ABSTRACT
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.
Subject(s)
Endemic Diseases , Pinta/epidemiology , Syphilis/epidemiology , Yaws/epidemiology , Anti-Bacterial Agents/therapeutic use , Developing Countries , Humans , Pinta/diagnosis , Pinta/drug therapy , Syphilis/diagnosis , Syphilis/drug therapy , Yaws/diagnosis , Yaws/drug therapyABSTRACT
Improved understanding of the differential diagnosis of endemic treponematoses is needed to inform clinical practice and to ensure the best outcome for a new global initiative for the eradication of yaws, bejel, and pinta. Traditionally, the human treponematoses have been differentiated based upon their clinical manifestations and epidemiologic characteristics because the etiologic agents are indistinguishable in the laboratory. Serological tests are still considered standard laboratory methods for the diagnosis of endemic treponematoses and new rapid point-of-care treponemal tests have become available which are extremely useful in low-resource settings. In the past ten years, there has been an increasing effort to apply polymerase chain reaction to treponematoses and whole genome fingerprinting techniques have identified genetic signatures that can differentiate the existing treponemal strains; however, definitive diagnosis is also hampered by widespread unavailability of molecular diagnostics. We review the dilemmas in the diagnosis of endemic treponematoses, and advances in the discovery of new diagnostic tools.
Subject(s)
Bacteriological Techniques/methods , Endemic Diseases , Molecular Diagnostic Techniques/methods , Pinta/diagnosis , Treponemal Infections/diagnosis , Yaws/diagnosis , Bacteriological Techniques/trends , Clinical Medicine/methods , Humans , Molecular Diagnostic Techniques/trends , Pinta/epidemiology , Pinta/pathology , Treponemal Infections/epidemiology , Treponemal Infections/pathology , Yaws/epidemiology , Yaws/pathologyABSTRACT
Endemic treponematoses including yaws, bejel, pinta are distinguished from venereal syphilis on the basis of epidemiological characteristics and clinical manifestations. They cannot be differentiated by morphological and serological methods. A few minor genetic differences have been identified among the subspecies (Treponema pallidum sp. pallidum, pertenue, endemicum, carateum). Although penicillin therapy is effective, these infectious diseases have yet to be eliminated.
Subject(s)
Treponemal Infections/epidemiology , Diagnosis, Differential , Endemic Diseases , Humans , Pinta/diagnosis , Pinta/epidemiology , Syphilis/diagnosis , Syphilis/epidemiology , Treponemal Infections/diagnosis , Treponemal Infections/drug therapy , Yaws/diagnosis , Yaws/epidemiologySubject(s)
Pinta/diagnosis , Skin/pathology , Bone Diseases/diagnosis , Bone Diseases/pathology , Humans , Pinta/pathology , Terminology as TopicSubject(s)
Treponemal Infections/diagnosis , Child , Diagnosis, Differential , Humans , Penicillins/therapeutic use , Pinta/diagnosis , Pinta/drug therapy , Pinta/pathology , Syphilis, Congenital/diagnosis , Syphilis, Congenital/drug therapy , Syphilis, Congenital/pathology , Treponemal Infections/drug therapy , Treponemal Infections/pathology , Yaws/diagnosis , Yaws/drug therapy , Yaws/pathologyABSTRACT
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.
Subject(s)
Pinta/epidemiology , Syphilis, Cutaneous/epidemiology , Yaws/epidemiology , Adolescent , Adult , Age Factors , Aged , Child , Child, Preschool , Developing Countries , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Pinta/diagnosis , Pinta/drug therapy , Pinta/transmission , Prevalence , Syphilis, Cutaneous/diagnosis , Syphilis, Cutaneous/drug therapy , Syphilis, Cutaneous/transmission , Yaws/diagnosis , Yaws/drug therapy , Yaws/transmissionSubject(s)
Pinta , Syphilis , Africa , Central America , Humans , Pinta/diagnosis , Pinta/therapy , South America , Syphilis/diagnosis , Syphilis/therapy , Treponema/isolation & purificationABSTRACT
Between 1983 and 1987, 62 out of 76519 pregnancies in 51 mothers had a positive miniaturised Treponema pallidum haemagglutination assay (TPHA) test--1 in 1234, or 0.81 per 1000 births. About two thirds of these mothers had syphilis and the remainder non-venereal treponematoses such as yaws or pinta. Antenatal screening identified 13 patients with previously unknown acquired syphilis, 11 of whom were given antibiotics during pregnancy. There were six fetal losses among the 62 TPHA positive pregnancies, but none had evidence of congenital syphilis. No live born child in this study group showed stigmata of congenital syphilis. It is concluded that despite the current low incidence of syphilis in the United Kingdom it is imperative to continue antenatal serological screening and to emphasise the importance of early adequate treatment of the infection.
