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This report deals with the geographical distribution, prevalence, epidemiology, etiology, serological, clinical, and histopathological features, and treatment of mal del pinto, or pinta, in Mexico.Repository penicillin preparations (PAM and Panbiotic) have been found highly effective in the treatment of this endemic, non-venereal treponematosis.
An attempt is made to explain along Darwinian lines the steps by which the treponematoses evolved and how they came to have their present distributions and characteristics. The original ancestors of the treponemes would have been free-living organisms, but various forms of symbiosis with larger creatures would in time lead to the development of parasitism with varying degrees of pathogenicity. Modern man may have acquired his treponemes from his ungeneralized primate ancestors and taken them with him on his migrations over the world. Isolation of man in different continents, especially after the end of the Ice Age, would lead to speciation in both man and his parasites; this would account for the features of pinta in Central America. Ecological isolations would produce syphilis and yaws, the latter being successful in warm areas where no clothes were worn or overcrowding was gross, and syphilis being successful in colder climates but not in endemic yaws areas where so many people were immune by puberty.A syphilis organism has little chance of survival if it fails to infect the genitalia. This is perhaps the reason for congenital infections in that disease. The organotropic properties of syphilis treponemes may be the results of repeated passage through the foetus; the conditions for survival in the foetus are much different from those in the mother, so that organotropic rather than genitotropic strains would be selected.
The occurring resurgence of endemic treponematoses warrant the renewal of WHO mass campaigns. These various infections, pinta, yaws, bejel and endemic syphilis, are due to a treponema apparently identical to the venereal syphilis one. These different treponematoses do act upon epidemiology of venereal syphilis. The recent outbreak of treponematoses justify the current researches in the development of a treponemal vaccine.
Endemic treponematoses including yaws, bejel, pinta are distinguished from venereal syphilis on the basis of epidemiological characteristics and clinical manifestations. They cannot be differentiated by morphological and serological methods. A few minor genetic differences have been identified among the subspecies (Treponema pallidum sp. pallidum, pertenue, endemicum, carateum). Although penicillin therapy is effective, these infectious diseases have yet to be eliminated.
Yaws and other endemic treponematoses (bejel or endemic syphilis, pinta) are resurging in many countries of the tropical belt. Today there are more than 2.5 million cases of these diseases, 75% of them in children. More than 100 million additional children are at risk for these disabling and disfiguring infections which destroy tissue and bone. In the 1950's and 1960's, through concerted efforts and leadership of UNICEF and WHO, more than 50 million individuals in 46 countries were cured and the diseases were brought under control or even eliminated from large parts of the world. Despite the success, endemic foci remained and in the last years there has been an alarming resurgence of the endemic treponematoses, in particular in parts of West and Central Africa. Endemic treponematosis control is based on treatment with single-dose penicillin of the entire treponemal reservoir. No instances of penicillin-resistance have been documented and these infections should be eliminated while the organisms still remain sensitive to penicillin. An endemic treponematosis control programme must be fully integrated into the primary health care system and the persistence of endemic treponematoses in an area is an indicator of the failing effectiveness of primary health care.
Pigmentary problems are one of the most frequent causes of dermatologic consultation in the tropics. This article deals with diseases seen mostly in tropical countries (ashy dermatosis, lichen planus pigmentosus, frictional dermatitis, pityriasis versicolor, and pinta) and in which a combination of racial, ecologic, nutritional, and social factors all contribute. Other common dermatoses seen worldwide, such as vitiligo and melasma, sometimes acquire dramatic expressions in tropical countries, and their management is usually difficult even for the most experienced dermatologists.
Despite major efforts to eradicate these disorders, yaws, bejel, and pinta (endemic treponematosis) remain serious health issues in many regions of the world. Aside from prominent skin manifestations, these diseases may also lead to significant osseous, neurologic, and ophthalmologic complications. Although progress has been made in differentiating the causative species in a research setting, a simple, specific, and sensitive diagnostic test remains elusive. Parenteral penicillin, in appropriate dosage, is the treatment of choice; alternative antibiotics such as tetracycline and erythromycin may also be effective.
UNLABELLED: Bacterial infections are common in tropical parts of the world and can include those species also seen regularly in temperate climates. Many tropical bacterial infections, however, are rarely diagnosed in temperate parts of the world and include bartonellosis, tropical ulcer, tropical pyomyositis, granuloma inguinale, lymphogranuloma venereum, yaws, pinta, melioidosis, and glanders. Some tropical bacterial diseases, eg, plague and anthrax, are associated with high mortality rates and are of potential use in bioterrorism. Some tropical bacterial diseases are closely associated with specific activities such as hunting (ie, tularemia) or eating raw seafood (Vibrio vulnificus infection). The bacterial diseases having the most severe medical impact in the tropics are those caused by members of the Mycobacterium genus. Millions of persons throughout the world suffer from tuberculosis and leprosy; Buruli ulcers are common causes of morbidity in many tropical countries. Because of the increasing frequency of travel to tropical parts of the world for tourism and work as well as the increasing number of immigrants and adoptees from these areas, it is imperative that physicians practicing in temperate climates be able to recognize the signs and symptoms of tropical bacterial diseases, carry out the proper diagnostic tests, and initiate appropriate therapy and prevention. LEARNING OBJECTIVE: At the completion of this learning activity, participants should be familiar with the clinical presentations, epidemiologies, diagnoses, therapies, and preventions of bacterial tropical diseases.
