Yaws

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Yaws
Classification & external
resources
Nodules on the elbow resulting from
a Treponema pertenue bacterial
infection.
ICD-10 A .
ICD-9 !"#
This article is about the tropical disease Yaws. For the web server written in Erlang, see
Yaws (web server.
Yaws $also frambesia tropica, thymosis, polypapilloma tropicum or pian% is a tropical
infection of the skin, bones and &oints caused by the spirochete bacterium Treponema
pertenue. 'ther treponematosis diseases are be&el $Treponema endemicum%, pinta
$Treponema carateum%, and syphilis $Treponema pallidum%.
[edit] Epidemioloy
(he disease is transmitted by skin contact with infected individuals or eye gnats, the
spirochete entering through an e)isting cut or similar damage. Within ninety days $but
usually less than a month% of infection a painless but distinctive *mother yaw* ulcer
appears. (hese tracts heal with keloid formation which can cause deformities, disabilities
and limb contractures. (he bone lesions caused are periostitis, osteitis, and osteomyelitis,
damage to the tibia can lead to a condition known as sabre shins. +n a very few cases a
condition known as goundou is caused where growths on the nasal ma)illae can result in
e)tensive and severe damage to the nose and palate.
(he largest group afflicted by yaws are children aged to !" years in the ,aribbean
+slands, -atin America, West Africa, ,entral Africa, .ast Africa, the /iddle .ast , +ndia,
'ceania or 0outheast Asia. (here were World 1ealth 'rgani2ation funded campaigns
against yaws from !345 to !36 which greatly reduced the incidence of the disease,
although more recently numbers have risen again.
(he disease is identified from blood tests or by a lesion sample through a darkfield
e)amination under a microscope. (reatment is by a single dose of penicillin,
erythromycin or tetracycline, recurrence or relapse is uncommon.
.)amination of ancient remains has led to the suggestion that yaws has affected hominids
for the last !.4 million years. (he current name is believed to be of ,arib origin, 7yaya7
meaning sore8 frambesia is a /odern -atin word inspired by the French word framboise
$7raspberry7%.
[edit] !ccurrence
9aws was nearly eradicated by a worldwide treatment program in the !34"s, which
reduced the number of sufferers of yaws from an estimated 4" million to nearly 2ero.
1owever, the World 1ealth 'rgani2ation reported in January #"": that yaws is on the
rise again, with roughly a half a million sufferers, mostly in poor, rural areas.
;!<
Dono"anosis
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Jump to: navigation, search
#edical
Classifications
Classification &
external resources
ICD-10 A 4=.
ICD-9 "33.#
Calymmatobacterium
granulomatis
$cientific classification
>ingdom: ?acteria
@hylum: @roteobacteria
,lass: Aamma
@roteobacteria
'rder: .nterobacteriales
Family: .nterobacteriaceae
Aenus: ,alymmatobacterium
or >lebsiella
0pecies: granulomatis
Dono"anosis, also known as %ranuloma Inuinale, is a bacterial disease that has
reached endemic proportions in many underdeveloped regions. ?ecause of the scarcity of
medical treatment, the disease is often neglected and allowed to reach morbid stages of
development. 0ymptoms of Bonovanosis include lesions, ulcers, mutilation and
destruction of internal and e)ternal tissue, and leakage of mucous and blood. +n addition,
the destructive nature of Bonovanosis seriously increases the risk of contracting other
diseases, called superinfection.
Contents
;hide<
! ,lassification
# 0ymptoms
6 (ransmission
5 Biagnosis
4 (reatment
@revention
: @ublished Ceferences
= .)ternal links
[edit] Classification
(he malady was once called Aranuloma +nguinale. Aranuloma refers to pathogenic and
destructive lesions, and inguinale refers to the inguinal region. ?ecause it commonly
infected the inguinal region, it was named inguinale. 1owever, reports of the disease in
other places, such as in the oral cavity or above the abdomen led to the renaming of the
malady as Bonovanosis, after the symptomatic Bonovan ?odies. (he term Bonovan
?odies refers to detectable bacteria that have been encapsulated by histiocytes, a cell of
the immune system. +ts original genus, Bonovania, is actually derived from the term
Bonovan ?odies. +ts speciation as Aranulomatis, from granuloma, refers to its
characteristic of inducing lesions8 the current genus name also refers to granulation.
