UPADAMSHA (Chancroid / SOFT CHANCRE)
- 1. Prof Sriram Chandra Mishra Kayachikitsa Department VYDS Ayurved Mahavidyalaya, Khurja
- 2. • UPADAMSA is first descried by Acharya Sushruta in S.NI.12, S. Chi. 19 chapter. एतं ध्वजभंगमुपदंशं क े चित् पंिववधं प्रिक्षते ॥ (Gangadhar Roy) • The disease DHWAJABHANGA (described by Maharshi Charak) have similarity with UPADAMSA. PARIBHASHA (Definition) • उपदंश संज्ञा ि दंशनोपाचधमंतरेणावप रुढा बोद्धव्या । (मा.नन. उपदंश) दंश अर्थात् कथटनथ । कथटनेसे यथ अन्य आघथतसे गुह्य भथगमें जो पिटीकथ उत्िन्न होती है, उसे उिदंश कहते हैं ।
- 3. • NIDANA (Etiology) Atimaithuna, Yoniroga, Kshata etc
- 4. • SAMPRAPTI (Pathogenesis) प्रक ु वपत दोषााः क्षतेऽक्षते वा श्वयथुमुपजनयन्तत, तमुपदंशममत्यािक्षते ॥ (सु. नन.17/7) ननदथनों क े सेवन से प्रक ु पित वथतथदद दोष क्षत यथ अक्षत शशश्न की त्वचथ में शोध उत्िन्न कर देते हैं , तत्िश्चथत् व्रणोत्िपि होकर उिदंश रोग को उत्िन्न करते है । Samprapti Ghatak Dosha – Pitta Pradhan Tridosha Dushya – Rakta, Lasika Srotas – Mutravaha, Sukravaha/Artav Vaha Srotodusti – Atipravritti Adhisthana - Jananendriya
- 6. • BHEDA (Types) – 5 स पञ्िववधन्रिमभदोषाः पृथक् समरतरसृजा िेनत ॥ (Su. Ni. 12/8) 1. Vataja, 2. Pittaja, 3. Kaphaja, 4. Sannipataja, 5. Raktaja
- 11. TREATMENT PRINCIPLE OF UPADAMSA
- 12. व्रणोपिार 1. वणण शोधनाथण • िंचक्षीरी वृक्ष क्वथर् • भूतघ्नचक्रिकथ द्रथव • त्रिफलथ क्वथर् • भृङ्गरथज स्वरस • आरग्वध्यथदद कषथय 2. व्रण रोपण हेतु (स्र्थननक प्रयोग) • त्रिफलथ मसी (त्रिफलथ की जली रथख) को मधु सैंधव शमश्रकर प्रलेि (भथ.प्र.) । • जथत्यथदद तैल तर्थ करंजथदद घृत, भूननम्बथदद घृत (भथ.प्र.) कथ प्रयोग । • जथत्यथदद घृत तर्थ कोशथतकी तैल • व्रणरथक्षस तैल • आगथर धूमथद्य तैल 3. क ु ष्ठ, नथडीव्रण तर्थ व्रणरोग में वर्णात घृतों कथ प्रयोग िररषेचनथर्ा, रोिणथर्ा तर्थ िथन क े शलए करनथ चथदहए ।
- 13. संशमन औषध योग • रस / भरम / वपष्टी – त्रिवंग भस्म, व्यथधधहरण रसथयन, अष्टमूनता रसथयन, उिदंशगजक े शरी रस, रसमथर्णक्य, गंधक रसथयन, अमीर रस, शुभ्रथभस्म, कथसीसभस्म, गैररकभस्म, रसकिूार, प्रवथल पिष्टी आदद । • वटी / गुग्गुलु - वरथदद गुग्गुलु, आरोग्यवधधानी वटी, क ै शोर गुग्गुलु, रस गुग्गुलु, रसशेखर वटी, आदद । • िूणण - कथसीस चूणा, चोिचीन्यथदद चूणा, ननम्बथदद चूणा • क्वाथ योग - िटोलथदद क्वथर्, उिदंशहर कषथय, ननम्बथदी कषथय, मंजजष्ठथदद कषथय आदद । • आसव / अररष्ट - महथमंजजष्ठथद्यथररष्ट, देवदथव्यथाद्यथररष्ट, सथररवथद्यथसव • अवलेह / पाक – सथररवथद्यवलेह, चोिचीनी िथक
- 14. • घृत / तल अन्तःप्रयोगथर्ा – करञ्जथद्य घृत, भूननम्बथद्य घृत । बथह्यः प्रयोगथर्ा - जथत्यथदद तैल, गोजजह्वथदद तैल, आगथरधूमथद्य तैल तर्थ कोशथतकी तैल । • लेप — उिदंशहर मल्हर, उिदंशहर चूणा प्रलेि, गैररकथदद लेि, िूगफल लेि, करवीर मूल लेि • अवूिणणन – ननम्बथदद चूणा, बबूल िि चूणा, दथड़िमत्वक चूणा, मथनव अजस्र्चूणा, अवचूणान तर्थ कथसीस चूणा अवचूणान । • प्रक्षालन योग जयन्ती, चमेली, करवीर, अक ा , अमलतथस क े िि कथ क्वथर् बनथकर मेढ्रव्रण प्रक्षथलनथर्ा प्रयुक्त करें । त्रिफलथ क्वथर् से व्रण कथ प्रक्षथलन करें । क्षीरी वृक्ष कषथय से व्रण प्रक्षथलन करें । आरग्वधथदद क्वथर् से प्रक्षथलन करें । -
- 16. PATHYAPATHYA
- 17. CHANCROID Definition Chancroid is a sexually transmitted disease caused by the gram- negative bacteria Haemophilus ducreyi and is characterized by painful necrotizing genital ulcers that may be accompanied by inguinal lymphadenopathy.
