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[The differential diagnosis of indolent ulcers upon return from the Tropics: frambesia].

A 26-year-old patient was referred for investigation of chronic skin ulcerations which had appeared 2 months after a one-week stay in the Ivory Coast. The diagnosis was established clinically and serologically and the patient was successfully treated with penicillin. Even if yaws is a rare imported disease in Switzerland, it should always be considered in differential diagnosis of painless skin ulcerations in travellers returning from tropical countries, bearing in mind that the number of cases of yaws has increased in several tropical countries.

Adult↗

Yaws in Suriname.

Frambesia tropica, or yaws, is still prevalent in the urban population of some of the districts in Suriname. In 1911 a campaign against yaws, probably the first such campaign in the world involving treatment with salvarsan, was organized. It resulted in the rapid cure of all hospitalized patients. As a consequence of this success, the disease became less important to the medical authorities in the country. After introduction of penicillin (1945) for the treatment of yaws, the disease almost disappeared in Suriname. After 1970 new cases were diagnosed, and the resurgence of yaws in Suriname became apparent. The symptoms in these cases were attenuated in comparison to those described in standard handbooks. A survey of yaws in the different districts of Suriname was undertaken to determine the prevalence of the disease and its spread through the country in order to plan a new treatment campaign.

Adolescent↗

The effect of C3 depletion on resistance of hamsters to infection with the yaws spirochete.

The role of complement in humoral-mediated resistance to frambesial infection (yaws) needs to be defined. The level of serum C3 was reduced shortly after infection of hamsters with Treponema pallidum subspecies pertenue. Five weeks after frambesial infection, the serum C3 level began to increase and by week 7 no difference was detected between infected and uninfected hamsters. When C3 was depleted in hamsters by injection of 20 units of cobra venom factor (CoVF), two alterations in host resistance to frambesial infection occurred. Depletion of C3 abrogated the ability of immune serum to confer complete protection on normal hamsters against infection with the yaws spirochete. In all hamsters receiving immune serum but not CoVF, lesions failed to develop and lymph nodes weighed significantly less (P less than or equal to 0.1) than those of controls. Furthermore, no treponemes were detected in the lymph nodes of passively immunized animals. Second, depletion of C3 increased the susceptibility of hamsters to frambesial infection. The onset and progression of frambesial lesions were enhanced as compared with frambesial-infected hamsters not treated with CoVF. Finally, CoVF treatment did not reduce the ability of frambesia-immune hamsters cured of disease with penicillin to resist reinfection. These results demonstrate that complement influences the pathogenesis of yaws.

Animals↗