TREPONEMATOSIS

Bejel. Pinta.
• Treponematosis traditionally refers to the
group of nonvenereal diseases that are
caused by Treponema species that are
morphologically and serologically identical
to each other and to Treponema pallidum
subspecies pallidum.

• All the nonvenereal Treponema species are

transmitted, chiefly by direct contact,
among children living in tropical and
subtropical climates.
 PINTA
Synonyms: pinta, azul, carate, endemic
treponematosis, mal de pinto.

• Pinta is an endemic, contagious, systemic,

nonvenereal treponematosis.

• Pinta is characterized by chronic skin

lesions that occur primarily in young
adults.
• It is an ancient disease that was first described
in the 16th century in Aztec and Carib
Amerindians.
• In 1938, treponemes indistinguishable from
those causing yaws and syphilis were
demonstrated in lesions of a Cuban patient.
 Etiology
• Family Spirochaetaceae
• Genus Treponema
• Species Treponema
carateum

• Treponema carateum is
morphologically identical
to Treponema pallidum.
 Morphology
• Slender spirals measuring
about 0,2 µm in width and
5-15µm in length.
• The organisms are actively
motile, rotating steadily
around their endoflagella
even after attaching to cell
by their tapered ends.
• The long axis of the spiral is
ordinarily straight but may
sometimes bend, so that
the organism forms a
complete circle for
moments at time, returning
then to its normal straight
position.
 Epidemiology

• Peak age of incidence is 15-30 years.

• Both sexes are affected with equal
frequency.
• The source of infection is infected person.
• Pinta is transmitted by nonsexual means,
either by direct contact through cuts in the
skin contact or through the agency of flies
or gnats.
• Pinta occurs endemically in all age groups in the New
World, particularly the Caribbean, Central America and
South America.
• It is a disease of poor regions with sub-standard
hygiene.
 Clinical symptoms
• Like other treponematoses, pinta is
classified into an early and late stage. The
early stage comprises the initial lesion and
the secondary lesions, while the late stage
comprises the latent phase and tertiary
stage.
• After an incubation period of
approximately 2-3 weeks, the initial lesion
appears on the skin.
 The primary lesion
• A papule or
erythematosquamous
plaque usually found on
exposed surfaces of the
legs, dorsum of the foot,
forearm, or hands.
• The lesion slowly
enlarges and becomes
pigmented and
hyperkeratotic.
• It is often accompanied
by regional
lymphadenopathy.
 Clinical symptoms
• Disseminated lesions,
referred to as pintids,
are similar to the
primary lesion and
may appear 3-9
months after infection.
• These secondary
lesions vary in size
and location and
become pigmented
with age.
 Late or tertiary pinta
• Disfiguring pigmentary
changes, hypochromia,
achromic lesions, and
hyperpigmented and
atrophic lesions.
• The pigmentary changes
often produce a mottled
appearance of the skin.
• Lesions may appear red,
white, blue.
 Laboratory diagnostics
• The darkfield
examination of
exudates from early
lesions.
• Organisms appear
white against a dark
background. May also
have a directed back
and forth movement.
• Treponemes can be
demonstrated in the
epidermis in primary
and secondary
lesions using silver
stain.
 Serologic tests
• Nontreponemal test results
(rapid plasma reagent [RPR],
Venereal Disease Research
Laboratory [VDRL]) are positive
in all stages of pinta except very
early lesions.
• Confirmatory treponemal test Reactive VDRL
results (Tr. pallidum
hemagglutination [TPHA],
microhemagglutination Tr.
pallidum [MHA-TP], fluorescent
treponemal antibody absorption
[FTA-Abs]) also are positive but
are not practical in remote
areas.
Non-reactive VDRL
 Histologic Findings
• Findings of pinta and yaws are
similar, but no ulcer formation
occurs in pinta.
• In early lesions, mild acanthosis is
present with migration of
lymphoid cells into the epidermis.
• In the late stage, irregular
acanthosis or epidermal atrophy
occurs.

