Se#+$* al1eoli *e(ebal" Sel0sel al1eoli h'#er+ro,i" E(!ar+eri+is obli+era(s !a( i(,il+rasi sel0sel ra!a() MN 0 *e(i()o1as-$ler s'#hilis" 0 kera+i+is i(+ers+i+ialis !a( -horioi!i+is" 0 s#o++e! re+i(a . oleh kare(a #e*be(+$ka( #i)*e( 'a() ab(or*al /" Syphilis congenital yang timbul lama sesudah lahir 9 lues congenitatarda :.

=" Or)a(0or)a( lai( 'a() %$)a !a#a+ +erke(a ra!a() 'a() !i,,$se !a#a+ #$la +er%a!i :

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Kelai(a( 'a() +er%a!i *iri# !e()a( l$es s+a!" III l$es -o()e(i+a se#er+i : sa!!le (ose" Saber shi(" kera+i+is i(+ers+i+ialis" Ke+$lia( N"HIII"

+e+a#i seri() !iser+ai +a(!a0+a(!a

Kelai(a( 'a() khas a!alah Trias H$+-hi(so( 'ak(i :

H$+-hi(so( +ee+h 'ak(i i(sisi1$s lebih ke-il !ari (or*al berbe(+$k se#er+i Obe()"

7ara() !i+e*$ka( -ar!io1as-$lar s'#hilis" Bila *e(i()o1as-$ler +erke(a !a#a+ +er%a!i a+ro,i N"I !a( ke+$lia( N"HIII"

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