Yaws, Haemophilus ducreyi, and Other Bacterial Causes of Cutaneous Ulcer Disease in the South Pacific Islands.

Cutaneous ulcers in the tropics are a painful and debilitating condition that anchors people into poverty. In rural regions of the South Pacific, infectious cutaneous ulcers are caused mainly by bacteria, including Treponema pallidum pertenue (yaws), Haemophilus ducreyi, and polymicrobial ulcers. For this group of infections the term cutaneous ulcer disease (CUD) is proposed. Some infections can cause malformations on the bone that have a permanent impact on lives in endemic communities. Better characterization of CUD may help design diagnostic tools and more effective antimicrobial therapies. This review updates the knowledge of CUD and discusses optimized terminology and syndromic management.

Performance of Syphilis Sentinel Surveillance in the context of endemic Treponematoses: experience from Ghana.

BACKGROUND: Use of treponemal tests to screen for syphilis (caused by Treponema pallidum pallidum) poses challenges with infection status classification, especially in settings where other treponemal infections are endemic. This study aimed to determine the validity of the syphilis surveillance testing strategy implemented since 2004 using two treponemal tests, and estimate the seroprevalence of active syphilis infection in Ghana where yaws (caused by Treponema pallidum pertenue) is endemic. METHODS: We retested sera from the 2007 HIV sentinel survey (HSS) using a traditional algorithm, quantitative rapid plasma reagin test followed by qualitative Treponema pallidum haemagglutination assay. The adjusted seroprevalence of active syphilis was calculated by applying the proportions of active syphilis within identified categories of HSS samples during the retesting, to the entire population of HSS samples. The 95% confidence intervals (CIs) were calculated for each proportion, and the t-test was used to assess differences in proportions. RESULTS: Of 2,214 samples that were retested, 203 (9.2%) had active syphilis infection, 21 (0.9%) were biological false reactions, 640 (28.9%) were past or treated syphilis infections, and 1,350 (61%) were uninfected. The current syphilis testing strategy overestimated the seroprevalence of active syphilis infection by a third (HSS versus traditional algorithm: 6.0% (95% CI: 5.6-6.3) vs. 4.5% (95% CI: 4.2-4.8); p < 0.001), and had low positive predictive value (16.8%) for detecting active syphilis infection. More than half (51.9%) of HSS syphilis positive cases were actually past/treated treponemal infections, possibly previous exposure to yaws. CONCLUSION: There is an urgent need to review the current syphilis sentinel surveillance testing strategy in Ghana in the context of concurrent endemic treponematoses, to better inform policy.

Clinical evidence for individual animal therapy for papillomatous digital dermatitis (hairy heel wart) and infectious bovine pododermatitis (foot rot).

Data supporting individual animal therapy for papillomatous digital dermatitis (PDD) and infectious pododermatitis (IP) in cattle are available for treatment with multiple drugs in the form of randomized, prospective clinical trials conducted in naturally occurring disease with negative controls and masked subjective evaluators. In the case of PDD, these trials support the use of topical tetracycline and oxytetracycline, lincomycin, a copper-containing preparation, and a nonantimicrobial cream. In individual therapy for IP, trial evidence is available to support systemic treatment with ceftiofur, florfenicol, tulathromycin, and oxytetracycline. However, it was not available for IP standards such as penicillin G, sulfadimethoxine, and tylosin.

The endemic treponematoses.

The agents of human treponematoses include four closely related members of the genus Treponema: three subspecies of Treponema pallidum plus Treponema carateum. T. pallidum subsp. pallidum causes venereal syphilis, while T. pallidum subsp. pertenue, T. pallidum subsp. endemicum, and T. carateum are the agents of the endemic treponematoses yaws, bejel (or endemic syphilis), and pinta, respectively. All human treponematoses share remarkable similarities in pathogenesis and clinical manifestations, consistent with the high genetic and antigenic relatedness of their etiological agents. Distinctive features have been identified in terms of age of acquisition, most common mode of transmission, and capacity for invasion of the central nervous system and fetus, although the accuracy of these purported differences is debated among investigators and no biological basis for these differences has been identified to date. In 2012, the World Health Organization (WHO) officially set a goal for yaws eradication by 2020. This challenging but potentially feasible endeavor is favored by the adoption of oral azithromycin for mass treatment and the currently focused distribution of yaws and endemic treponematoses and has revived global interest in these fascinating diseases and their causative agents.

Efficacy of salicylic acid in the treatment of digital dermatitis in dairy cattle.