Cal!mmatobacterium comes from kalymma which means a hood or veil, and refers to the
lesions that contain the bacteria. A proposal that the organism be reclassified under the
genus "lebsiella has been put forward. (his would be a drastic ta)onomic change, as the
two genera donDt even share the same phylum. 1owever, polymerase chain reaction
$@,C% techniEues using a colorimetric detection system showed a 33F similarity with
other species in the "lebsiella genus. (he classification is currently being debated.
[edit] $ymptoms
Bonovanosis of the penis
0mall, painless nodules appear after about !"G5" days of the contact with the bacteria.
-ater the nodules burst, creating open, fleshy, oo2ing lesions. (he infection spreads,
mutilating the infected tissue. (he infection will continue to destroy the tissue until
treated. (he lesions occur at the region of contact typically found on the shaft of the
penis, the labia, or the perianal region. Carely, the vaginal wall or cervi) is the site of the
lesion.
[edit] &ransmission
(he Aranulomatis $the species name, regardless of the current classification debate%
spreads from one region to another, whether it be on the same host or on a different host,
through contact with sores. Haginal and anal intercourse are high risk behaviors to engage
in with someone who is infected.
[edit] Dianosis
(he patientDs se)ual history is reEuested. .)perienced doctors are able to diagnose
Bonovanosis by only looking at the ulcers. 1owever, it may be necessary for the health
care provider to take a sample of tissue in order to correctly diagnose the disease. 1e or
she may decide to add a WrightIAiesmsa stain in order to better view the cells.
Additionally, the presence of Bonovan bodies in the tissue sample confirms Bonovanosis.
[edit] &reatment
(hree weeks of treatment with erythromycin, streptomycin, or tetracycline, or !# weeks
of treatment with ampicillin are standard forms of therapy. Normally, the infection will
begin to subside within a week of treatment, however, the full treatment period must be
followed in order to minimi2e relapse.
[edit] 're"ention
(he disease is effectively treated with antibiotics, therefore, developed countries, like the
Jnited 0tates, have a very low incidence of Bonovanosis, $appro)imately !"" cases
reported each year in the Jnited 0tates.% 1owever, se)ual contacts with individuals in
endemic regions dramatically increases the risk of contracting the disease. Avoidance of
these se)ual contacts, and 0(B testing before beginning a se)ual relationship are
effective preventative measures for Bonovanosis.KKKKKKKKKKKKKKKKK
General Discussion
Yaws is an infectious tropical disease caused by the spirochete (spiral shaped) bacterium known
as Treponema pertenue. The disease presents in three stages of which the first and second are
easily treated. The third, however, may involve complex changes to the bones in many parts of
the body. The first stage is characterized by the appearance of small, painless bumps on the skin
that group together and grow until they resemble a strawberry. The skin may break open, forming
an ulcer. The second stage (usually starting several weeks or months after the first) presents with
a crispy, crunchy rash that may cover arms, legs, buttocks andor face. !f the bottoms of the feet
are involved, walking is painful and the stage is known as "crab yaws." #tage $ yaws involves the
long bones, %oints, andor skin. Yaws is very common in tropical areas of the world but rare in the
&nited #tates. !t is not a sexually transmitted disease.
[edit] 'ublished (eferences
#nternational $ournal of %!stematic &acteriolog!, Hol 53, !34G!:""
N. 'DFarrell, Bonovanosis. %exuall! Transmitted #nfections Bec #""#8 :=: 54#G
54:.
Aavin 1art /B, /@1 (ranscript of the lecture given at the Australian 0ociety for
+nfectious BiseasesLAustralasian ,ollege of (ropical /edicine ,onference at
@alm ,ove $,airns%, Mueensland on !3 April !333.
