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Handley BL, Sokana O, Addo KK, Wagner J, Fookes M, Harding-Esch E, Marks M, Thomson NR, Doyle RM. Using 16s rRNA sequencing to characterize the microbiome of tropical cutaneous ulcer disease: insights into the microbial landscape and implications for diagnosis and treatment. Microb Genom 2024; 10. [PMID: 38739120 DOI: 10.1099/mgen.0.001234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Cutaneous ulcers are common in yaws-endemic areas. Although often attributed to 'Treponema pallidum subsp. pertenue' and Haemophilus ducreyi, quantitative PCR has highlighted a significant proportion of these ulcers are negative for both pathogens and are considered idiopathic. This is a retrospective analysis utilising existing 16S rRNA sequencing data from two independent yaws studies that took place in Ghana and the Solomon Islands. We characterized bacterial diversity in 38 samples to identify potential causative agents for idiopathic cutaneous ulcers. We identified a diverse bacterial profile, including Arcanobacterium haemolyticum, Campylobacter concisus, Corynebacterium diphtheriae, Staphylococcus spp. and Streptococcus pyogenes, consistent with findings from previous cutaneous ulcer microbiome studies. No single bacterial species was universally present across all samples. The most prevalent bacterium, Campylobacter ureolyticus, appeared in 42% of samples, suggesting a multifactorial aetiology for cutaneous ulcers in yaws-endemic areas. This study emphasizes the need for a nuanced understanding of potential causative agents. The findings prompt further exploration into the intricate microbial interactions contributing to idiopathic yaw-like ulcers, guiding future research toward comprehensive diagnostic and therapeutic strategies.
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Affiliation(s)
- Becca L Handley
- Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Oliver Sokana
- Solomon Islands Ministry of Health, Honiara, Solomon Islands
| | - Kennedy Kwasi Addo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | | | - Emma Harding-Esch
- Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Marks
- Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Hospital for Tropical Diseases, London, UK
- University College London, London, UK
| | | | - Ronan M Doyle
- Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Ndzomo P, Tchatchouang S, Njih Tabah E, Njamnshi T, Tsanga MVN, Bondi JA, Handley R, González Beiras C, Tchatchueng J, Müller C, Lüert S, Knauf S, Boyomo O, Harding-Esch E, Mitja O, Crucitti T, Marks M, Eyangoh S. Prevalence and risk factors associated with Haemophilus ducreyi cutaneous ulcers in Cameroon. PLoS Negl Trop Dis 2023; 17:e0011553. [PMID: 38150487 PMCID: PMC10791135 DOI: 10.1371/journal.pntd.0011553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/09/2024] [Accepted: 12/15/2023] [Indexed: 12/29/2023] Open
Abstract
Epidemics of yaws-like cutaneous ulcers are regularly documented in children in the tropics. They occur mainly in poor and remote communities without access to health facilities. The integration of molecular tools into yaws control efforts has made it possible to describe Haemophilus ducreyi (HD) as a major cause of cutaneous ulcers. The objective of this study was to determine the prevalence of HD as cause of cutaneous ulcers, investigate its presence in asymptomatic individuals and identify associated risk factors. A cross-sectional study was conducted in yaws endemic districts of Cameroon. Participants included people presenting yaws-like ulcers and asymptomatic individuals. Swab samples were collected from each participant and tested for HD and Treponema pallidum (TP) using an established qPCR method. Additionally, demographic, habitat, proximity, and hygiene characteristics were collected using a structured questionnaire. A total of 443 individuals participated in the study, including 271 ulcer cases and 172 asymptomatic contacts. The prevalence of HD in ulcers was 30.3% (Confidence Interval (CI) 95% [24.8-35.7]) and the prevalence of asymptomatic HD carriage was 8.6% (CI95% [4.5-12.9]). TP was also detected in our sample among ulcer cases but in lower proportion (5.2% CI95% [2.5-7.8]) compared to HD. The adjusted logistic regression model showed that women were as much at risk of having HD cutaneous ulcer as men regardless of age. Physical proximity to a confirmed ulcer case was the major factor identified favouring HD transmission. HD ulcers were more likely to be present on Bantu individuals compared to Baka as well as HD colonization. These findings highlight HD as the most common cause of cutaneous ulcers in yaws-endemic communities in Cameroon. The exact implications of detecting HD on intact skin are not yet clear. Further studies are needed to understand the significance of this carriage in the spread dynamics of the disease.
