Endemic treponemal diseases.

The endemic treponemal diseases, consisting of yaws, bejel (endemic syphilis) and pinta, are non-venereal infections closely related to syphilis, and are recognized by WHO as neglected tropical diseases (NTDs). Despite previous worldwide eradication efforts the prevalence of yaws has rebounded in recent years and the disease is now a major public health problem in 14 countries. Adequate data on the epidemiology of bejel and pinta is lacking. Each disease is restricted to a specific ecological niche but all predominantly affect poor, rural communities. As with venereal syphilis, the clinical manifestations of the endemic treponemal diseases are variable and can be broken down in to early stage and late stage disease. Current diagnostic techniques are unable to distinguish the different causative species but newer molecular techniques are now making this possible. Penicillin has long been considered the mainstay of treatment for the endemic treponemal diseases but the recent discovery that azithromycin is effective in the treatment of yaws has renewed interest in these most neglected of the NTDs, and raised hopes that global eradication may finally be possible.

Nonvenereal treponematoses: yaws, endemic syphilis, and pinta.

The nonvenereal treponematoses--yaws, endemic syphilis, and pinta--constitute a major health concern for many third world countries. These diseases are caused by an organism that is morphologically and antigenically identical to the causative agent of venereal syphilis, Treponema pallidum. Nonvenereal treponematoses differ significantly in their modes of transmission, epidemiology, and clinical presentation from venereal syphilis. Like venereal syphilis, they have a chronic relapsing course and have prominent cutaneous manifestations. Recently, several cases of imported yaws and endemic syphilis have been described in Europe. With the escalating U.S. military presence in many remote areas of the world and ever-increasing world-wide travel, the diagnosis of the nonvenereal treponematoses must be considered in appropriate clinical and historical situations.

[Review: endemic treponematoses are not always eradicated]. / Revue: les tréponématoses endémiques ne sont toujours pas éradiquées.

Yaws and other endemic treponematoses (bejel or endemic syphilis, pinta) are resurging in many countries of the tropical belt. Today there are more than 2.5 million cases of these diseases, 75% of them in children. More than 100 million additional children are at risk for these disabling and disfiguring infections which destroy tissue and bone. In the 1950's and 1960's, through concerted efforts and leadership of UNICEF and WHO, more than 50 million individuals in 46 countries were cured and the diseases were brought under control or even eliminated from large parts of the world. Despite the success, endemic foci remained and in the last years there has been an alarming resurgence of the endemic treponematoses, in particular in parts of West and Central Africa. Endemic treponematosis control is based on treatment with single-dose penicillin of the entire treponemal reservoir. No instances of penicillin-resistance have been documented and these infections should be eliminated while the organisms still remain sensitive to penicillin. An endemic treponematosis control programme must be fully integrated into the primary health care system and the persistence of endemic treponematoses in an area is an indicator of the failing effectiveness of primary health care.

[Immunology of tertiary pinta]. / Imunologia da pinta terciaria.

We've studied the immunological performed of twenty two natives Tikunas suffering from tertiary pinta. Among those, patients had been treated previously (two years earlier) which 2,400,000 IU of G benzathine penicillin, and twelve had no treatment. Both groups demonstrated an increment in the IgM synthesis (72.72%), IgG (50%), indicating the presence of strong antigenic stimuli. The great majority presenting a negative response revealed also a reduction in the cellular immune competence to at least two of the tests performed (92.3%), when were realized the PPD, DNCB and skin grafts tests.

[Histopathological aspects of tertiary pinta]. / Aspectos histopatológicos da pinta terciária.

A study was made of twenty-two biopsies of achromic lesions of Tikuna Indians, carriers of tertiary pinta, inhabitants of the Umariuassu island, on the Peruvian border, ten of the subjects had been treated two years previously with a single dose of penicillin. The histopathological picture was similar for both groups. In most cases (86.36%) slight hyperkeratosis was found on the epidermis, as well as acanthosis (18.18%), with atrophy in only two cases (9.09%). In all cases there was a reduction of the melanin of the basal layer. The inflammatory lymphocyte infiltrate was predominantly perivascular (88.18%). There wasn't any endothelial swelling.