#""! National Auideline for the management of Bonovanosis $granuloma
inguinale% Association for Aenitourinary /edicine and the /edical 0ociety for
the study for the study the study for Henereal Biseases
0eEuencing of !0 rBNA of >lebsiella: ta)onomic relations within the genus and
to other .nterobacteriaceae. #nternational $ournal of 'edical 'icrobiolog!. #""6
Feb8#3#$:I=%:534G4"6.
#olluscum contaiosum
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Jump to: navigation, search
#olluscum contaiosum
Classification & external
resources
(ypical fleshIcolored, domeIshaped
and pearly lesions
ICD-10 ? "=.!
ICD-9 ":=."
DiseasesD) =66:
#edline'lus """=#
e#edicine dermL#:"
Vaccinia virus
*irus classification
Aroup: Aroup + $dsBNA%
Family: (oxviridae
Aenus: 'olluscipoxvirus
0pecies: Molluscum
Contagiosum
Virus
Molluscum contagiosum $#C% is a viral infection of the skin or occasionally of the
mucous membranes. /, infects humans, other primates and kangaroos. (he infecting
virus is a BNA po)virus called the molluscum contagiosum virus $/,H%. (here are 5
types of /,H, /,HI! to I5, with /,HI! being the most prevalent and /,HI# seen
usually in adults and often se)ually transmitted. (he incidence of /, infections in young
children is around !:F and peaks between #I!# years of age. /, affects any area of the
skin but is most common on the body, arms, and legs. +t is spread through direct contact,
saliva, or shared articles of clothing $including towels%.
+n adults, molluscum infections are often se)ually transmitted and usually affect the
genitals, lower abdomen, buttocks, and inner thighs. +n rare cases, molluscum infections
are also found on the lips and mouth.
(he time from infection to the appearance of lesions ranges from ! week to months,
with an average incubation period of weeks.
Contents
;hide<
! 0ymptoms
# (reatments
6 Footnotes
5 0ee also
4 .)ternal links
[edit] $ymptoms
/olluscum contagiosum lesions are fleshIcolored, domeIshaped, and pearly in
appearance. (hey are often !I4 millimeters in diameter, with a dimpled center. (hey are
generally not painful, but they may itch or become irritated. @icking or scratching the
bumps may lead to further infection or scarring. +n about !"F of the cases, ec2ema
develops around the lesions.
+n most patients, the lesions are asymptomatic. (hey may be complicated by secondary
bacterial infections. (hey may cause itching and conseEuent ec2ema around the tumors.
(he central wa)y core contains the virus. +n a process called Autoinoculation, the virus
may spread to neighboring skin areas. ,hildren are particularly susceptible to autoI
inoculation, and may have widespread clusters of lesions.
[edit] &reatments
/olluscum lesions may go away on their own in si) to nine months, but can persist, via
autoinoculation, for up to four years. (reatment is often unnecessary
;!<
depending on the
location and number of lesions, nonetheless, treatment may be sought after for the
following reasons:
/olluscum lesions on an arm.
/edical +ssues including:
o ?leeding
o 0econdary infections
o +tching N Biscomfort
o @otential 0carring
o ,hronic keratocon&unctivitis
0ocial Ceasons
o ,osmetic
o .mbarrassment
o Fear of transmission to others
o 0ocial e)clusion
1ealth professionals usually recommend treating bumps located in the genital area to
prevent them from spreading. (he virus can spread from one part of the body to another
or to other people. /olluscum contagiosum is contagious until the bumps are goneO
which, if untreated, may be up to months or longer.
