Tropical syphilis (yaws): causes, symptoms, diagnosis, treatment

Yaws are a tropical infectious disease characterized by high contagiousness, damage to the skin, mucous membranes, and also bones and joints. Typical cutaneous papillomatous elements resemble the raspberry fruit (Fr. Framboise).

Causes of yaws

The driver of yaws, Treponema pertenue, is close to the causative agent of venereal syphilis (T. Pallidum), but does not cause birth defects, because it does not penetrate the placenta. T. Pertenue is quickly killed by oxygen, drying and heating; on nutrient media does not grow, is visualized in the dark field of the microscope.

The reservoir of infection is children aged 2 to 15 years.

Epidemiology

The yaws are transmitted by direct non-sexual contact from person to person (with exudate or serum of infectious lesions). Patients in the latent and tertiary periods practically

Distribution of yaws is facilitated by crowding and low sanitary and hygienic living standards.

Course of the disease

The incubation period is 3-4 weeks.

The primary period is up to 0.5 years.

The secondary period is 1.5-2 years.

The secondary period is characterized by a cyclic change in active manifestations and latent (latent) periods of the disease. Throughout the entire secondary period (1.5-2 years), there may be 2-3 clinical relapses occurring after latent periods. In many patients, the disease ends there.

Tertiary period - occurs in 10-30% of untreated patients after 7-25 years against a background of a long latency period that occurred after the completion of the secondary stage of the disease.

Symptoms of yaws

The primary period is a single papule, soft, itchy, pale pink, with papillomatous growths (a kind of raspberry). On the surface of the papule often forms a shallow ulcer (yaw), which is covered with a crust and heals with a scar. Frameses are usually located in children in open areas of the body, especially on the face (lips, ears, mouth, nose area), brushes; in nursing mothers, they are often localized in the area of the mammary glands, and in adult males - on the legs, feet, less often on the genitals.

There are secondary chlamydia-chancres-satellites.

The secondary period is characterized by the appearance on the trunk and limbs of multiple itchy papules-yaws, which look like raspberries, as well as squamous and erythematous-squamous spots, rarely papillo- hillocks, vesicle-pustules with ulceration. Often in this period, hyperkeratosis of the palms and soles is revealed, which can be of limited or diffuse nature.

Tertiary period - characterized by the formation of gum, ulcers, scars, gangos (mutating rhinopharyngitis), osteoperiostitis, saber-like shins, hyperostosis of the anterior nasal bone (gundu, gondo), and periarticular knots.

Diagnosis of yaws

Diagnosis of yaws is based on:

• results of the epidemiological survey of the outbreak;
• a typical clinical picture of the disease;
• the detection in the dark field of the pathogen microscope in the primary frambesiome, the exudate from the primary lesion, in the secondary efflorescence;

Treatment of yaws

In accordance with the recommendations of the WHO, for the treatment of yaws, the appointment of prolonged penicillin - benzathine benzylpenicillin (BBP) is preferred. Outpatiently, one of his injections is administered intramuscularly to the upper outer quadrant of the buttocks at a dose of 2,400,000 units, which creates a treponemocidal level of the drug for more than 3 weeks. A single administration of BNP provides a cure for treponemal diseases and protection against reinfection during this period.

Recommended preventive doses of BNP for persons in contact with patients with endemic treponematosis:

• at the age of 10 years - 600 000 units of benzathine benzylpenicillin;
• for persons older than 10 years - 1 200 000 units of benzathine benzylpenicillin.

Depending on the prevalence of yaws in endemic areas, appropriate treatment tactics are used. In cases of allergy to penicillin, patients with yaws, endemic syphilis, pint are prescribed other antibiotics:

• tetracycline or erythromycin 500 mg orally before meals 4 times a day, treatment course at least 15 days;
• children of 8-15 years are prescribed a half dose of tetracycline or erythromycin;
• Children up to 8 years are prescribed only erythromycin in doses corresponding to their body weight.

The drug should be given in small doses every 4-6 hours for at least 15 days.

It is not recommended to appoint tetracycline to pregnant women, as it causes renal complications in them and affects the formation of the skeleton of the fetus.

Prevention

• Improvement of economic, social and living conditions of the population of endemic areas.
• Timely detection of patients with active forms of yaws and all who contacted them.
• Identification of patients with latent forms of the disease, in which relapses of contagious shrambesides are likely.
• Conducting appropriate treatment for these contingents in order to reduce and eliminate the incidence of this treponematosis;
• Conducting periodic surveys of residents of rural areas, where previously patients with yaws were identified.