Chancroid in Emergency Medicine Workup

  • Author: Ninfa Mehta, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...
 
Updated: Dec 13, 2010
 

Laboratory Studies

Culture is unreliable and insensitive. Sensitivities have been found to be between 50% and 100%.[5] Use of a special medium is required to culture H ducreyi due to its heme dependence. The growth temperature is also lower (33°C) than most organisms. If cultures are going to be positive, they usually grow organisms within 3 days.

Polymerase chain reaction (PCR) is 100% sensitive.[5] However, PCR is not usually performed on site, therefore, causing a time delay in making the diagnosis as well as being expensive. PCR directed against one of two genomic segments (either the ribosomal RNA gene, rrs-rrl ribosomal intergenic spacer region, or the GroEL gene, which encodes a heat shock protein) can be used.

Gram stain is similar to PCR in the time it takes and the delay in diagnosis and treatment. Microbiologists have described H ducreyi to look like "schools of fish," "railroad tracks," and "fingerprints".[4] Histologic findings include neutrophils, fibrin, erythrocytes, and necrotic tissue.

Immunochromatography is a rapid diagnostic test that usually takes approximately 15 minutes to perform. Immunochromatography tests use monoclonal antibodies to the hemoglobin receptor of H ducreyi, hgbA, which is an outer membrane protein. Patterson reported this test to have a specificity of 100%.[5] However, sensitivity is not as good. Positive characteristics are ease of use, low cost, and stability in a variety of climates. This test will not be commercially available until the sensitivity can be increased.

The syndromic management approach by the World Health Organization and Centers for Disease Control and Prevention (CDC) suggests a positive diagnosis if the patient has one or more painful ulcers (ulcers with painful adenopathy are pathognomonic) with no evidence of syphilis (darkfield examination of ulcer exudates) or herpes simplex virus.

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Contributor Information and Disclosures
Author

Ninfa Mehta, MD  Fellowship Director in Ultrasound Division, Department of Emergency Medicine, State University of New York Downstate Medical Center, Kings County Hospital

Ninfa Mehta, MD is a member of the following medical societies: American Association of Physicians of Indian Origin, American College of Emergency Physicians, American Medical Association, American Medical Student Association/Foundation, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

David FM Brown, MD  Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital

David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Barry J Sheridan, DO  Chief, Department of Emergency Medical Services, Brooke Army Medical Center

Barry J Sheridan, DO is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP  Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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This photograph shows an early chancroid on the penis, along with accompanying regional lymphadenopathy. Courtesy of the CDC/Dr. Pirozzi.
Chancroid usually starts as a small papule that rapidly becomes pustular and eventually ulcerates. The ulcer enlarges, develops ragged undermined borders, and is surrounded by a rim of erythema. Unlike syphilis, lesions are tender and the border of the ulcer is not indurated. Courtesy of Hon Pak, MD.
This patient shows the characteristic lesions of chancroid. The bubo on the right side drained spontaneously. The bubo in the left inguinal canal required needle aspiration.
Large fluctuant buboes should be drained with the patient under local anesthesia and a large-gauge needle inserted through surrounding healthy skin. The insertion site should be superior or lateral to the bubo to prevent chronic drainage from the site.
 
 
 
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