Lymphogranulome vénérien 543599 30234789 2008-06-02T09:16:48Z Escarbot 115455 robot Ajoute: [[it:Linfogranuloma venereo]] {{ébauche|médecine}} {{CIM-10 | Nom = Lymphogranulome vénérien | ICD10 = A55 | }} <!-- ICD9 = 099.1 |--> Le '''lymphogranulome vénérien''' ou '''maladie de Durand-Nicolas-Favre''' est une [[infection sexuellement transmissible]] due à une infection par les [[sérovar]]s (ou [[biovar]]) invasifs L1, L2, ou L3 de ''[[Chlamydia trachomatis]]''. La maladie a été découverte par Wallace en 1833 puis par Durand, Nicolas, et Favre en 1913. Elle affecte surtout le [[système lymphatique]]. Aux États-Unis, en Europe, en Australie et dans la majeure partie de l'Asie et de l'Amérique du Sud, le LGV est généralement considéré comme une maladie rare. Elle est endémique en Afrique, en Inde, dans certaines régions du sud-est asiatique et dans les Antilles. ==Épidémiologie== Sa transmission est fréquente et ses conséquences redoutables. Elle atteint les sujets jeunes et représente une grande cause de stérilité chez la femme. Cette infection peut passer inaperçue chez l'homme, mais surtout chez la femme d'où la facilité de transmission. C'est une IST fréquente en région tropicale. ==Signes et symptômes== <!--The clinical manifestation of LGV depends on the site of entry of the infectious organism (the sex contact site) and the stage of disease progression. Inoculation at the mucous lining of external sex organs (penis and vagina) can lead to the '''inguinal syndrome''' named after the formation of buboes or [[abscess]]es in the groin (inguinal) region where draining lymph nodes are located. The '''rectal syndrome''' arises if the infection takes place via the rectal mucosa (through anal sex) and is mainly characterized by [[proctocolitis]] symptoms. The '''pharyngeal syndrome''' is rare, starts after infection of pharyngeal tissue and bubo's in the neck region can occur.--> ===Stade primaire=== Après une incubation de 3 à 30 jours dans les suites d'un rapport sexuel, apparaissent des papules érosives indolores sur les organes génitaux, la sphère ano-rectale ou pharyngée pendant quelques jours. Chez la femme, ces lésions sont généralement vaginales et nécessitent un examen au spéculum pour être détectées. <!--LGV may begin as a self-limited painless genital [[ulcer]] that occurs at the contact site 3-12 days '''or longer''' in this primary stage. Rarely do women notice a primary infection, because the initial ulceration where the organism penetrates the mucosal layer are located out of sight in the vaginal wall. Also in men fewer than 1/3 of those infected notice the first signs of LGV. This primary stage heals in a few days. [[Erythema nodosum]] occurs in 10% of cases.--> ===Stade secondaire=== Deux à six semaines après le rapport sexuel contaminant, apparaissent des adénopathies sur les régions drainant les organes touchés lors du stade primaire. Dans la majorité des cas, ces adénopathie sont inguinales ou fémorales. Lors de contamination ano-rectale, on note un [[rectite]] associée à des douleurs rectales ([[ténesme]]), écoulements diarrhéiques mucopurulants et coliques abdominales. Cette phase s'accompagne de fièvre, de frissons et de douleurs articulaires. L'évolution laisse apparaitre une adhérence des tissus cutanées aux adénopathies abcédées qui s'y fistulisent pour laisser sourdre du pus. ===Stade tertiaire=== Les tissus génitaux se sclérosent et une fibrose se forme ainsi qu'un lymphœdème des membres inférieurs. Ces lésions sont définitives. <!--The secondary stage occurs from 10-30 days later most often, but has occurred up to 6 months later. The infection is then spread to the lymph nodes through lymphatic drainage pathways. The most frequent presenting clinical manifestation of LGV among males whose primary exposure was genital is unilateral, in 2/3 of cases, [[adenitis|lymphadenitis]] and [[lymphangitis]], often tender inguinal and/or femoral lymphadenopathy because of the drainage pathway for their likely infected areas. Lymphangitis of the dorsal penis may also occur and resembles string or cord. If the route was anal sex the infected person may experience lymphadenitis and lymphangitis noted above or may have proctitis, inflammation limited to the rectum (the distal 10--12 cm) that may be associated with anorectal pain, [[tenesmus]], or rectal discharge, or [[proctocolitis]], inflammation of the colonic [[mucosa]] extending to 12 cm above the anus and is associated with symptoms of [[proctitis]] plus diarrhea or abdominal cramps and or inflammatory involvement of perirectal or perianal [[lymphatic tissue]]s. In females [[cervicitis]], [[perimetritis]], or [[salpingitis]] may occur as well as the [[lymphangitis]] and [[lymphadenitis]] in deeper nodes. Because of lymphatic drainage pathways, some end up with an abdominal mass which seldom suppurates and only 20-30% end up with inguinal lymphadenopathy. Systemic signs: fever, decreased appetite, and malaise, may occur as well. Diagnosis is more difficult in women and homosexual men who may not have the inguinal symptoms. Over the course of the disease, lymph nodes enlarge, enlarged nodes are called buboes, and become painful at first (which may occur in any infection of the same areas as well). The next most common thing is inflammation, thinning and fixation of the overlying skin. Lastly in the progression are [[necrosis]], fluctuant and suppurative lymph nodes, [[abscess]]es, fistulas, strictures, and sinus tracts all may occur. During the infection and when it subsides and healing takes place, fibrosis may occur. This can result in varying degrees of lymphatic obstruction, chronic [[edema]], and [[stricture]]s. These late stages characterised by fibrosis and edema are also known as the third stage of LGV and are mainly permanent.