26 - 171 - ENDEMIC (NONVENEREAL) TREPONEMATOSES Flashcards
caused by Treponema carateum
pinta
caused by T. pallidum ssp. pertenue
yaws
caused by T. pallidum ssp. endemicum
bejel
It is the most benign form of endemic treponematosis, with clinical manifestations limited to the skin, including vitiligo-like achromic lesions as well as hyperpigmented lesions.
Pinta
the only treponematosis without extracutaneous manifestation
Pinta
What are the two different clinical stages of pinta
primary and late stage
describe the primary stage of pinta
- characterized by two phases:
**1. Early phase or initial period **
- appears 7 to 20 days after the treponema inoculation
- primary lesions consist of one to several erythematous scaly papules affecting most commonly the face, upper and lower extremities, or other exposed areas.
- lesions tend to grow in extension, producing erythematosquamous or erythematous, hyperpigmented plaques, varying in size and shape (arciform, circinate, polycyclic, and serpiginous)
- Generally, the lesions are asymptomatic, but eventually patients may complain of pruritus
- Regional lymphadenopathy is common
2. Secondary phase or period of cutaneous dissemination
- Within 6 months to 2 to 3 years of the first lesions’ appearance, hypochromic, erythematous, or erythematohypochromic patches appear, initiating the period of cutaneous dissemination (secondary phase).
- Those lesions present variable degrees of hyperkeratosis
- They gradually enlarge and coalesce, affecting large areas of the body; the centers of the lesions look like normal skin.
- lesions are referred to as pintides and are initially red to violaceous and later become slate-blue, brown, gray, or black
describe the late or tertiary stage of pinta
- appears 2 to 5 years after the first lesion
- characterized by the appearance of achromic patches, especially over body prominences, such as the dorsum of the hands, wrist, elbows, anterior aspect of the tibia, ankles, and dorsal and plantar areas of the foot
- Another very important aspect of the late phase of pinta is the appearance of **hyperchromic and hyperkeratotic patches **most commonly on exposed areas of the upper and lower extremities
- On the palmar surfaces, hyperpigmented and achromic patches associated with hyperkeratosis are usually observed
- Plantar hyperkeratosis is quite frequent
remains the cornerstone of diagnosis of pinta
serology
The T. pallidum particle agglutination (TPPA) and hemagglutination (TPHA) assays are used to detect Treponema-specific antibodies
- when the result is positive, it usually remains positive for life
- VDRL and RPR are nonspecific
- serologic techniques cannot distinguish pinta from syphilis or any of the other nonvenereal treponematoses
the most prevalent of the endemic treponematosis.
Yaws
he recommended treatment for pinta, irrespective of the stage of the disease,
single or divided dose of long-acting benzathine penicillin** (1.2 MU for adults; 0.6 MU for children),**
- This renders the lesions noninfectious in less than 24 hours
- Within a few days, the hypochromic and erythematosquamous lesions disappear.
Eroded or hyperkeratotic palmoplantar lesions with fissuring induce a** crablike gait**
Periostitis and dactylitis are common
Yaws
- Because the acral lesions are tender or painful, patients develop a peculiar gait, known as crab yaws.
- Pianic onychia is a paronychia that originates from hyperkeratotic lesions in the nail folds
primary lesion of yaws
papule that develops 21 days (range, 9 to 90 day) after initial contact
- The papule evolves into a proliferative, exudative, papillomatous lesion 2 to 5 cm in diameter or evolves into a crusted, nontender ulcer, most commonly located on the legs.
- Even if left untreated, the lesion resolves spontaneously over a 3- to 6-month period, leaving a pigmented scar.
- A patient may have primary and secondary lesions simultaneously
mode of transmission of yaws
direct skin contact with an infectious lesion and facilitated by abrasion or erosion of the skin
They represent hematogenous and lymphatic spreading to the skin and bone in patients with yaws
Secondary lesions
exudative, proliferative, and papillomatous lesions of yaws
pianomes or frambresiomas
- They are usually generalized, bilateral, and symmetrical, from a few millimeters to 2 cm in diameter, soft, wet, red yellowish in color, with either a moist surface or a crust.
- By resembling raspberries, they are the most representative lesions of yaws.
- They can affect scalp and folds; in the latter location, they may resemble condyloma lata of syphilis.
- Mucosal lesions tend to be located around natural orifices, presenting as a bilateral exudative, angular cheilitis
dry and and papulosquamous lesions of yaws
pianides
- They are multiple and generalized, and they can have annular or discoid morphology, with a squamous collaret (tinea yaws), grouped in a corymbose pattern.
- On the face, lesions may resemble psoriasis or seborrheic dermatitis.
- Multiple, florid lesions are associated with the wet seasons; they become scarce and restricted to intertriginous areas in dry climate
The complete destruction of the nasal cartilage and the collapse of the nasal pyramid results in a deformity known as what?
This is seen in late stage of what treponematosis?
Gangosa
Yaws
The most important noncutaneous findings of yaws
involvement of osteoarticular structures.
- In secondary yaws, early osteoperiostitis of fingers (dactylitis) or long bones (forearm, fibula, and tibia) might result in nocturnal bone pain swelling.
- Early bone changes can be visualized on radiography, and the thickened periosteum can be palpated clinically; a fusiform swelling of a finger affecting the two proximal phalanges is a common expression of this dactylitis (ghoul hand)
- The average number of bones involved is three, with common involvement of hand and feet.
- A specific hypertrophic bone exostosis of the paranasal area known as goundou is rarely seen nowadays.
An important difference with syphilis and yaws in histopath
yaws does not induce vascular changes or endothelial proliferation
treatment of choice for yaws
- benzathine penicillin 1.2 million units: older than 10 years
- benzathine penicillin 0.6 million units: < 10 years
- One oral dose of azithromycin (30 mg/kg, to a maximal dose of 2 g) is considered as effective as penicillin.
- Yaws lesions become noninfectious in 24 hours after therapy. Joint pain disappears in 24 to 48 hours.
- All clinical lesions resolve within 2 to 4 weeks after therapy.
considered alternative drugs for adults who are allergic to penicillin
Oral tetracyclines, doxycycline, and erythromycin
treatment of choice for children with yaws younger than 12 years of age
erythromycin
disease in which more emphasis should be put on the risk of transmission by fomites transported in utensils and drinking vessels
bejel
