early yaws

Early Yaws Presentation

Yaws initially presents as a papilloma (a wart-like tumour) teemed with bacteria, which makes clinical diagnosis straightforward [1]. The papilloma will ulcerate without treatment [1].

The initial skin lesion typically heals after 3–6 months [3]. It begins with a round, hard swelling of the skin, 2 to 5 cm (0.79 to 1.97 in) in diameter [3]. The center may break open and form an ulcer [3].

In its early stages, yaws is characterized by marked epidermal hyperplasia and papillomatosis, often with focal spongiosis [14]. Neutrophils accumulate in the epidermis [14].

Early detection and treatment can avoid gross disfigurement and disability which occur in about 10% of cases [13].

Early Yaws Signs and Symptoms

Yaws, an infectious disease caused by the bacterium Treponema pertenue, initially presents with distinct signs and symptoms. The primary stage of yaws typically occurs 3 to 4 weeks after infection, causing noticeable papules or lesions on the skin.

• Papillomas: Early symptoms include the appearance of small, painless bumps or papillomas on the face, limbs, and genital areas [1][2]. These lesions are teemed with bacteria and can quickly spread to others if left untreated.
• Skin Lesions: The primary stage is characterized by the development of skin lesions that look like raspberries at the initial site of infection [3].
• Painless Bumps: Early symptoms may remain dormant for years, but when they appear, they typically start as small, painless bumps that gradually develop into papillomas [11].

Key Points to Remember

• Yaws is highly curable if treated in its early stages with a single injection of long-acting penicillin into a muscle.
• Early recognition and treatment are crucial for preventing long-term complications.

References:

[1] Signs & Symptoms. [2] Signs and symptoms. [3] Yaws Symptoms . [11] Recognizing the early signs and symptoms of Yaws is crucial for timely treatment and prevention of long-term complications.

Early Detection of Yaws

Yaws, a tropical bacterial infection caused by Treponema pallidum ssp. pertenue, can be challenging to diagnose in its early stages. However, several diagnostic tests are available to detect the presence of the disease.

• Non-treponemal tests: These tests, such as Rapid Plasma Reagin (RPR) and Venereal Disease Research Laboratory (VDRL), are usually positive in all stages of infection, except very early lesions [7]. However, they cannot distinguish yaws from syphilis.
• Specific anti-Treponema pallidum tests: These tests, such as Treponema pallidum particle agglutination (TPPA) and rapid plasma reagin (RPR), are widely used to diagnose treponemal infections, including syphilis and yaws [10]. However, they cannot distinguish between the two diseases.
• Point-of-care tests: These tests have proved useful in diagnosing syphilis and may also be of value in diagnosing yaws with good sensitivity and specificity [12].
• Rapid serologic test: A rapid serologic test has been evaluated for its capacity to detect patients with ulcers that tested PCR positive for Treponema pallidum [6].

It's essential to note that caution should be exercised when interpreting the results of these tests, as the antibody response to treponemal infections is often not detectable during the first one to three weeks of infection [11]. Additionally, diagnosis of congenital syphilis can be confused by transferred antibodies from the mother.

Early detection and treatment of yaws are critical to avoid gross disfigurement and disability, which occur in about 10% of cases [14].

References:

[6] Jun 14, 2023 — A rapid serologic test that can support a diagnosis of early yaws. [7] Traditionally, laboratory-based serological tests such as Treponema pallidum particle agglutination (TPPA) and rapid plasma reagin (RPR) are widely used to diagnose treponemal infections (for example, syphilis and yaws). [10] Traditionally, laboratory-based serological tests such as Treponema pallidum particle agglutination (TPPA) and rapid plasma reagin (RPR) are widely used to diagnose treponemal infections (for example, syphilis and yaws). [11] Caution should be exercised in interpretation of the any of the above-mentioned serologic tests results for yaws: i) the antibody response to treponemal infections is often not detectable during the first one to three weeks of infection , ii) diagnosis of congenital syphilis can be confused by transferred antibodies from the mother, and most ... [12] Point-of-care tests have proved useful in syphilis and results of an initial study in Papua New Guinea suggest they may also be of value in the diagnosis of yaws with good sensitivity and specificity. [14] Early detection and treatment can avoid gross disfigurement and disability which occur in about 10% of cases.