(here are a few treatment options that can be done at home. ?etadine surgical scrub can
be gently scrubbed on the infected area for 4 minutes daily until the lesions resolve $this
is not recommended for those allergic to iodine or betadine%. 1owever, the ability of
iodine to penetrate intact skin is poor, and without a pin prick or needle stick into each
molluscum lesion this method does not work well. A recent study published in the &ournal
?iomedicine and @haracotherapy $#""5:4=$5%:#54I:%demonstrated resolution of
molluscum in children by treatment with an e)tract of essential oil of Australian lemon
myrtle. (his preparation has been improved upon by the authors of the study, and is
commercially available overItheIcounter $http:LLwww.molluscumIcontagiosum.net. For
mild cases, overItheIcounter wart medicines, such as salicylic acid may shorten infection
duration. Baily topical application of tretinoin cream $7CetinIA "."#4F7% may also
trigger resolution.
;#<

;6<
(hese treatments reEuire several weeks for the infection to clear.
Cepeated application of adhesive or duct tape after bathing for ! weeks led to cure in
3"F of patients in one study. 0ubseEuent studies have failed to achieve such high
response rates, and the repeated application of duct tape to young skin is very often Euite
irritating. Also treating with apple cider vinegar $soak cotton ball in vinegar, place on
molluscum, then cover with bandIaid for #5 hours. Wart will be gone with only scab
remaining%
(he infection can also be cleared without medicine if there are only a few lesions. First,
the affected skin area should be cleaned with an alcohol swab. Ne)t, a sterile needle is
used to cut across the head of the lesion, through the central dimple. (he contents of the
papule is removed with another alcohol swab. (his procedure is repeated for each lesion
$and is therefore unreasonable for a large infection%. With this method, the lesions will
heal in two to three days.
0urgical treatments include cryosurgery, in which liEuid nitrogen is used to free2e and
destroy lesions, as well as scraping them off with a curette. Application of liEuid nitrogen
may cause burning or stinging at the treated site, which may persist for a few minutes
after the treatment. 0carring or loss of color can complicate both these treatments. With
liEuid nitrogen, a blister may form at the treatment site, but it will slough off in two to
four weeks. Although no longer available in the Jnited 0tates, the topical blistering agent
cantharidin can be effective. +t should be noted that cryosurgery and curette scraping are
not painless procedures. (hey may also leave scars andLor permanent white
$depigmented% marks.
@ulsed dye laser therapy for molluscum contagiosum may be the treatment of choice for
multiple lesions in a cooperative patient $Bermatologic 0urgery, !33=%. (he use of pulsed
dye laser for the treatment of /, has been documented with e)cellent results. (he
therapy was well tolerated, without scars or pigment anomalies. (he lesions resolved
without scarring at # weeks. 0tudies show 3FG33F of the lesions resolved with one
treatment.
;5<

;4<
(he pulsed dye laser is Euick and efficient, but its e)pense makes it less
cost effective than other options. Also, not all dermatology offices have this 4=4nm laser.
(o prevent molluscum contagiosum from spreading:
(ry not to scratch. @ut a piece of tape or a bandage over any bumps.
Avoid contact sports, swimming pools, and shared baths and towels.
+f bumps are on the face, avoid shaving.
+f bumps are on the genital area, avoid se)ual activity. KKKKKKKKKKKKKKKK
What is molluscum contagiosum?
A skin disease caused by the molluscum contagiosum virus (MCV) usually causing one or more
small lesions/bumps. MCV is generally a benign infection and symptoms may self-resolve. MCV as
once a disease primarily of children! but it has evolved to become a se"ually transmitted disease in
adults. #t is believed to be a member of the po" virus family.
How is it transmitted?
Molluscum contagiosum may be se"ually transmitted by skin-to-skin contact (does not have
to be mucous membranes) and/or lesions. $ransmission through se"ual contact is the most
common form of transmission for adults.
MCV may be transmitted from inanimate ob%ects such as toels and clothing that come in
contact ith the lesions. MCV transmission has been associated ith simming pools and
sharing baths ith an infected person.
MCV also may be transmitted by autoinoculation! such as touching a lesion and touching
another part of the body. $o stop from further spreading the infection! do not shave over or
close to areas that are visibly infected.
What is the incubation period?
$he incubation period averages & to ' months and may range from ( eek to ) months.
How long are you infectious?
$his is not knon for certain! but researchers assume that if the virus is present it may be
transmitted.