Fibrosis, swollen venules, and

granulation tissue can be seen
between fat lobules and the
connective tissue septa.
 Treatment
• The goals of pharmacotherapy are to
eradicate the infection, to reduce
morbidity, and to prevent complications.
• Drug Category: Antibiotics -- Benzathine
penicillin is the DOC but should not be
administered to patients who are penicillin-
allergic. Alternative therapies are
tetracycline or erythromycin.
 Prognosis
• The prognosis is good.

• The skin is the only organ affected.

Primary and secondary lesions usually
heal within 6-12 months.
• Pigmentary changes persist in late lesions.
 Prophylaxis
• No vaccines for the disease are available.
 Bejel
(ENDEMIC SYPHILIS ).
• Synonyms and related keywords:
nonvenereal syphilis of children, sibbens, radseyege,
siti, therlijevo, njovera, frenjak, Tr. pallidum subsp.
endemicum, nonvenereal endemic syphilis Bejel,
non-venereal endemic syphilis Bejel

• Endemic syphilis is also known as sibbens

(Scotland), radseyege (Scandinavia), siti
(Gambia), therlijevo (Croatia), njovera
(Southern Rhodesia), frenjak (Balkans),
and nonvenereal endemic syphilis (Bejel).
 Etiology
• Endemic syphilis is
caused by a
spirochete closely
related to T bejel
(pallidum), which is T
pallidum subsp
endemicum.
• It is morphologically
identical to
Treponema pallidum.
 Epidemiology
• Endemic syphilis is transmitted through direct or
indirect skin-to-skin or mouth-to-mouth contact of the
infected lesion.
• Children aged 2-15 years are most commonly affected;
25% of cases occur before age 6 years, and 55% of
cases occur before age 16 years.
• The remaining 20% of cases occur in adults who are in
close contact with children who are infected. Because
children are the active transmitters of the disease,
infection of all members of a household is very
common.
• Both sexes are equally affected, especially in the
pediatric population.
• The common housefly, Musca domestica,
• has not been established as a potential vector.
• Endemic syphilis occurs chiefly in Africa but also
in the Middle East, in Southeast Asia, and
elsewhere. It is also widely spread in rural areas
of poor hygiene and education.
 Clinical symptoms
• Endemic syphilis rarely involves the
nervous and cardiovascular systems.
• The clinical manifestation of neurosyphilis
is minor and not significant.
• Congenital syphilis is rarely encountered
because the disease can be treated during
pregnancy.
 The incubation period is 10-90 days.

The disease has 2 stages:

• an early stage
• a secondary stage.

• The early stage consists of primary and secondary

lesions very similar to those of venereal syphilis.

• The secondary stage consists of late latent disease and

tertiary lesions. Each stage affects different tissues
and organs.
 The primary lesions
• A small, eroded or
ulcerated papule is
usually asymptomatic.
• Primary lesions heal
in 1-6 weeks and
often go
undiagnosed.
 Secondary stage
• Secondary stage lesions
can appear as mucous
patches on the lips, the
palate, and the larynx.
• Angular stomatitis,
condylomata, oral ulcers,
and generalized
adenopathy can also be
seen in the secondary
stage.
• Painful osteoperiostitis in
the long bones (eg, tibia)
can occur.
• This stage can persist for
6-9 months.
 Tertiary and late-stage
• Tertiary and late-stage
disease usually develops
6 months to years after
inoculation and may
manifest as gummas of
the skin, the bones, or
the cartilage.
• Saddle nose deformity
and palate perforation
can occur. Neurologic
involvement and cardiac
involvement are rare.
 Laboratory diagnostics
Dark-field microscopy
• This is the best method to
confirm a treponemal
disease. Although it does
not specify the correct
species because of
similarities in morphology,
the test promptly confirms
that the infection is
caused by a treponeme.
 Serologic tests
• The fluorescence
treponemal antibody
absorption (FTA-ABS)
test, are positive in all
stages of the disease.
• Nontreponemal tests,
such as the Venereal
Disease Research
Laboratory (VDRL) test
and the rapid plasma
reagent (RPR) test, are
reactive 2-3 weeks after
the onset of the primary
lesion.
 Treatment
Drug Category:
• Antibiotics –
● Penicillin G benzathine (Bicillin LA);
● Tetracycline (Sumycin) and
● Erythromycin can be used in patients allergic
to penicillin.
 Prophylaxis
• No vaccines for the disease are available.