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Affiliation(s)
- Philippe Ndzomo
- Centre Pasteur du Cameroun, Yaounde, Cameroon
- Department of Microbiology, Faculty of Science, University of Yaounde 1, Yaounde, Cameroon
| | | | - Earnest Njih Tabah
- National Yaws, Leishmaniasis, Leprosy and Buruli ulcer Control Programme, Ministry of Public Health, Yaounde, Cameroon
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, West Cameroon
| | - Theophilus Njamnshi
- National Yaws, Leishmaniasis, Leprosy and Buruli ulcer Control Programme, Ministry of Public Health, Yaounde, Cameroon
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | | | | | - Rebecca Handley
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Camila González Beiras
- Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Claudia Müller
- Institute of International Animal Health/One Health, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Greifswald—Insel Riems, Germany
| | - Simone Lüert
- Institute of International Animal Health/One Health, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Greifswald—Insel Riems, Germany
| | - Sascha Knauf
- Institute of International Animal Health/One Health, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Greifswald—Insel Riems, Germany
| | - Onana Boyomo
- Department of Microbiology, Faculty of Science, University of Yaounde 1, Yaounde, Cameroon
| | - Emma Harding-Esch
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Oriol Mitja
- Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Tania Crucitti
- Experimental Bacteriology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospital, London, United Kingdom
- Division of Infection and Immunity, University College London, London, United Kingdom
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Ekeke N, Iyama FS, Chukwu JN, Asiedu K, Marks M, Omotowo B, Agwu-Umahi O, Nvene VO, Paul S, Nwafor CC, Meka AO, Eze CC, Ezeakile OE, Njoku MI, Murphy-Okpala NN. Is there still yaws in Nigeria? Active case search in endemic areas of southern Nigeria. PLoS Negl Trop Dis 2023; 17:e0011753. [PMID: 37983269 PMCID: PMC10695364 DOI: 10.1371/journal.pntd.0011753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 12/04/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Yaws is a disease caused by the bacteria Treponema pallidum subspecies pertenue, which is most commonly seen among children below 15 years. In the twentieth century yaws was endemic in Nigeria but eradication strategies markedly reduced the disease burden. Currently there is minimal data on the ongoing transmission of yaws in Nigeria, despite reports of confirmed yaws cases in neighbouring West African countries. METHODS We conducted both community and school-based active yaws case search among school-aged children in southeast Nigeria. Children were screened by trained community volunteers. Suspected yaws cases were clinically reviewed and tested using rapid diagnostic serological tests. RESULTS Between February and May 2021, up to 28 trained community volunteers screened a total of 105,015 school children for yaws. Overall, 7,706 children with various skin lesions were identified. Eight (8) suspected cases of yaws were reported, reviewed and screened, but none was confirmed using rapid diagnostic tests. The four most common skin conditions identified were scabies (39%), papular urticaria (29%), tinea corporis (14%) and tinea capitis (12%). CONCLUSIONS No case of yaws was confirmed in this large population of children in south-east Nigeria. Continuous community awareness and yaws case finding activities have been recommended across Nigeria.