--> ==Complications générales== On note parfois dans les suites d'une contamination par cette chlamydiae des complications tels un [[érythème noueux]], et une [[méningo-encéphalite]]. ==Pronostic== <!--Highly variable. Spontaneous remission is common. Complete cure can be obtained with proper antibiotic treatment. Course is more favorable with early treatment. Bacterial superinfections may complicate course. Death can occur from bowel obstruction or perforation. Follicular conjunctivitis due to autoinoculation of infectious discharge.--> ==Complications à long terme== <!--Genital [[elephantiasis]] or [[esthiomene]] ,which is the dramatic end-result of lymphatic obstruction, which may occur because of the strictures themselves, or fistulas. This is usually seen if females, may ulcerate and often occurs 1-20 years after primary infection. Fistulas of, but not limited to, the penis, urethra, vagina, uterus, or rectum. Also, surrounding edema often occurs. Rectal or other strictures and scarring. Systemic spread may occur, possible results are arthritis, pneumonitis, hepatitis, or perihepatitis.--> ==Diagnostic== <!--The [[diagnosis]] usually is made [[Serology|serologically]] (through complement fixation) and by exclusion of other causes of inguinal lymphadenopathy or [[genital]] [[ulcer]]s. Serologic testing is has a sensitivity of 80% after 2 weeks. Serologic testing may not be specific for serotype (has some cross reactivity with other chlamydia species) and can suggest LGV from other forms because of their difference in dilution, 1:64 more likely to be LGV and lower than 1:16 is likely to be other chlamydia forms (emedicine). For idenification of serotypes, culture is often used. Culture is difficult. Requiring a special media, cycloheximide-treated McCoy or HeLa cells, and yields are still only 30-50%. DFA, or direct fluorescent antibody test, PCR of likely infected areas and pus, are also sometimes used. DFA test for the L-type serovar of C trachomatis is the most sensitive and specific test, but is not readily available. If polymerase chain reaction (PCR) tests on infected material are positive, subsequent restriction endonuclease pattern analysis of the amplified outer membrane protein A gene can be done to determine the genotype. Recently a fast realtime PCR (Taqman analysis) has been developed to diagnose LGV. With this method an accurate diagnosis is feasible within a day. It has been noted that one type of testing my not be thorough enough.--> ==Recommandations complémentaires== <!--As with all [[STD]]'s sex partners of patients who have LGV should be examined and tested for [[urethra]]l or [[cervix|cervical]] [[chlamydia]]l infection. After a positive culture for chalamydia, clinical suspicion should be confirmed with testing to distinguish serotype. Antibiotic treatment should be started if they had sexual contact with the patient during the 30 days preceding onset of symptoms in the patient. Patients with a sexually transmited disease need to be tested for other STD's. Antibiotics are not without risks and prophylaxtic broad antibiotic coverage is not recommended.--> ==Prophylaxie et traitement== La prévention passe par l'usage du préservatif. Le traitement est une antibiothérapie par [[cyclines (antibiotiques)|cycline]]s (doxycycline, tétracycline) pendant une durée de 3 semaines minimales chez les malades de plus de huit ans. ([[Érythromycine]] chez l'enfant ou en cas d'allergie aux cyclines) Les lésions sclérosantes sont traitées chirurgicalement ou par dilatation mécanique. Les abcés ganglionaires sont mis à plat, et drainés par aspiration à l'aiguille. ==Références et liens externes== <!--* Original article from the public domain resource "1998 Guidelines for Treatment of Sexually Transmitted Diseases" MMWR 47(RR-1);1-118 Publication date: [[23 January]] [[1998]] at http://wonder.cdc.gov/wonder/prevguid/p0000480/p0000480.asp#head007005000000000 note that this has not been modified since 1998, and may be out of date. * [http://www.emedicine.com/EMERG/topic304.htm Article on eMedicine.com] Last Updated: [[16 October]] [[2004]] * Centers for Disease Control and Prevention. Proctitis, proctocolitis, and enteritis. Sexually transmitted diseases treatment guidelines. MMWR Recomm Rep 2002 [[10 May]];51(RR-6):66-7. * Fitzpatrick's color atlas and synopsis of clinical dermatology 5th ed. Wolff et al. * Rosen T. Brown: Genital ulcers - evaluation and treatment. Dermatology Clin. 1998;16:673. * Nederlands tijdschrift voor geneeskunde. vol. 148, no. 51 ([[18 December]] [[2004]]): 2544-6. * Dermatology. vol. 209, no. 3 (2004): 230-2. * MMWR. Morbidity and mortality weekly report. vol. 53, no. 42 ([[29 October]] [[2004]] ): 985-8. * International journal of STD & AIDS. vol. 13, no. 6 (2002 Jun): 427-9. * http://www.essti.org/ * Emerging Infectious Diseases vol. 11 no. 7 [[July]] [[2005]]: 1090-2. [http://www.cdc.gov/ncidod/EID/vol11no07/04-0883.htm] * Emerging Infectious Diseases vol. 11 no. 8 [[August]] [[2005]]: 1311-2. * Emerging Infectious Diseases vol. 11 no. 11 [[November]] [[2005]]: 1787-8. * Clinical Infectious Diseases vol. 42 no. 2 [[January 15]] [[2006]]: 186-94.--> {{Palette Infections bactériennes}} {{portail médecine}} [[Catégorie:Infection bactérienne]] [[Catégorie:Maladie sexuellement transmissible]] [[de:Lymphogranuloma venereum]] [[en:Lymphogranuloma venereum]] [[es:Chalamydia trachomatis]] [[fi:Neekerisankkeri]] [[it:Linfogranuloma venereo]] [[nl:Lymfogranuloma venereum]] [[pt:Linfogranuloma venéreo]] [[sv:Lymphogranuloma venereum]]