Subject(s)
Mass Screening , Pregnancy Complications, Infectious/prevention & control , Syphilis Serodiagnosis , Cost-Benefit Analysis , England , Female , Hemagglutination Tests , Humans , Infant, Newborn , Pinta/diagnosis , Pregnancy , Prenatal Diagnosis , Retrospective Studies , Syphilis/epidemiology , Syphilis, Congenital/prevention & control , Yaws/diagnosisABSTRACT
A pinta é uma treponematose própria da América Latina onde ela ocorre em áreas endêmicas ou sob a forma de casos esporádicos e isolados em locais afastados das zonas endêmicas. O critério do diagnóstico epidemiológico só clínico ou com complemento sorológico é admissível dentro das áreas endêmicas, porem os casos isolados, esporádicos que aparecem em locais delas afastados e sem as terem jamais visitado só devem ser aceitos como comprovadamente de pinta pelo achado do T. carateum na linfa das lesöes examinadas pelo método do campo escuro. Desta forma é afastada a possibilidade de serem de sífilis ou framboésia embora os casos destas, descritos em aspecto pintóide, careçam da prova negativa da pesquisa de treponemas de campo escuro. A partir de 1944 foi por um de nós comprovada a indubitável existência da pinta no Brasil e daí para cá 20 casos esporádicos com a comprovaçäo da presença do treponema foram diagnosticados no Rio de Janeiro. Dezesseis destes casos säo agora representados. Oito deles säo autóctones da Cidade do Rio de Janeiro; os outros oito säo provenientes de cidades vizinhas ou de outros Estados do Brasil. Nenhum desdes haviam estado na Amazônia que é a área endêmica do Brasil. A linfa das lesöes de alguns dos nossos pacientes autóctones ou näo,incluindo um que referiu ter tido framboésia no passado, inoculada em voluntários humanos, reproduziu a pinta comprovando, também, assim, que sua doença era pinta e näo outra treponema tose. A enigmática ocorrência de casos isolados esporádicos de pinta sem contato com zonas endêmicas é discutida como um dos principais objetivos deste trabalho. A sua existência é atribuída provavelmente a contato repetido com casos ignorados de pinta a qual pelo desenvolvimento de fenômenos imunológicos pouco intenóss permite a permanência da doença com treponemas nas lesöes, de virulência atenuada, facilitando assim a transmissäo pelos constantes contatos
Subject(s)
Adolescent , Adult , Middle Aged , Humans , Male , Female , Pinta/diagnosis , Treponema/isolation & purification , BrazilABSTRACT
No presente trabalho são discutidos os principais aspectos relacuionados ao histórico das treponematoses, analisando-se a provável origem da primeira treponematose endêmica, a bouba, e a partir dessa primeira doença, o surgimento da sífilis endêmica, pinta e sífilis venérea. São, também, abordados os aspectos sobre a epidemiologia da pinta -a distribuição, provavelmente, exclusiva no continente americano e a possível confusão diagnóstica que teria havido entre a bouba pintóide e a pinta, em outras regiões, fora do continente americano. Em relação à distribuição da pinta no Brasil, verificou-se que a concentração maior de pacientes foi na Amazônia ocidental. Fora da Amazônia, foram diagnosticados casos isolados de pinta, principalmente no Rio de Janeiro. Os outros casos registrados, am Minas Gerais e Bahia constituem, provavelmente, casos de bouba pintóide. A divisão epidemiológica da pinta em zonas pintógenas e áreas com casos isolados aplica-se bem à situação brasileira - a zona pintógena na Amazônia e os casos isolados no Rio de Janeiro...
Subject(s)
Humans , Pinta/epidemiology , Pinta/microbiology , Brazil/epidemiology , Pinta/diagnosis , Pinta/etiology , Pinta/therapy , Pinta/transmissionABSTRACT
En 41 pacientes con carate tardío se hace un estudio comparativo entre el FTA-ABS y el VDRL en suero y LCR. En suero el VDRL fue reactivo en 48% de los casos y el FTA-ABS en 68%. Ambas pruebas fueron siempre negativas en LCR. Se hace una corta discusión sobre los resultados y revisión de la literatura