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Affiliation(s)
- Ngozi Ekeke
- German Leprosy and Tuberculosis Relief Association (GLRA), Enugu, Nigeria
| | - Francis S. Iyama
- German Leprosy and Tuberculosis Relief Association (GLRA), Enugu, Nigeria
| | - Joseph N. Chukwu
- German Leprosy and Tuberculosis Relief Association (GLRA), Enugu, Nigeria
| | - Kingsley Asiedu
- Department of Control of Neglected Tropical Diseases, WHO, Geneva, Switzerland
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene and Tropical Medicine (LSHTM), London, England
| | | | | | - Victor O. Nvene
- Institute of Public Health, University of Nigeria, Nsukka, Nigeria
| | - Shiloh Paul
- Neglected Tropical Diseases Division, Federal Ministry of Health, Abuja, Nigeria
| | - Charles C. Nwafor
- German Leprosy and Tuberculosis Relief Association (GLRA), Enugu, Nigeria
| | - Anthony O. Meka
- German Leprosy and Tuberculosis Relief Association (GLRA), Enugu, Nigeria
| | - Chinwe C. Eze
- German Leprosy and Tuberculosis Relief Association (GLRA), Enugu, Nigeria
| | | | - Martin I. Njoku
- German Leprosy and Tuberculosis Relief Association (GLRA), Enugu, Nigeria
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Piamale G, Bohy-Ngombet RGZ, Doyama-Woza RH, Fandema E, Pamatika CM, Dombeti CJ, Diemer HSC, Longo JDD, Gresenguet G. Prospecting for yaws in the Mbaïki Health District in the Central African Republic. Pan Afr Med J 2023; 45:121. [PMID: 37790147 PMCID: PMC10543901 DOI: 10.11604/pamj.2023.45.121.34060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/09/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction yaws is endemic in the Central African Republic. The last cases of yaws notified by CAR to WHO date back to 2012. The objective of this study was to measure the prevalence of yaws in the health district of Mbaïki and to describe its clinical and epidemiological characteristics. Methods this is a descriptive cross-sectional study, conducted from April 10 to 18, 2020 in the Mbaïki health district. Yaws cases were sought in 570 households in the 38 selected villages of the district. Any consenting individual over the age of one year with yaws-like skin lesions was a suspected case of yaws and included in the study. Blood was taken from suspected cases for serological testing (TDR, RPR and TPHA). Any suspected case of yaws with positive RPR and TPHA was considered a confirmed case. Results a total of 1967 people were examined, of whom 113 were considered suspected cases of yaws. All suspected cases were RPR-positive, 41 TPHA-positive and 13 RDT-positive. Forty-one cases of yaws were confirmed in 18 (47.37%) villages. The prevalence of yaws in the Mbaïki health district was 2.08%. Among the cases, 38.94% were children aged 1 to 14. The sex ratio was 1.69. Lesions clinically suggestive of yaws were papilloma-like in 77.00% of cases, followed by micropapules (8.00%) and ulcerations (5.00%). Conclusion eight of the nine communes in the Mbaïki health district are yaws-endemic. This result suggests the need to implement the Morges strategy in the Mbaïki health district.
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Affiliation(s)
- Germain Piamale
- Doctoral School of Human and Veterinary Health Sciences, University of Bangui, Bangui, Central African Republic
| | | | - Rodrigue Herman Doyama-Woza
- Department of Public Health, Faculty of Health Sciences, University of Bangui, Bangui, Central African Republic
| | - Emmanuel Fandema
- Department of Public Health, Faculty of Health Sciences, University of Bangui, Bangui, Central African Republic
| | - Christian Maucler Pamatika
- Integrated Disease Surveillance Service, Bangui University Hospital Center, Bangui, Central African Republic
| | | | - Henri Saint Calvaire Diemer
- Department of Public Health, Faculty of Health Sciences, University of Bangui, Bangui, Central African Republic
| | - Jean De Dieu Longo
- Department of Public Health, Faculty of Health Sciences, University of Bangui, Bangui, Central African Republic
| | - Gérard Gresenguet
- Doctoral School of Human and Veterinary Health Sciences, University of Bangui, Bangui, Central African Republic
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Griesenauer B, Xing Y, Fortney KR, Gao X, González-Beiras C, Nelson DE, Ren J, Mitjà O, Dong Q, Spinola SM. Two Streptococcus pyogenes emm types and several anaerobic bacterial species are associated with idiopathic cutaneous ulcers in children after community-based mass treatment with azithromycin. PLoS Negl Trop Dis 2022; 16:e0011009. [PMID: 36534698 PMCID: PMC9810193 DOI: 10.1371/journal.pntd.0011009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 01/03/2023] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In yaws-endemic areas, two-thirds of exudative cutaneous ulcers (CU) are associated with Treponema pallidum subsp. pertenue (TP) and Haemophilus ducreyi (HD); one-third are classified as idiopathic ulcers (IU). A yaws eradication campaign on Lihir Island in Papua New Guinea utilizing mass drug administration (MDA) of azithromycin initially reduced but failed to eradicate yaws; IU rates remained constant throughout the study. Using 16S rRNA gene sequencing, we previously determined that Streptococcus pyogenes was associated with some cases of IU. Here, we applied shotgun metagenomics to the same samples we analyzed previously by 16S rRNA sequencing to verify this result, identify additional IU-associated microorganisms, and determine why S. pyogenes-associated IU might have persisted after MDA of azithromycin. METHODOLOGY/PRINCIPAL FINDINGS We sequenced DNA extracted from 244 CU specimens separated into four groups based upon microorganism-specific PCR results (HD+, TP+, TP+HD+, and TP-HD- or IU). S. pyogenes was enriched in IU (24.71% relative abundance [RA]) specimens compared to other ulcer sub-groups, confirming our prior results. We