171 - Endemic (Nonvenereal) Treponematoses Flashcards
Endemic treponematoses include
Pinta
Yaws
Bejel
Important differences between the endemic treponematoses and syphilis
Nonvenereal form of transmission
Endemic occurrence
Tendency to affect children
Less likely risk for congenital transmission
Most benign of endemic treponematosis
Clinical manifestations limited to the skin, including vitiligo-like achromic lesions as well as hyperpigmented lesions
Pinta
Etiologic agent of pinta
Treponema carateum
Considered the first trepanematosis to occur in humans
Pinta
It has been said that _____ was man’s best friend: it follows him to the grave
Pinta
Stages of pinta
- Primary stage
a. Early phase or initial period
b. Secondary phase or period of cutaneous dissemination - Late stage
Lesions of pinta that are initially red to violaceous and later become slate-blue, brown, gray, or black
Pintides
Areas that are often spared by pinta
Groin
Genital area
Inner and upper parts of the thighs
Y/N: Therapy can reverse the skin changes of late pinta
No - cannot reverse
Y/N: The only known reservoir of pinta is human beings
Yes
Assays used to detect Treponema-specific antibodies
When the result is positive, it usually remains positive for life
T. pallidum particle agglutination (TPPA)
T. pallidum particle hemagglutination (TPHA)
Y/N: The venereal disease research laboratory (VDRL) and rapid plasma reagin (RPR) tests are specific tests
No - nonspecific
More accurate to reflect disease activity, with titers falling rapidly after successful treatment
RPR
VDRL
Y/N: Serologic techniques cannot distinguish pinta from syphilis or any of the other nonvenereal treponematoses
Yes
Recommended treatment for pinta
Single or divided dose of long-acting benzathine penicillin (1.2 MU for adults; 0.6 MU for children)
Treatment with benzathine penicillin renders yaws lesions non-infectious in less than
24 hours
Most prevalent of the endemic treponematoses
Yaws
Countries with the largest cases of yaws
Papua New Guinea
Solomon Islands
Ghana
Causative agent of yaws
T. pallidum spp pertenue
Primary lesion of yaws: papule that evolves into a proliferative, exudative, papillomatous lesion or a crusted, nontender ulcer, most commonly located on the legs
Mother yaws, maman pian, or buba madre
Secondary lesions of yaws: exudative, proliferative, and papillomatous
Usually generalized, bilateral, and symmetrical
Pianomes
Secondary lesions of yaws: dry and papulosquamous
Multiple and generalized, and have annular or discoid morphology, with a squamous collaret (tinea yaws), grouped in a corymbose pattern
Pianides
Most representative lesion of yaws
Pianomes or frambesiomas
Because the acral lesions of yaws are tender or painful, patients develop a peculiar gait known as
Crab yaws
Paronychia that originates from hyperkeratotic lesions in the nail folds in yaws
Crab yaws
Y/N: All secondary yaws resolves, either spontaneously or after treatment
Yes
Relapsing yaws tend to localize in
Perioral, perianal, and axillary areas
About _____% of untreated yaws patients progress to the tertiary stage
10
The complete destruction of the nasal cartilage and the collapse of the nasal pyramid in yaws results in a deformity known as
Gangosa
The most important noncutaneous findings refer to the involvement of _____ in yaws
Osteoarticular structures
Fusiform swelling of a finger affecting the two proximal phalanges is a common expression of this dactylitis in yaws
Ghoul hand
Average number of bones involved in yaws
Three
Specific hypertrophic bone exostosis of the paranasal area in yaws
Gondou
Y/N: Late yaws is not associated with cardiovascular or neurologic disease
Yes
False positives with RPR and VDRL can be seen in patients with
Other tropical diseases, such as malaria and leprosy
Rheumatic diseases
An importance difference in histopathology with syphilis is that yaws
Does not induce vascular changes or endothelial proliferation
Treatment of choice for yaws
Single-dose, long-acting penicillin
- 2 MU for patient older than 10 years
- 6 MU for those younger than 10 years
Considered as effective as penicillin for yaws
One oral dose of azithromycin (30 mg/kg, to a maximal dose of 2g)
Alternative drugs for adults with yaws who are allergic to penicillin
Oral tetracyclines, doxycycline, and erythromycin
Alternative drug of choice for children younger than 12 years of age with yaws
Erythromycin
Yaws lesions become noninfectious in ______ after therapy
24 hours
Transmission routes of bejel
Direct contact
Fomites by sharing utensils
Countries and regions with the largest number of bejel cases
African Sahelian countries
Saudi Arabia
(dry, hot climates)
Among all the nonvenereal treponematosis, _____ is the one with which the differential diagnosis with venereal syphilis might be tricky
Bejel
Treatment of choice for bejel
1.2 MU of benzathine penicillin in adults
Half the dose in children younger than 10 years
Causative agent of bejel
T. pallidum spp endemicum
