Streptococcus pyogenes Is Associated with Idiopathic Cutaneous Ulcers in Children on a Yaws-Endemic Island.

Exudative cutaneous ulcers (CU) in yaws-endemic areas are associated with Treponema pallidum subsp. pertenue (TP) and Haemophilus ducreyi (HD), but one-third of CU cases are idiopathic (IU). Using mass drug administration (MDA) of azithromycin, a yaws eradication campaign on Lihir Island in Papua New Guinea reduced but failed to eradicate yaws; IU rates remained constant throughout the campaign. To identify potential etiologies of IU, we obtained swabs of CU lesions (n = 279) and of the skin of asymptomatic controls (AC; n = 233) from the Lihir Island cohort and characterized their microbiomes using a metagenomics approach. CU bacterial communities were less diverse than those of the AC. Using real-time multiplex PCR with pathogen-specific primers, we separated CU specimens into HD-positive (HD+), TP+, HD+TP+, and IU groups. Each CU subgroup formed a distinct bacterial community, defined by the species detected and/or the relative abundances of species within each group. Streptococcus pyogenes was the most abundant organism in IU (22.65%) and was enriched in IU compared to other ulcer groups. Follow-up samples (n = 31) were obtained from nonhealed ulcers; the average relative abundance of S. pyogenes was 30.11% in not improved ulcers and 0.88% in improved ulcers, suggesting that S. pyogenes in the not improved ulcers may be azithromycin resistant. Catonella morbi was enriched in IU that lacked S. pyogenes As some S. pyogenes and TP strains are macrolide resistant, penicillin may be the drug of choice for CU azithromycin treatment failures. Our study will aid in the design of diagnostic tests and selective therapies for CU.IMPORTANCE Cutaneous ulcers (CU) affect approximately 100,000 children in the tropics each year. While two-thirds of CU are caused by Treponema pallidum subspecies pertenue and Haemophilus ducreyi, the cause(s) of the remaining one-third is unknown. Given the failure of mass drug administration of azithromycin to eradicate CU, the World Health Organization recently proposed an integrated disease management strategy to control CU. Success of this strategy requires determining the unknown cause(s) of CU. By using 16S rRNA gene sequencing of swabs obtained from CU and the skin of asymptomatic children, we identified another possible cause of skin ulcers, Streptococcus pyogenes Although S. pyogenes is known to cause impetigo and cellulitis, this is the first report implicating the organism as a causal agent of CU. Inclusion of S. pyogenes into the integrated disease management plan will improve diagnostic testing and treatment of this painful and debilitating disease of children and strengthen elimination efforts.

Osteoperiostitis in early yaws: case series and literature review.

We describe the clinical and radiological manifestations and outcome after treatment of 7 children who received a diagnosis of early yaws osteoperiostitis. Osteoperiostitis occurred some weeks after the primary infection, and the most common finding was hypertrophic periostitis of long bones. All treated patients had excellent responses to benzyl-penicillin therapy.

Characterization of the skeletal manifestations of the treponemal disease yaws as a population phenomenon.

Documentation of the antiquity and tracking of the derivation of human treponemal diseases have been complicated by an inability to distinguish among these diseases biochemically, histologically, and immunologically. Skeletal impact, as a population phenomenon, has been suspected to vary sufficiently among the treponemal disorders to allow their differentiation. As yaws was the only treponemal infection present in pre-Spanish Guam, definitive characterization of this disease in terms of its skeletal impact has been possible. In the studies described herein, skeletons from a 500-year-before-present archaeological site at Gognga-Gun Beach were examined. Yaws-related periostitis was noted in 19% of skeletons, achieving full population "penetrance" by the second decade of life. While the cortical-surface striations were often quite subtle, general osseous expansion and saber shin deformity were noted in one-fourth of skeletons. Gummatous destruction was found in 15% of individuals and draining cloacae in 10%. Invariably, the presence of irregular/striated cortical-surface markings (along with saber shin deformity) and the absence of epiphyseal separation or dental abnormalities distinguished the lesions of yaws from those of syphilis.

Reactive serological tests for syphilis in tropical spastic paraparesis: a dilemma.

The prevalence of reactive serological tests for syphilis (STS) was investigated in 183 Jamaican patients with tropical spastic paraparesis (TSP) and 200 age and sex matched controls. A significantly higher prevalence of reactive STS was found in TSP patients (34.9%) compared with controls (14.0%, P < 0.001). The biological false positive (BFP) rate was also significantly higher in TSP patients (P < 0.01) as well as controls (P < 0.001) over 40 years of age. However, these findings do not imply a pathogenetic role for treponemal disease in TSP. The high prevalence of reactive STS in Jamaican TSP patients may be multifactorial, and include biological false positives (BFP), previous childhood yaws and concurrent syphilis.