bioinformatically identified the emm (M protein gene) types found in the S. pyogenes IU specimens and found matches to emm156 and emm166. Only ~39% of IU specimens contained detectable S. pyogenes, suggesting that additional organisms could be associated with IU. In the sub-set of S. pyogenes-negative IU specimens, Criibacterium bergeronii, a member of the Peptostreptococcaceae, and Fusobacterium necrophorum (7.07% versus 0.00% RA and 2.18% versus 0.00% RA, respectively), were enriched compared to the S. pyogenes-positive sub-set. Although a broad range of viruses were detected in the CU specimens, none were specifically associated with IU. CONCLUSIONS/SIGNIFICANCE Our observations confirm the association of S. pyogenes with IU in yaws-endemic areas, and suggest that additional anaerobic bacteria, but not other microorganisms, may be associated with this syndrome. Our results should aid in the design of diagnostic tests and selective therapies for CU.
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Affiliation(s)
- Brad Griesenauer
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana United States of America
| | - Yue Xing
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois United States of America
| | - Katherine R. Fortney
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana United States of America
| | - Xiang Gao
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois United States of America
| | | | - David E. Nelson
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana United States of America
| | - Jie Ren
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana United States of America
| | - Oriol Mitjà
- Carretera de Canyet, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Qunfeng Dong
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois United States of America
| | - Stanley M. Spinola
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana United States of America
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana United States of America
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana United States of America
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Fongwen N, Handley BL, Martin DL, Beiras C, Dyson L, Frimpong M, Mitja O, Asiedu K, Marks M. Diagnostics to support the eradication of yaws—Development of two target product profiles. PLoS Negl Trop Dis 2022; 16:e0010554. [PMID: 36048897 PMCID: PMC9473620 DOI: 10.1371/journal.pntd.0010554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/14/2022] [Accepted: 08/15/2022] [Indexed: 11/19/2022] Open
Abstract
Background Yaws is targeted for eradication by 2030, using a strategy based on mass drug administration (MDA) with azithromycin. New diagnostics are needed to aid eradication. Serology is currently the mainstay for yaws diagnosis; however, inaccuracies associated with current serological tests makes it difficult to fully assess the need for and impact of eradication campaigns using these tools. Under the recommendation of the WHO Diagnostic Technical Advisory Group (DTAG) for Neglected Tropical Diseases(NTDs), a working group was assembled and tasked with agreeing on priority use cases for developing target product profiles (TPPs) for new diagnostics tools. Methodology and principal findings The working group convened three times and established two use cases: identifying a single case of yaws and detecting azithromycin resistance. One subgroup assessed the current diagnostic landscape for yaws and a second subgroup determined the test requirements for both use cases. Draft TPPs were sent out for input from stakeholders and experts. Both TPPs considered the following parameters: product use, design, performance, configuration, cost, access and equity. To identify a single case of yaws, the test should be able to detect an analyte which confirms an active infection with at least 95% sensitivity and 99.9% specificity. The high specificity was deemed important to avoid a high false positive rate which could result in unnecessary continuation or initiation of MDA campaigns. If used in settings where the number of suspected cases is low, further testing could be considered to compensate for imperfect sensitivity and to improve specificity. The test to detect azithromycin resistance should be able to detect known genetic resistance mutations with a minimum sensitivity and specificity of 95%, with the caveat that all patients with suspected treatment failure should be treated as having resistant yaws and offered alternative treatment. Conclusions The TPPs developed will provide test developers with guidance to ensure that novel diagnostic tests meet identified public health needs. Accurate diagnostic tests are needed to aid yaws eradication efforts. Diagnostic tests are important for determining where yaws is present and for monitoring eradication efforts. Whilst there are tests available, they have limitations and will not all be suitable in all settings, especially as disease prevalence reduces in the move towards eradication. Therefore, new diagnostics solutions are needed. To aid with this, we determined the programmatic areas of greatest need (use cases) and then developed a shortlist of product requirements (target product profiles, or TPPs) for each scenario. These TPPs can then be used by product developers to ensure that novel diagnostic tools in development are fit for purpose. There were two programmatic use cases for which yaws TPPs were developed. The first TPP focused on diagnostics to detect a single case of yaws in a community, thus highlighting the need for, or continuation of mass drug administration efforts. The second TPP lays out the requirement for a test that can detect resistance to azithromycin, the antibiotic used for the eradication campaigns. This will be key to rapidly detect emergent antibiotic resistant bacteria and prevent it from being passed on.
