Chapter 171- Endemic (Nonvenereal) Treponematoses Flashcards
Important diff of endemic treponematoses and syphilis (4):
- Nonvenereal form of transmission
- Endemic
- Tendency to affect children
- Less likely risk for congenital transmission
Chronic infectious and contagious disease recognized as neglected tropical disease
Pinta
Most benign form of endemic treponematosis with clinical manifestations limited to the skin
Pinta
Treatment for Pinta
Long acting benzathine penicillin 1.2 M units for adults, 0.6 M units for children
Other names for pinta (3)
Azula
Carate
Mal de pinto
First to occur in humans
Pinta
Early serology test for syphilis positive in majority of cases of pinta
Wassermann test
Late stage pinta cannot be reinfected while patients with early stage pinta who has been cured can be reinfected.
True or False
True
Pinta can be cured spontaneously.
True or False
False, cell mediated immunity is not completely effective hence persists indefinitely
Primary stage of pinta is divided into (2)
- Early phase or initial period
2. Secondary phase or period of cutaneous dissemination
Initial period appears ___ days after treponema inoculation and secondary phase occurs ___ after first lesions’ appearance. Late or tertiary lesion occurs ___ after the first lesion
7 to 20 days
6 months to 2-3 years
5 years
Pinta spares (3)
Groin
Genitals
Inner and upper parts of the thighs
Early lesions are irreversible.
True or False
False, late lesions giving permanent ‘vitiligo like’ appearance
Reservoir of pinta? MOT?
Humans
Spread via direct contact with infected person or fomites
Cornerstone of diagnosis of pinta
Serology
Reflect disease activity for nonvenereal treponematoses
RPR/VDRL
Serology can distinguish endemic treponematoses from syphilis.
True or False
False, cannot
Stains for treponemes
Warthin Starry
Mass treatment of __ in communities to prevent spread of endemic treponematoses
Azithromycin 1g oral dose
Most prevalent of endemic treponematoses
Yaws
Countries with highest number of yaws (3)
Papua New Guinea
Solomon Islands
Ghana
Eroded or hyperkeratotic palmoplantar lesions with fissuring inducing a crablike gait
Crab yaws
Effective in treatment of patients with yaws (2)
Penicillin Azithromycin 2g (30mkday) single dose
Matching type
- Papillomatous
- Moist and papillomatous (frambesiomas)
- Dry and papulosquanous (pianides)
- Ulcer
- Bilateral
- Hematogenous spread
- Lymphatic spread
A. Primary
B. Secondary
A B B A B B B
Other terms for primary yaws (3)
Mother yaws
Maman pian
Buba madre
Primary lesion of yaws may resolve spontaneously in 3 to 6 months leaving a pigmented scar.
True or False
True
Most representative lesion of yaws
Resembling raspberries
Multiple, generalized with annular or discoid morphology with squamous collarette grouped in corymbose pattern
Tinea yaws
Tender or painful acral lesions resulting to peculiar gait
Crab yaws
Paronychia originating from hyperkeratotic lesions in the nail folds
Pianic onychia
Secondary yaws resolves spontaneously with or without scarring.
True or False
True
Relapsing yaws localizes in (3) for as long as __ after initial infection
Perioral
Perianal
Axillary
5 years
Most common manifestation of late stage of yaws
Simultaneous skin and bone involvement
Complete destruction of nasal cartilage and collapse of nasal pyramid
Gangosa
Yaws present with ff noncutaneous findings (6)
Osteoperiostitis Ghoul hand Rhinopharyngitis obliterans/ gangosa Goundou Optic atrophy Sabre shins
Late yaws is similar to late syphilis and presents with cV or neurologic manifestations.
True or False
False, opposite, does not
Fusiform swelling of finger affecting 2 proximal phalanges
Ghoul hand
Central face deformity
Rhinopharyngitis obliterans
Gangosa
Exostosis of paranasal area
Goundou
T. Pallidum ssp pertenue is sensitive to
Tetracycline
Penicillin
Erythromycin
Response to T. Pallidum ssp. Pertenue
Humoral and cellular
Important difference of yaws with syphilis (2)
- Does not induce vascular changes or (2) endothelial obliteration
Radiographic findings of yaws in periostitis
Onion latering (periosteal reaction) Loss of clarity of cortex
Treatment of choice of yaws
Single dose long acting benzathine penicillin 1.2 M units for more than 10, 0.6 M units for less than 10
Yaws lesions become noninfectious in ___, joint pain disappears in ___, lesions resolve within ___ after therapy
24 hours
24 to 48 hours
2 to 4 weeks
RPR and VDRL decreases to a minimum in ___ and becomes negative in ___
6 to 12 months
Next 2 years
Who eardication program for yaws include yearly serologic surveys in children younger than __
5years
Peak incidence of yaws
6 - 10 years old