Previous mass campaigns against the endemic treponematoses have taught investigators several lessons that, along with current constraints and altered circumstances, must be considered in the formulation of a contemporary strategy for the control or eradication of yaws, endemic syphilis, or pinta. A time-limited, vertical approach is necessary in highly endemic areas initially to reduce the level of transmission. Elsewhere, control activities should be integrated into other primary health care interventions, especially health education, water and sanitation programs, maternal and child health care, and provision of essential drugs. Control of the endemic treponematoses is an ideal means of strengthening primary health care in endemic areas.
The sensitivity and specificity of an indirect immunofluorescence assay (IFA) and ELISA for Lyme disease were estimated. Sera from patients with Lyme disease, patients with other infections, and healthy individuals were examined. Significant cross-reactivity occurred only with sera from patients with syphilis, yaws, and pinta . All tested sera from patients with Lyme disease, however, gave negative results in the rapid reagin screening test and the microhemagglutination assay for antibodies to Treponema pallidum confirmatory for syphilis. When sera from patients with treponemal diseases were excluded from the analysis, the IFA and ELISA were highly specific, having 97% and 100% reliability, respectively. Sensitivity of both tests varied with the stage of disease but was 100% for both tests during complicated Lyme disease. The results indicate that both tests are highly specific and sensitive for complicated Lyme disease but relatively insensitive for patients with erythema chronicum migrans alone.
An enzyme-linked immunosorbent assay (ELISA) for syphilis has been developed that detects IgG antibody to purified recombinant Treponema pallidum surface antigen 4D. The 4D ELISA was capable of detecting 25 ng of 4D antigen-specific antibody. Neither 172 nonsyphilitic sera nor 20 false-positive sera in the Venereal Disease Research Laboratory test reacted in the 4D ELISA. The sensitivity of the 4D ELISA was comparable to that of the adsorbed fluorescent treponemal antibody test in primary, secondary, and latent disease. Most sera from patients with yaws or pinta were also reactive, a result indicating that a 4D antigen-like molecule also exists in the closely related pathogenic treponemes Treponema pertenue and Treponema carateum.
Analysis of the stigmata of congenital syphilis in two study populations indicates that the imprints of the disease are the same, whether the patient population is of Caribbean or of North American origin. If the Columbian theory of origin of syphilis were correct, the longer syphilization of the West Indies might have tended to lessen the effects of the disease by attenuating Treponema pallidum. The presence of yaws and pinta in the West Indies may even have had an immunizing effect. The similar findings in the two population groups suggests that the events postulated by the Columbian theory did not take place.
As part of a case-control study to investigate the high incidence of cervical cancer in Costa Rican women, the seroprevalence of the treponematoses, in particular, syphilis was determined. In each age group, women with a history of two or more sex partners were two to four times more likely to be seroreactive in tests for syphilis than women with zero or one sex partner. The highest percentage of reactive results in the microhemagglutination assay for antibodies to Treponema pallidum (MHA-TP) was seen in samples from women aged 50-59 who had had two or more lifetime partners (23.8%). Three observations from our study support reactivity due to syphilis rather than yaws or pinta: (1) a similar percent of reactive rapid plasma reagin (RPR) card test results among MHA-TP reactors in the two age groups of women who were surveyed (42 vs. 49%) was observed; (2) women who were seroreactive in the MHA-TP had multiple risk factors for STD [low socioeconomic status (9.4%), urban residence (22.8%), first intercourse under 16 years of age (14.1%), and multiple sex partners (26.3%)], and (3) only sexually experienced women had reactive results in the MHA-TP test.