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Affiliation(s)
- Noah Fongwen
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
| | - Becca L. Handley
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
| | - Diana L. Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta United States of America
| | - Camila Beiras
- Fight Aids and Infectious Diseases Foundation, Badalona, Spain
| | - Louise Dyson
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, United Kingdom
| | - Michael Frimpong
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Oriol Mitja
- Fight Aids and Infectious Diseases Foundation, Badalona, Spain
| | - Kingsley Asiedu
- Department for the Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Michael Marks
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospital, London, United Kingdom
- Division of Infection and Immunity, University College London, London, United Kingdom
- * E-mail:
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Dofitas BL, Kalim SP, Toledo CB, Richardus JH. Yaws in the Philippines: A clinico-seroprevalence study of selected communities in Mindanao. PLoS Negl Trop Dis 2022; 16:e0010447. [PMID: 35648735 PMCID: PMC9159601 DOI: 10.1371/journal.pntd.0010447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/26/2022] [Indexed: 11/19/2022] Open
Abstract
Background Yaws is a chronic, highly contagious skin and bone infection affecting children living in impoverished, remote communities. It is caused by Treponema pallidum subsp. pertenue. We report the prevalence of active yaws among elementary schoolchildren based on clinical and serological criteria in selected municipalities of Southern Philippines. Methods From January to March 2017, exploratory cross-sectional surveys and screening of skin diseases were conducted in the Liguasan Marsh area of the provinces Maguindanao, Sultan Kudarat, and Cotabato. We included 9 municipalities and randomly selected one public elementary school per municipality. Members of students’ households and the communities were also examined and treated. Yaws suspects and contacts had blood tests for treponemal and non-treponemal antibodies using Dual Pathway Platform and Treponema pallidum particle agglutination (TPPA) tests. Results A total of 2779 children and adults were screened for any skin disease: 2291 students, 393 household members, and 95 community members. Among 210 yaws suspects and contacts, 150 consented to serologic tests. The estimated prevalence of active yaws among schoolchildren screened was 1 out of 2291 (0.04%). Among 2532 children who were 14 years old and younger, 4 (0.2%) had active yaws. Eight adult household contacts and community members had latent yaws and 2 had past yaws. Five out of 9 municipalities were endemic for yaws. Conclusions This study confirmed that the Philippines is endemic for yaws but at a low level in the schools surveyed. This is an under-estimation due to the limited sampling. The lack of proper disease surveillance after the eradication campaign in the 1960’s has made yaws a forgotten disease and has led to its resurgence. Yaws surveillance is needed to determine the extent of yaws in the Philippines and to help develop a strategy to eradicate yaws by 2030. Yaws is a chronic, highly contagious skin and bone infection affecting children living in impoverished, remote communities. It is caused by bacteria called Treponema pallidum subspecie pertenue. To determine the prevalence of yaws, we conducted cross-sectional surveys and integrated screening of skin diseases and blood tests in nine selected schools and students’ households in three provinces located in Liguasan Marsh, Mindanao Island, Southern Philippines. A total of 2779 children and adults were screened for any skin disease: 2291 students, 393 household members, and 95 community members. Among 210 yaws suspects and contacts, 150 consented to serologic tests. The estimated prevalence of yaws among schoolchildren screened was 1 out of 2291 (0.04%). Among 2532 children who were 14 years old and younger, 4 (0.2%) had active yaws. Eight adult household contacts and community members had latent yaws and 2 had past yaws. Five out of 9 municipalities were endemic for yaws. This study confirmed that the Philippines is endemic for yaws. The occurrence among schoolchildren in the study sites was low probably due to limited sampling. A yaws surveillance and eradication program is needed for endemic communities in the Philippines. Yaws could be unreported in other previously endemic countries as well because the skin and bone signs are not recognized anymore.