Early Yaws Treatment Options

According to various sources, early yaws can be effectively treated with antibiotics.

• Azithromycin: A single oral dose of 30 mg/kg (maximum 2 g) is the preferred treatment for early yaws [13]. This antibiotic has been shown to be highly effective in curing the disease [12].
• Penicillin: Oral phenoxymethylpenicillin for 7–10 days (50 mg/kg daily in four doses; maximum dose 300 mg four times a day) is also an effective treatment option [6].

These treatments can help prevent the skin lesions from turning into lifelong scars or deformities, which is crucial in stopping the progression of the disease [7]. It's essential to catch yaws in its early stages for proper treatment and prevention of complications.

References: [12] Mitjà O. (2012) Yaws—a nonvenereal treponemal infection—can be cured with an oral single dose of azithromycin. [6] Oral phenoxymethylpenicillin for 7–10 days (50 mg/kg daily in four doses; maximum dose 300 mg four times a day) was effective in a yaws control programme. [13] Azithromycin: A single oral dose of 30 mg/kg (maximum 2 g) is the preferred treatment.

The differential diagnosis of early yaws involves considering various conditions that may present similarly to yaws, particularly in its initial stages. According to the available information [1, 3, 5, 7], some of these conditions include:

• Bacterial skin infections such as tropical ulcer
• Parasitic infections like cutaneous leishmaniasis
• Syphilis, which is a key differential diagnosis for all three endemic treponemal infections [2, 5]
• Other diseases that may cause lesions in the skin, bone, and cartilage, such as Buruli ulcer and leprosy [8, 9]

It's worth noting that the differential diagnosis of yaws can be extensive, even for experienced clinicians [4]. The early lesions of yaws may appear on any part of the skin from the scalp to the sole of the foot, with the majority being found in the lower limbs due to greater exposure [7].

In some cases, the primary lesions of yaws may be mistaken for cutaneous leishmaniasis, tropical ulcer caused by fusobacteria and Treponema vincentii, or pyoderma [11]. Therefore, a thorough discussion with a physician who has expertise in tropical medicine is recommended to ensure accurate diagnosis and choice of investigations, which may vary depending on the patient's country of origin [8, 9].

References: [1] Yaws is a non-venereal tropical infectious disease caused by the organism Treponema pertenue. [2] Syphilis is a key differential diagnosis for all three endemic treponemal infections. [3] The early lesions of yaws may also be confused with bacterial skin infections including tropical ulcer, and parasitic infections. [4] The clinical diagnosis may be difficult even for experienced clinicians because yaws produces lesions in the skin, bone, and cartilage, which can resemble several other diseases in the tropics. [5] Syphilis is a key differential diagnosis for all three endemic treponemal infections. The early lesions of yaws may also be confused with bacterial skin infections including tropical ulcer, and parasitic infections. [7] Early yaws lesions may appear on any part of the skin from the scalp to the sole of the foot, with the majority being found in the lower limbs due to greater exposure. [8] The differential diagnosis of yaws lesions is wide and includes syphilis, leishmaniasis, leprosy and Buruli ulcer, as well as non-infectious causes. Discussion with a physician with expertise in tropical medicine is recommended as the differential diagnosis and choice of investigations will vary depending on the patient's country of origin. [9] The differential diagnosis of yaws lesions is wide and includes syphilis, leishmaniasis, leprosy and Buruli ulcer, as well as non-infectious causes. Discussion with a physician with expertise in tropical medicine is recommended as the differential diagnosis and choice of investigations will vary depending on the patient's country of origin. [11] The differential diagnosis of tropical ulcerative lesions is broad 30 and varies depending on the stage and type of lesion. As examples, the primary lesions of yaws may be mistaken for cutaneous leishmaniasis, tropical ulcer caused by fusobacteria and Treponema vincentii, or pyoderma.