Download Endemic Treponematoses

YAWS
1. PIAN
2. BUBAS
3. FRAMBOESIA
Yaws and its relatives
are caused by spirochete bacteria
Treponema
• Contagious , non venereal treponemal infection.
• No cardiovascular or neurological abnormalities
Yaws is typically found in tropical areas of
Africa, South America, and Asia
Between 1950 and 1970, WHO and UNICEF led a
campaign to treat people in 46 countries
It worked, but these diseases now receive
little attention
Caused by Treponema pertenue .
Reservoir of infection – Man
Age - It affect children < 15 years [peak
incidence 6-10 years].
Immunity – no natural immunity. Provides
partial immunity to veneral syphilis.
ENVIRONMENTAL FACTORS
• Climate – endemic in warm and humid
conditions
• Social factors
scanty clothing
Poor personal cleanliness
Overcrowding
Bad housing
Low standard of living
Absence of soap
MODE OF TRANSMISSION
• Direct contact
• Fomites
• Vector
INCUBATION PERIOD
3 to 5 weeks
The endemic treponematoses are mainly
transmitted by human-to-human contact
CLASSIFICATION
• Primary stage …..lesion at site of inoculation.
• Secondary stage ….multiple skin lesion.
• Latent stage …..no symptom but skin lesion can
relapse.
• Tertiary ….bone , joint & soft tissue deformality
OTHER CASSIFICATION
• Early----: primary & secondary { contagious
skin lesion }.
• Late -----: tertiary (not contagious).
CLINICAL PRESENTATION
 Primary lesion called….. mother yaw.[IP 9-90 days].
 1ry papule---enlarge → papilloma {resolve
spontaneously after 3-6 months }.
 2ry may occur near the 1ry or elsewhere on the body
{last for more than 6 months }
 Macule , papules , nodules ,and hyperkeratotic lesion
in palms & soles { CRAB YAWS } ,lesions may ulcerate.
 Saber shin due to chronic untreated osteoperiostitis.
 Pt with late yaws → juxtaarticular nodules →
gangosa [ rhinopharyngitis mutilans ]
The first sign of yaws is a primary lesion
known as a “mother yaw”
Without treatment, secondary
widespread lesions form
After years without treatment,
larger problems may develop
Gangosa
Saber shin / tibia
INVESTIGATIONS
Diagnosis on clinical findings.
 Non treponema test:VDRL. Positive in all
stages except early lesions .
 Dark-field examination ….. + ve .
 Biopsy.
These diseases can be diagnosed in
two ways
Dark field
microscopy
Serological
Tests
MANAGEMENT
Benzathine penicillin ( penicillin G ) 1.2 million
units IM once
Penicillin V for 7-10 days.[ for 1ry , 2ry &latent].
Tetracyclin 1-2 g\ day for 7-14 days.[tertiary]
Erythromycin [tertiary].
Doxycycline 200mg 1 st ,100 mg\day for 7-14
days.[tertiary].
Benzathine penicillin is the main
drug of choice for treatment
CONTROL
1. Survey
2. Treatment
Total mass treatment ( more than 10% prevalence)
Juvenile mass treatment ( 5% to 10 %)
selective mass treatment (less than 5 %)
3. Resurvey and treatment
( every 6 to 12 months)
4. Surveillance
5. Environmental improvement
6. Resurgence of yaws
7. Evaluation