Digital dermatitis (DD) is one of the most important causes of lameness in dairy cattle worldwide. The objective of this study was to evaluate the efficacy of salicylic acid in the treatment of the disease. A total of 201 DD lesions from 173 cows from four commercial dairy herds were evaluated at day 0 during routine hoof trimming and were allocated into two groups, namely, a control group given chlortetracycline spray, and a treatment group given 10 g of salicylic acid powder applied topically within a bandage. Pain, lesion size and clinical appearance (scored M0 to M4) were evaluated on days 3, 14 and 34 post-treatment. A change to M0 was defined as healing, while changes of M2 or M4 to M1 or M3 were classified as clinical improvements. Healing rates did not differ significantly between treatment groups at days 3 and 14. By day 34 the healing rate was fivefold better (P=0.01) for the treatment vs. the control group, with healing rates of 13.6% and 3.1%, respectively. By day 3, the rate of improvement was 2.5-fold better (P=0.02) for the controls. By day 34 the overall positive effect (i.e. healing and improvement) was 1.75-fold better (P=0.05) for the treatment group. Lesions from the control group were 2.2 times more likely (P=0.09) to have a pain score equal to 2 by day 14. The proportion of lesions getting smaller by days 14 and 34 was 2.5 times higher (P<0.08) for the treatment vs. the control group. The findings suggest salicylic acid should be considered as an alternative to chlortetracycline for the treatment of DD as it appears more efficacious and would assist in reducing antibiotic use.

Short communication: minimum bactericidal concentration of disinfectants evaluated for bovine digital dermatitis-associated Treponema phagedenis-like spirochetes.

The bacterial spirochetes, Treponema spp., are thought to be a major contributor to the etiology of bovine digital dermatitis (DD), a skin disease with worldwide economic impact. Hoofbath strategies are commonly used in an attempt to control and prevent the development of DD and continuing research has been done to develop an optimal hoofbath strategy for this purpose. The aim of this study was to develop a protocol that can be used as part of the screening process for candidate hoofbath disinfectants. This protocol allows an accurate determination of the in vitro minimum inhibitory concentration and minimum bactericidal concentration of a series of disinfectants for Treponema microorganisms. Assays were performed in triplicate for each of the disinfectants at 30-s and 10-min exposure times and exposed to 10 and 20% manure (vol/vol). The results of this study can be used to categorize disinfectants based on the effect of exposure and manure concentration regarding their ability to inhibit Treponema growth. This information can then aid in optimizing strategies for hoofbath-based control of DD development and spread.

Antimicrobial susceptibility testing of bovine digital dermatitis treponemes identifies macrolides for in vivo efficacy testing.

Digital dermatitis (DD) is a major infectious lameness of dairy cattle and sheep considered to be caused by treponemes. The aim of this study was to identify antibiotics effective against DD treponemes that might be useful in the treatment of ruminant DD in the future or to identify antibiotics useful in isolation studies. Here, a microdilution method was used to identify in vitro antimicrobial susceptibility of treponemes cultured from DD lesions to eight relevant antibiotics. DD treponemes exhibited highest susceptibility to amoxicillin, azithromycin and gamithromycin. Unfortunately, amoxicillin whilst having potential for DD treatment in other animals (e.g. sheep) would require milk withhold periods in dairy cattle. DD treponemes were not particularly susceptible to two cephalosporins: cefalexin and ceftiofur, which do not require milk withhold. The bacteria demonstrated low susceptibility to trimethoprim and especially colistin suggesting these antimicrobials may be particularly useful in isolation of DD treponemes. The most promising high susceptibility results for macrolides indicate a rationale to consider veterinary licensed macrolides as DD treatments. Furthermore, given the DD treponeme antibiotic susceptibility similarities to established treatments for human treponematoses, identification of treponemacidal, long acting ß-lactam analogues not requiring milk withhold may allow for development of a successful treatment for dairy cattle DD.

Endemic treponematosis: review and update.

Despite major efforts to eradicate these disorders, yaws, bejel, and pinta (endemic treponematosis) remain serious health issues in many regions of the world. Aside from prominent skin manifestations, these diseases may also lead to significant osseous, neurologic, and ophthalmologic complications. Although progress has been made in differentiating the causative species in a research setting, a simple, specific, and sensitive diagnostic test remains elusive. Parenteral penicillin, in appropriate dosage, is the treatment of choice; alternative antibiotics such as tetracycline and erythromycin may also be effective.

[Overview of endemic treponematoses]. / Panorama des tréponématoses endémiques.

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.

Clinical features and rapid plasma reagin antibody titers in spontaneous and experimental rabbit syphilis.

Rapid plasma reagin (RPR) titers were periodically examined during and after treatment in three rabbits clinically diagnosed with rabbit syphilis. RPR titers remained positive after clinical recovery and then gradually declined. Of the two rabbits inoculated experimentally, one showed clinical signs of the disease, while the other did not. RPR titers were also periodically evaluated before and after inoculation in these two rabbits. The trends in RPR titers reflected the course of infection, both in the spontaneous and in the experimental cases. An inapparent case and cases without clinical signs after clinical recovery showed low titers for long period of time. Useful information for interpretation of RPR titers measured clinically was obtained by this survey.

[Rare cause of cholestatic hepatitis]. / Seltene Ursache einer cholestatischen Hepatitis.