- 18. Transmission • Sexually by direct contact with purulent lesions • By autoinoculation (self infection) to nonsexual sites, such as the eye and skin. • Health workers become infected through contact with infected patients. Incubation period • 1 day to 2 weeks, with a median time of 5-7 days.
- 19. Pathophysiology • H. ducreyi penetrates the skin through disrupted mucosa (injury/scratch/cut) and causes a local inflammatory reaction. • It produces a cytocidal distending toxin that appears to be responsible for its destructive effects. • The local tissue reaction leads to • Development of erythomatous papule, • Progresses to pustule in 4–7 days. • Then undergoes central necrosis to ulcerate. Cytocidal – Kill the host cell through changes in cell morphology etc
- 20. Sign & Symptoms • The first lesion of Chancroid Begins as a small tender papule with surrounding erythema Rapidly becomes pustular Then erodes to form an extremely painful and deep ulcer. The ulcer is painful, bleeds easily, drains a grey or yellowish pus. The adjacent ulcers may merge and form confluent lesions. Super infection of ulcers, especially fuso-spirochetal, may occur and lead to rapid destruction of the external genitalia, known as phagedenic chancroid.
- 21. Ulcer base is composed of • Easily friable granulation tissue that is usually covered with malodorous yellow-gray exudates. (malodorous - very unpleasant smell) • It has soft, sharply defined, ragged margins (differ from primary syphillis Chancre - typically painless, indurated and has a clean base) • Vary in size from 1-20 mm. Friable – Easily Crumbled
- 22. • Ulcer in men & women • About half of infected men have only a single ulcer. • Women often have four or more ulcers. • Women may be asymptomatic carriers of the disease. • The chief symptom may be dysuria or dyspareunia. • May have a higher incidence of resolution after papule formation without ulcer formation. Dyspareunia – Recurrent genital pain in intercourse
- 23. Common locations of ulcers • In men are the shaft or head of the penis, foreskin, the groove behind the head of the penis, the opening of the penis, and the scrotum. • In circumcised men - Coronal sulcus • In uncircumcised men - Prepuce. Lesions may be obscured by a painful phimosis in uncircumcised men. • In women, common locations are the labia majora (outer lips), labia minora (inner lips), perianal area (area around the anal opening) and inner thighs.
- 24. Lymphadenopathy • One week after the formation of the genital ulcer, Painful, usually unilateral, regional lymphadenopathy occurs. (approximately 50% of patients and is more common in men) • Of patients with lymphadenitis, 25% may have progression to a suppurative bubo which may rupture spontaneously and ulcerate. (The swollen lymph nodes and abscesses are also called buboes) • If untreated, chronic draining sinuses may follow and forming another ulcer.
- 25. Chancroid Male Regional adenopathy Chancroid ulcers
- 26. Other types of Chancroid Although relatively rare, chancroid sometimes may be associated with various presentations that differ from the classic form described above. • Transient chancroid produces an ulcer that rapidly resolves in 4-6 days, followed 10-20 days later by a suppurative lymphadenitis. • Dwarf chancroid manifests as one or several herpes like ulcerations, with or without inguinal lymphadenopathy. • Follicular chancroid produces ulcerations of the pilar apparatus in hair-bearing areas. • Giant chancroid consists of multiple small ulcerations, which coalesce to form a single large lesion. • Pseudogranuloma inguinale - Pseudogranuloma inguinale is another chancroid variety that closely resembles granuloma inguinale.
- 27. Laboratory findings • Microscopically - From bubo pus or ulcer secretions, H. ducreyi can be identified. • PCR-based identification • Antigen detection methods - Simple, rapid, sensitive and inexpensive • Serologic detection of H. Ducreyi (uses outer membrane protein and lipooligosaccharide)
- 28. CHANCROID Gram stain of Haemophilus ducreyi
- 29. MANAGEMENT • Antibiotics • Azithromycin - 1 g orally (PO) as a single dose OR • Ceftriaxone - 250 mg intramuscularly as a single dose OR • Erythromycin base - 500 mg PO 3 times daily for 7 days OR • Ciprofloxacin - 500 mg PO twice daily for 3 days OR • Ceftriaxone is the treatment of choice in pregnant women
- 30. • The ulcer(s) may be cleaned and soaked to reduce the swelling. • Salt solution dressings may be applied to the ulcer(s) to reduce the spread of the bacteria and prevent additional ulcers. • A serious infection of the foreskin may require circumcision. • Pus would be removed from infected lymph nodes by using a needle and syringe. • Very large buboes may require surgical drainage.
- 31. Prognosis of Chancroid / Soft Chancre • Without treatment, chancroid may either go away quickly or patients may experience the painful ulcers for many months. • A complete cure is obtained with antibiotic treatment. • Severe ulcers may cause permanent scars. • Urethral fistulas may occur and requires corrective surgery.