Reactive serological test for syphilis in tropical spastic paraparesis: a dilemma

The prevelence of reactive serological tests for syphilis (STS) was investigated in 183 Jamaican patients with tropical spastic paraparesis (TSP) and 200 age and sex matched controls. A significantly higher prevalence of reactive STS was found in TSP patients (34.9 percent) compared with controls (14.0 percent, P < 0.001). The biological false positive (BFP) rate was also significantly higher in TSP patients (P < 0.01) as well as controls (P < 0.001) over 40 years of age. However, these findings do not imply a pathogenetic role for treponemal disease in TSP. The high prevalence of reactive STS in Jamaican TSP patients may be multifactorial, and include biological false positives (BFP), previous childhood yaws and concurrent syphilis (AU)

Nasal manifestations of yaws.

Yaws is an infectious, non-venereal disease of the tropical countries, which is caused by Treponema pertenue. Gangosa and goundou were seen commonly in cases of yaws in Africa, particularly in the early part of this century. After successful WHO mass treatment campaigns, these conditions are rarely seen now. A case of yaws with gangosa, goundou, and a nasopharyngeal carcinoma is presented here for its rarity.

Juxta-articular bone lesions in tertiary yaws.

A case of tertiary yaws in an immigrant from the Solomon Islands is presented. The report highlights the atypical features and diagnostic difficulties of late-stage treponemal infection.

Occurrence of congenital, cardiovascular, visceral, neurologic, and neuro-ophthalmologic complications in late yaws: a theme for future research.

Late lesions of yaws are thought to be limited to skin, bones and joints, without congenital, visceral, or central nervous system (CNS) involvement. However, the treponemes isolated from patients with yaws, endemic syphilis, and venereal syphilis are genetically identical subspecies of Treponema pallidum. The controversy surrounding distinctions between syphilis and yaws is presented in its historical context, and reports of congenital, visceral, and CNS complications of yaws are reviewed. Isolation of treponemes from aqueous humor, as well as CSF abnormalities in 24.9% of 902 patients with yaws, indicate the existence of CNS involvement. The high prevalence of tropical myeloneuropathies of unknown origin discovered in areas of previous treponemal endemicity, particularly in Jamaica and Colombia, may represent late complications of yaws. Careful analysis of the collected evidence indicates that potential sequelae of yaws include congenital, visceral, and tertiary CNS lesions identical to those of venereal syphilis. The current worldwide resurgence of endemic treponematoses provides an unparalleled opportunity to settle conclusively questions still unanswered regarding the natural history of these infections.

Resurgent yaws in the Solomon Islands.

We report a resurgence of yaws in the Solomon Islands and describe the combined clinico-serological survey and mass penicillin treatment campaign to define and curb it.

Musculoskeletal lesions in yaws.

Yaws, a spirochetal infection that is endemic in certain tropical countries, including Malaysia, may present with various orthopedic problems. As the condition is relatively unknown, diagnosis is often missed, which leads to poor management. There are initial, early, and late phases of the disease process. By involving skin, bone, and joints, yaws can produce deep ulcerations, joint deformities, and bone destruction. Within a ten-year period in Malaysia, 14 cases of serologically proven yaws have been treated for chronic ulcers, gross joint deformities, and pathologic fractures.

[The differential diagnosis of indolent ulcers upon return from the Tropics: frambesia]. / Zur Differentialdiagnose indolenter Ulzera bei Tropenrückkehrern: die Frambösie.

A 26-year-old patient was referred for investigation of chronic skin ulcerations which had appeared 2 months after a one-week stay in the Ivory Coast. The diagnosis was established clinically and serologically and the patient was successfully treated with penicillin. Even if yaws is a rare imported disease in Switzerland, it should always be considered in differential diagnosis of painless skin ulcerations in travellers returning from tropical countries, bearing in mind that the number of cases of yaws has increased in several tropical countries.

Plaque-host imbalance in severe periodontitis. A discussion based on two cases.

One child and one adult with severe periodontitis were investigated for relevant systemic factors and predominant periodontal pocket bacteria. The child had a chronic neutropenia, the adult late yaws, a chronic iron deficiency and possibly rheumatoid arthritis. The predominant organisms in both pocket floras were gram-negative cocci showing occasional filament formation and resembling strains of Bacteroides asaccharolyticus and possibly Actinobacillus actinomycetemcomitans described by others. There were indications that the flora was determined by the host response rather than vice versa and that thorough systemic investigation may aid the efficient diagnosis and treatment of patients with severe periodontitis.