When bile duct obstruction is ruled out newly developed icterus is mainly caused by infection with hepatotropic viruses, autoimmune hepatitis or drug induced hepatopathy. We report on a 30 year old previously healthy patient with cholestatic hepatitis which was caused by infection with Treponema pallidum. Cholestatic hepatitis resolved after administration of penicillin without recurrence.

Acute bacterial suppurative parotitis: microbiology and management.

The parotid gland is the salivary gland most commonly affected by inflammation. The most common pathogens associated with acute bacterial parotitis are Staphylococcus aureus and anaerobic bacteria. The predominant anaerobes include gram-negative bacilli (including pigmented Prevotella and Porphyromonas spp.), Fusobacterium spp., and Peptostreptococcus spp. Streptococcus spp. (including S. pneumoniae) and gram-negative bacilli (including Escherichia coli) have also been reported. Gram-negative organisms are often seen in hospitalized patients. Organisms less frequently found are Arachnia, Haemophilus influenzae, Klebsiella pneumoniae, Salmonella spp., Pseudomonas aeruginosa, Treponema pallidum, cat-scratch bacillus, and Eikenella corrodens. Mycobacterium tuberculosis and atypical mycobacteria are rare causes of parotitis. Therapy includes maintenance of hydration and administration of parenteral antimicrobial therapy. Once an abscess has formed surgical drainage is required. The choice of antimicrobial depends on the etiologic agent. Maintenance of good oral hygiene, adequate hydration, and early and proper therapy of bacterial infection of the oropharynx may reduce the occurrence of suppurative parotitis.

Detection of spirochetes by polymerase chain reaction and its relation to the course of digital dermatitis after local antibiotic treatment in dairy cattle.

The aim of the study was to monitor the course of digital dermatitis after local antibiotic treatment in an experimental group (treated on diagnosis) and a control group (treated 5 days later). The present study was carried out on 2 farms involving 18 animals. Monitoring was performed by means of clinical findings and detection of spirochetes on the surface of the lesions, using a polymerase chain reaction. Superficial wound smears were taken before and after treatment. Twelve animals on both farms followed the classical healing process, but six animals responded poorly to treatment. We observed that without treatment, there was no self-cure in the control group within 5 days. There was a significant improvement in the clinical condition of all animals after treatment on both farms, during the follow-up period. The time until reappearance of new digital dermatitis lesions was not significantly different between the experimental and control group, but it was different between the two farms which could be due to the influence of farm factors. Using primers specific for Treponema denticola and Treponema vincentii, all the disease stages had at least one positive polymerase chain reaction result indicating the presence of spirochetes in samples of all the disease stages during the healing process. This implies that the spirochetes are not completely eradicated from the surface of the lesions after treatment. It was also observed that the classical ulcerative disease stage (M2) had relatively more positive polymerase chain reaction results compared to any other disease stage, showing a possible link between the presence of spirochetes and clinical disease.

Bejel in Malatya, Turkey.

Bejel is a form of endemic syphilis which is transmitted by non-venereal route. According to our knowledge, no cases of bejel have been reported from Turkey for more than 30 years. In this report, three children and their father who suffer from bejel are presented. The history, physical findings, laboratory investigations, treatment and results of the cases are reviewed, and the related literature is discussed.

[Provision and measures for sanitation in piglet breeding operations with latent swine dysentery]. / Voraussetzungen und Massnahmen zur Sanierung von Ferkelerzeugerbetrieben mit latenter Schweinedysenterie.

The eradication and control of swine dysentery in breeding or farrow-to-finish herds require comprehensive knowledge about the epidemiology, pathogenesis and immunology of this typical multifactorial disease. Based upon this background information, the characteristics of chemotherapy, immunoprophylaxis and other necessary concomitant measures are described. The objectives of the eradication and control schemes should be the production of Treponema-free weaner pigs and a long-term prevention of reinfections.

Role of intestinal excretion in the effect of subcutaneously administered sedecamycin on cecal infection caused by Treponema hyodysenteriae in mice.

The therapeutic effects of subcutaneously administered sedecamycin on experimental Treponema hyodysenteriae infection in mice were evaluated. Sedecamycin was more active than tiamulin and lincomycin. The efficacy of sedecamycin upon subcutaneous administration was similar to that upon oral administration. Sedecamycin given subcutaneously provided similar degrees of protection in bile duct-ligated and intact mice. Pharmacokinetic studies utilizing a liquid chromatographic technique were carried out to determine the concentration of sedecamycin in the cecum, the site of T. hyodysenteriae infection in mice. Little sedecamycin was found; however, lankacidinol, a major metabolite of sedecamycin, was found in the cecal contents of intact mice after subcutaneous or oral administration of sedecamycin. Lankacidinol was also found in the cecal contents of bile duct-ligated mice, although the concentration found after subcutaneous administration of sedecamycin was much lower than that found after subcutaneous or oral administration to intact mice. These results indicate that sedecamycin is excreted directly into the intestinal tract as an active metabolite by a route other than the bile duct. It is suggested that this intestinal excretion plays an important role in the efficacy of subcutaneously administered sedecamycin against cecal infection of mice by T. hyodysenteriae.