ABSTRACT
The results of a yaws survey on the island of Sumatra in Indonesia are presented. The prevalence of yaws in the investigated region was found to be very high, a minimum of 300 cases per 100,000 individuals, which indicates that yaws is far from being eradicated and that campaigns for treatment are necessary. Patients suffering from early infectious yaws showed florid skin lesions. Of 101 serum samples from such patients, 100 had a positive reaction in one or more treponemal tests. The Treponema pallidum haemagglutination assay was found to be the most sensitive test (97% positive) in detecting antibodies against Treponema pallidum subsp. pertenue, followed by the fluorescent treponemal antibody absorption test (94%), the Venereal Disease Research Laboratory test and the TmpA enzyme immunoassay (91%), and analysis by Western blot using Treponema pallidum antigens (88%). Of 42 asymptomatic contacts of yaws patients 32 showed positive reactions in one or more tests, indicating that many people in the investigated region have been infected with treponemes. Eight new Treponema pallidum subsp. pertenue strains were isolated from yaws skin lesions. In vitro amplification of treponemal DNA and hybridisation with specific DNA probes showed that all eight strains were identical with Treponema pallidum subsp. pertenue CDC 2575, with regard to the subsp. pertenue specific tyfl gene.
Subject(s)
Treponema pallidum/isolation & purification , Yaws/diagnosis , Adolescent , Adult , Blotting, Western , Child , Child, Preschool , DNA Probes , Female , Fluorescent Antibody Technique , Hemagglutination Tests , Humans , Immunoenzyme Techniques , Indonesia/epidemiology , Male , Middle Aged , Polymerase Chain Reaction , Prevalence , Skin/pathology , Treponema pallidum/genetics , Yaws/epidemiologyABSTRACT
In this paper attention is focused on the following conditions: perianal skin problems such as pruritus in the perianal area, the eczemas, psoriasis, premalignant and malignant tumours such as Bowen's disease and Bowenoid papulosis, squamous cell carcinoma, dermatophyte and yeast infections and sexually transmitted diseases such as syphilis, condylomata acuminata (warts) and genital herpes. Principles of clinical, bacteriological and histopathological diagnosis will be discussed briefly for each of the above-mentioned diseases. For some of these, therapeutic effectiveness and particular side effects due to the use of topically applied drugs containing corticosteroids, anaesthetics, antibiotics and preservatives will also be considered.
Subject(s)
Anus Diseases/diagnosis , Anal Canal/pathology , Humans , Neoplasms/diagnosis , Pruritus Ani/diagnosis , Sexually Transmitted Diseases/diagnosis , Skin Diseases/diagnosisABSTRACT
Two children suffering from early yaws in Indonesia are presented. Apart from skin lesions and a positive treponemal serology in both patients, involvement of tubular bones, particularly of the hands, was revealed by radiological examination. In one patient involvement of a distal phalanx was remarkable. Early diagnosis and treatment of yaws is important since a delay in treatment may result in severe and irreversible bone deformities of the late stage of the disease. This report illustrates that radiological changes, although rare, can still be detected in the early stage of yaws in areas where yaws is resurgent nowadays.
Subject(s)
Bone and Bones/diagnostic imaging , Skin/pathology , Yaws/diagnostic imaging , Adolescent , Child , Female , Fingers/pathology , Humans , Indonesia , Male , Penicillin G Benzathine/therapeutic use , Radiography , Yaws/drug therapy , Yaws/pathologyABSTRACT
This paper presents the light microscopic findings in biopsies of skin lesions from 45 patients, in whom a diagnosis of early yaws was suspected. In 27 cases typical light-microscopic features of yaws were observed, consisting of parakeratosis or crust containing exudate, marked acanthosis with widening and elongation of the rete ridges or pseudo-carcinomatous hyperplasia and spongiosis. Intraepidermal microabscesses consisting of polymorphonuclear leucocytes were frequently encountered. In a large majority a moderate to dense infiltrate was present, composed mainly of lymphocytes and plasma cells. Vascular changes consisted of only slight endothelial cell proliferation and thickening of vessel walls. Steiner staining revealed the presence of treponemes in the epidermis in 23 of 27 cases. Remarkably, clusters of treponemes were also seen in the papillary dermis in three out of 23 cases. Seven other cases were strongly suggestive of yaws. Other histopathological diagnoses were made in 6 patients, due to the simultaneous occurrence of other skin diseases. The remaining five specimens did not contain enough tissue to allow conclusions to be made.
Subject(s)
Skin/pathology , Yaws/pathology , Adolescent , Adult , Blood Vessels/pathology , Child , Child, Preschool , Female , Humans , Infant , Male , Plasma Cells/pathology , Skin/blood supply , Treponema/isolation & purification , Yaws/diagnosisABSTRACT
A 3 1/2-year-old boy, born and living in Indonesia, experienced disseminated skin lesions and an ulcerated, crusted, papillomatous lesion on the prepuce of his penis. This location suggested venereal syphilis, but on clinical, serologic, and epidemiologic grounds a diagnosis of early yaws was made. This treponemal disease should be considered in children who have traveled to or migrated from remote tropical regions, and who have unusual skin lesions in combination with a positive treponemal serology. Although yaws is considered a rare and exotic disease in the United States and Europe, it is still widespread in some parts of the world.
