Yaw (Tropical Syphilis) | Cutaneous Conditions | Dermatology

YAWS

Nurul Nadia Mohammed Saffari Group 40 A 2012

Definition
• A common chronic infectious disease that occurs mainly in the warm humid regions of the tropics with characteristic bumps on the skin of the face, hands, feet and genital • The disease has many names (for example, pian, parangi, paru, frambesia tropica).

Cause
• The disease is caused by the bacterium called Treponema pertenue, a Gram-negative Spirochete closely related to Treponema pallidum which causes syphilis.

Way of infection
• Yaws is transmitted by direct skin contact and primarily affects children younger than 15 years, with a peak incidence in those aged 610 years. • Similar to syphilis, yaws can persist for years as a chronic, relapsing disease

Clinical picture
• The disease most often starts as a single lesion that becomes slightly elevated, develops a crust that is shed, leaving a base that resembles the texture of a raspberry or strawberry. • This primary lesion is termed the mother yaw (also termed buba, buba madre, or primary frambesioma). • Secondary lesions, termed daughter yaws, develop in about six to 16 weeks after the primary lesion. Almost all cases of yaws begin in children under 15 years of age, with the peak incidence in 6-10-year-old children. The incidence is about the same in males and females.

Stage
• Primary stage, in which the initial yaws lesion develops at the inoculation site • Secondary stage, in which widespread dissemination of treponemes results in multiple skin lesions that are similar to the primary yaws lesion • Latent stage, in which symptoms are usually absent but skin lesions can relapse • Tertiary stage, in which bone, joint, and soft tissue deformities may occur • Cutaneous lesions characterize the primary and secondary stages of yaws. The tertiary stage of yaws may involve the skin, bones, and joints.

Initial papilloma, also called mother yaw or primary frambesioma

• Another classification distinguishes early yaws from late yaws. • Early yaws includes the primary and secondary stages and is characterized by the presence of contagious skin lesions. • Late yaws includes the tertiary stage, when lesions are not contagious.

Early yaws ulcero-papillomatous lesions on hands and legs

Late yaws on face causing facial disfiguration

Differential diagnosis
• • • • • • Atopic Dermatitis Cutaneous Tuberculosis Impetigo Leishmaniasis Leprosy Molluscum Contagiosum • Psoriasis, Plaque • • • • Rhinoscleroma Sarcoidosis Scabies South American Blastomycosis • Syphilis • Tungiasis • Warts, Nongenital

Investigations
• The diagnosis of yaws is made by clinical evaluation of lesions and is confirmed by the detection of treponemes on dark-field microscopy of serum obtained by squeezing the bases of the lesions. • Serologic tests for yaws are identical to those for venereal syphilis, including rapid plasma reagent (RPR) test, Venereal Disease Research Laboratory (VDRL) test, fluorescent treponemal antibody absorption (FTA-ABS) test, T pallidum immobilization (TPI) test, and T pallidum hemagglutination assay (TPHA). • RPR and VDRL tests are reactive 2-3 weeks after the onset of the primary lesion, and they generally remain reactive throughout all stages.

• No serologic test can distinguish yaws from other nonvenereal treponematoses; therefore, diagnosis is ultimately based on correlation of the clinical findings, epidemiologic history, and positive serologic results that are suggestive of yaws. Biopsy of late lesions may be needed to show characteristic histopathology.

Treatment
• Penicillin is the drug of choice for yaws. After a single penicillin injection, early lesions become noninfectious after 24 hours and heal within 1-2 weeks. • Tetracycline, erythromycin, or doxycycline should be considered for patients allergic to penicillin

• Ulcers in patients with primary-stage or secondary-stage yaws who were re-examined 2 weeks after treatment(A, B) Red, moist, bedded, 5 cm ulcer on the left leg of a 9-year-old patient with primary yaws. • (C, D) Partially epithelialised tumour 2 weeks after treatment with azithromycin.

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