The endemic treponematoses which comprise yaws, endemic syphilis (bejel) and pinta constitute a group of potentially disabling and disfiguring infections which primarily afflict children in tropical and subtropical areas. Foci where these diseases are now endemic have a patchy distribution and are typically confined to underprivileged communities living in remote rural areas, with little or no access to health services and removed from the mainstream of socioeconomic development. A drastic decline in the prevalence of these infections was brought about by the implementation of mass treatment campaigns with penicillin under the technical guidance of WHO and with material support from UNICEF in the 1950s and 1960s. These worldwide campaigns against the endemic treponematoses halted disease transmission in many areas and held the promise of complete eradication if intensive surveillance could be continued for some time with the increasing involvement of the basic health services. National campaigns were so successful that relatively low priority was given to the preparation of the rural health services for this new task. The failure of many countries to integrate active control measures into the functions of the rural health services led to the gradual build-up and extension of treponemal reservoirs and the resurgence of foci of increased disease transmission particularly in communities where standards of hygiene and health care had remained low. In a number of former endemic foci only low-level transmission persisted; in a few areas disease prevalence increased dramatically to reach pre-campaign levels. The lack of technical and financial resources limited the success of renewed national control activities in the most affected areas. Today, with waning interest in these diseases confined to remote, and thus silent, population groups, and a decreasing ability of health staff to identify cases, data collected by countries need to be supplemented by information from other sources in order to arrive at a more valid assessment of the situation concerning the endemic treponematoses. Central and West Africa are most severely affected by the resurgence of the endemic treponematoses. In recent years a number of countries (e.g. Ghana, Côte d'Ivoire and Mali) have launched renewed control efforts, often combining yaws or endemic syphilis control with other public health programmes. In Central Africa itinerant pygmy groups are still highly affected by yaws and are an important source of infection for the sedentary population with which they come into contact. In Chad, Sudan and Ethiopia, there is some evidence of persistent foci of endemic treponematoses; the epidemiological situation in Southern Africa is not well established.(ABSTRACT TRUNCATED AT 400 WORDS)
Yaws (framboesia tropica), caused by Treponema pallidum subspecies pertenue, is a chronic infectious disease, found in tropical rural regions. As a result of mass treatment campaigns conducted in the 1950s and 1960s the prevalence of yaws and the other endemic treponematoses (pinta and endemic syphilis) has decreased greatly. However, in several tropical regions in the world resurgence of yaws was reported in the 1980s. In this article we present the results of a small survey on yaws in six health centres in the Pariaman region in West Sumatra, Indonesia. A general conclusion from this small survey is that yaws is far from being eradicated and that in this region the disease is on the increase again. Some major findings of T. pertenue research are presented here.
This study deals with the development of a method to identify typical food dishes, successfully applied in the State of Sonora, Mexico. The State was divided into six regions considering the size of the territory and existence of different physical, economic and sociocultural conditions, and how they influence the consumption patterns. A list of 66 regional food dishes was prepared by interviewing housewives from different parts of Sonora who now lived in the city of Hermosillo. From this list, 47 dishes were identified as regionally consumed, and a State-wide survey was performed to determine their frequency of consumption. Based on the categories of "very frequently", "frequently" and "less frequently", a group of 15 dishes (2 per region, plus 3 dishes throughout the State) was selected. A questionnaire was used to obtain the different ways they had of preparing them. The "typical recipe" for each dish was also determined, using the mode as statistical parameter. Samples of these food dishes were prepared at the laboratory following the selected home recipes for proximal analysis and determination of their vitamin A, thiamine, riboflavin, niacin, calcium, phosphorus and iron content. The results showed that a portion of "gallina pinta" contributed more than 25% of the daily recommended intake established by the National Institute of Nutrition "Salvador Zubirán" (INNSZ) for an adult man for energy, protein, iron, niacin and 24.3% thiamine and 21.0% calcium. The "chivichangas de queso", for example, contributed 45.2% of the calcium requirement, and the "tamales de carne", 36% iron.(ABSTRACT TRUNCATED AT 250 WORDS)
Although the treatment of whole communities with long-acting penicillin for the control of endemic treponematoses of childhood during the past twenty years has led to a remarkable initial regression of disease, early clinical yaws has not yet been eliminated in large endemic areas and the elimination of early childhood syphilis has been observed in favourable environmental conditions in a single instance only. In most areas, transmission of infection continues at varying levels and recrudescence or periodic focal outbreaks continue to occur.Mass penicillin campaigns have been undertaken in 46 countries and up to the end of 1970 some 160 million people had been examined and some 50 million clinical cases, latent cases, and contacts had been treated. In the past few years, sero-epidemiological studies of the changing pattern of disease and infection have become possible and methods for long-term surveillance of endemic treponematoses have been developed. The application of these methods to the study of "disappearing" disease is described, particularly with regard to yaws but also to childhood syphilis and pinta.
The European-American exchange of infectious diseases was responsible for the demographic havoc of the native population in the New World after 1492. Prior to this date medical writers describe the presence in Spain of viral diseases like influenza, parotitis, smallpox, measles, poliomyelitis, and rabies; there were also rickettsiasis, diphtheria, salmonellosis, plague, tubercolosis, leprosy, malaria, scabies and tinea. In America, before European arrivals, there were no records of human viral diseases, though there were records of rickettsiasis, treponematosis--pinta, yaws and syphilis--leihsmaniasis, amibiasis and perhaps leprosy. With the discovery of America in 1492, Columbus's sailors were contaminated by yaws and spread this disease into Europe. In 1493 influenza, as a zoonosis, was introduced into Santo Domingo and was responsible for the annihilation of the natives of the Antilles in less than a quarter of a century; in 1518 smallpox was also introduced in Santo Domingo and then to the American continent by negro slaves: by the same means measles were introduced in 1531. The previous existence or introduction of other infectious diseases in America is also discussed.