Symptoms
*esions are usually present on the thighs! buttocks! groin and loer abdomen of adults! and
may occasionally appear on the e"ternal genital and anal region.
Children typically develop lesions on the face! trunk! legs and arms.
$he lesions may begin as small bumps hich can develop over a period of several eeks
into larger sores/bumps. $he lesions can be flesh colored! gray-hite! yello or pink. $hey
can cause itching or tenderness in the area! but in most cases the lesions cause fe
problems. *esions can last from & eeks to + years -- the average is & years.
,eople ith A#-. or others ith compromised immune systems may develop e"tensive
outbreaks.
Testing/Diagnosis
-iagnosis is usually made by the characteristic appearance of the lesion. MCV may be diagnosed by
collecting a specimen from the lesion! placing it onto a slide and staining ith a /ram stain hich
shos changes in infected cells. -iagnosis may be made by collecting a specimen from the lesion
and vieing it under an electron microscope.
Treatment
Most symptoms are self-resolving! but generally lesions are removed. 0emoval of lesions
reduces autoinoculation and transmission to others.
*esions can be removed surgically and/or treated ith a chemical agent such as
podophyllin! cantharidin! phenol! silver nitrate! trichloracetic acid or iodine.
Cryotherapy is an alternative method of removal.
*esions may recur! but it is not clear hether this is due to reinfection! e"acerbation of
subclinical infection! or reactivation of latent infection.
What does it mean for my health?
#n people ith 1#V infection! molluscum contagiosum is often a progressive disease.
Reduce your risk
2ecause transmission through se"ual contact is the most common form of transmission for
adults! preventing skin-to-skin contact ith an infected partner ill be most effective in
preventing MCV.
*ate" condoms or other moisture barriers for vaginal! oral! and anal se" may help to
prevent such contact. *imitations of such barriers must be recogni3ed as MCV does NT
re4uire mucous membrane contact to be passed.
5sing spermicides is not recommended as they can irritate the skin or vaginal tissue and!
especially for omen! cause abrasions (tiny openings in skin) that may make it easier to
contract .$-s/.$#s.
5sing condoms may protect the penis or vagina from infection! but do not protect from
contact ith other areas such as the scrotum or anal area.
Mutual monogamy (se" ith only one uninfected partner)
#f you do get molluscum contagiosum! avoid touching the lesion and then touching another part of
the body ithout ashing your hands to prevent chance of autoinoculation.
What is molluscum contagiosum?
'olluscum contagiosum is a viral infection of the skin that causes small pearly or flesh(colored
bumps. The bumps may be clear, and the center is often indented (umbilicated). The virus is
easily spread (contagious) but is not harmful. )owever, in people with impaired immune systems,
such as )!* infection, the bumps can be extensive and disfiguring and are often considered a
sign of late(stage disease.
+
What are the symptoms?
The small, round, indented bumps are usually about $ mm (,.+ in.) to - mm (,.. in.) in size (a
little smaller than a pencil eraser). They may appear alone or in groups. They are most often
found on the trunk, face, eyelids or genital area. !n children, bumps usually appear on the trunk,
face, and arms. !n sexually active teenagers and young adults, the bumps are usually located in
the genital area.
.
The bumps may become inflamed and turn red as part of the body/s natural
immune system response as it fights the virus. 0czema often develops around the bumps.
The incubation period1the time from exposure to the virus until bumps develop1is usually . to 2
weeks but can be up to 3 months.
$
!n people who have an impaired immune system, such as )!* infection, symptoms of molluscum
contagiosum are more severe.
How does molluscum contagiosum spread?
The virus commonly spreads through skin(to(skin contact. This includes sexual contact or
touching or scratching the bumps and then touching the skin. )andling ob%ects that have the virus
on them, such as a towel, can also result in infection. The virus can spread from one part of the
body to another or to other people. 'olluscum contagiosum is contagious until the bumps are
gone1which, if untreated, may be up to 3 months or longer.
'olluscum contagiosum in a child/s genital area is common, usually because the child infects the
area through scratching. )owever, if other factors are present, sexual abuse may be considered.
How is molluscum contagiosum diagnosed?
'olluscum contagiosum is usually diagnosed during a physical examination. !f the diagnosis is
unclear and other conditions are suspected, your health professional may take a sample of the
bump to examine (biopsy). !f an adult has bumps in his or her genital area, the health
professional may check for other sexually transmitted diseases, such as genital herpes.
How is it treated?
!n healthy people, treatment may not be necessary because individual bumps usually go away on
their own in . to 4 months, although it may take longer. #ome people choose to remove the
bumps because they are embarrassed by them, or to keep them from spreading to other people.
)ealth professionals usually recommend treating bumps located in the genital area to prevent
them from spreading.
!f needed, treatment choices include5
6emoving the viral material in the center by scraping the center briskly (curettage).
7reezing the skin growth (cryotherapy).
8utting medication on the skin (topical medication).
Taking medication by mouth (oral medication).
Who is affected by molluscum contagiosum?
'olluscum contagiosum is most common in children and is typically seen in children age . to -.
4
!n teens and young adults, molluscum contagiosum is primarily a sexually transmitted disease.
)owever, it is also found among wrestlers, swimmers, gymnasts, masseurs, and people who use
steam rooms and saunas.
'olluscum contagiosum is more common in warm, humid climates with crowded living conditions
than in mild climates.
@+N(A
Important
!t is possible that the main title of the report 8inta is not the name you expected. 8lease check the
synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report.
Synonyms
9zul
:arate
0mpeines
;ota
'al del 8into
Tina
(back to top)
Disorder Subdivisions
<one
(back to top)
General Discussion
8inta is a rare infectious tropical disease affecting the skin that is caused by the bacterium
Treponema carateum, which is transmitted by direct, nonsexual contact. 8inta progresses
through three distinct stages, which are characterized by various skin lesions and discoloration.
=ther organ systems are not affected. 0xposed areas of the skin such as the face and extremities
are most often affected.
8inta is classified as a treponematosis, which is an infectious disease caused by a treponema.
Treponemas are a genus of spiral(shaped bacteria (spirochetes). Treponemas caused several
infectious diseases including pinta, yaws, and syphilis.
(back to top)
Resources
Centers for Disease Control and revention
+3,, :lifton 6oad <0
9tlanta, >9 $,$$$
Tel5 (4,4)3$?($-$4
Tel5 (@,,)$++($4$-
0mail5 http5www.cdc.govnetinfo.htm
!nternet5 http5www.cdc.gov
!IH"!ational Institute of #llergy and Infectious Diseases
?,,, 6ockville 8ike
Auilding $+9
Aethesda, 'B .,@?.
Tel5 ($,+)4?3(-2+2
7ax5 ($,+)4,.(,+.,
!nternet5 http5www.niaid.nih.gov
World Health $rgani%ation &WH$' Regional $ffice for the #mericas &#(R$'
8an 9merican )ealth =rganization (89)=)
-.- .$rd #treet <C
Cashington, B: .,,$2
Tel5 (.,.)?24($,,,
7ax5 (.,.)?24($33$
0mail5 postmasterDpaho.org
!nternet5 http5www.who.ch
(back to top)
)or a Complete Report
This is an abstract of a report from the <ational =rganization for 6are Bisorders, !nc. E (<=6B).
9 copy of the complete report can be obtained for a small fee by visiting the <=6B website. The
complete report contains additional information including symptoms, causes, affected population,
related disorders, standard and investigational treatments (if available), and references from
medical literature. 7or a full(text version of this topic, see
http5www.rarediseases.orgsearchrdblist.html
The information provided in this report is not intended for diagnostic purposes. !t is provided for
informational purposes only. <=6B recommends that affected individuals seek the advice or
counsel of their own personal physicians.
!t is possible that the title of this topic is not the name you selected. 8lease check the #ynonyms
listing to find the alternate name(s) and Bisorder #ubdivision(s) covered by this report.