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Affiliation(s)
- Belen Lardizabal Dofitas
- Department of Dermatology, College of Medicine, University of the Philippines Manila, Metro Manila, Philippines
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - Sherjan P. Kalim
- Department of Pathology, Cotabato Regional and Medical Center, Cotabato City, Philippines
| | - Camille B. Toledo
- Institute of Psychiatry and Behavioral Medicine, Southern Philippines Medical Center, Davao City, Philippines
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Handley BL, González-Beiras C, Tchatchouang S, Basing LA, Hugues KA, Bakheit M, Becherer L, Ries C, Njih Tabah E, Crucitti T, Borst N, Lüert S, Frischmann S, Haerpfer T, Landmann E, Amanor I, Sylla A, Kouamé-Sina MS, Ndzomo-Ngono JP, Tano A, Arhinful D, Awondo P, Ngazoa Kakou S, Eyangoh S, Addo KK, Harding-Esch EM, Knauf S, Mitjà O, Marks M. LAMP4yaws: Treponema pallidum, Haemophilus ducreyi loop mediated isothermal amplification - protocol for a cross-sectional, observational, diagnostic accuracy study. BMJ Open 2022; 12:e058605. [PMID: 35351731 PMCID: PMC8966536 DOI: 10.1136/bmjopen-2021-058605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Yaws, caused by the bacterium Treponema pallidum subsp. pertenue, is a neglected tropical disease targeted for eradication by 2030. Improved diagnostics will be essential to meet this goal. Diagnosis of yaws has relied heavily on clinical and serological tools. However, the presence of coendemic cutaneous skin ulcer diseases, such as lesions caused by Haemophilus ducreyi (HD), means these techniques do not provide a reliable diagnosis. Thus, new diagnostic tools are needed. Molecular tools such as PCR are ideal, but often expensive as they require trained technicians and laboratory facilities, which are often not available to national yaws programmes. METHODS AND ANALYSIS The LAMP4yaws project is a cross-sectional, observational, diagnostic accuracy study of a combined Treponema pallidum (TP) and HD loop mediated isothermal amplification (TPHD-LAMP) test performed under real world conditions in three endemic countries in West Africa. Individuals with serologically confirmed yaws will be recruited in Cameroon, Côte d'Ivoire and Ghana. Each participant will provide paired swabs, one of which will be sent to the respective national reference laboratory for yaws quantitative PCR and the other will be tested for both TP and HD using the TPHD-LAMP test at local district laboratories. Sensitivity and specificity of the TPHD-LAMP test will be calculated against the reference standard qPCR. We will also assess the acceptability, feasibility and cost-effectiveness of the test. We anticipate that results from this study will support the adoption of the TPHD-LAMP test for use in global yaws eradication efforts. ETHICS AND DISSEMINATION We have received ethical approval from all relevant institutional and national ethical committees. All participants, or their parents or guardians, must provide written informed consent prior to study enrolment. Study results will be published in an open access journal and disseminated with partners and the World Health Organization. TRIAL REGISTRATION NUMBER NCT04753788.
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Affiliation(s)
- Becca Louise Handley
- Clinical Research Department, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Camila González-Beiras
- Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Laud Antony Basing
- University of Ghana Noguchi Memorial Institute for Medical Research, Accra, Greater Accra, Ghana
| | - Kouadio Aboh Hugues
- National Program of African Trypanosomiasis Elimination, Abidjan, Côte d'Ivoire
- Institut Pasteur de Cote d'Ivoire, Abidjan, Lagunes, Côte d'Ivoire
| | | | - Lisa Becherer
- IMTEK - Department of Microsystems Engineering, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christina Ries
- Institute of International Animal Health/One Health, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Greifswald - Insel Riems, Germany
| | - Earnest Njih Tabah
- National Buruli Ulcer, Leprosy, Yaws and Leishmaniasis Control Program, Ministry of Public Health, Yaounde, Centre Region, Cameroon
- Public Health & Epidemiology, University of Dschang, Yaounde, West Region, Cameroon
| | - Tania Crucitti
- Experimental Bacteriology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Nadine Borst
- IMTEK - Department of Microsystems Engineering, University of Freiburg, Freiburg im Breisgau, Germany
| | - Simone Lüert
- Institute of International Animal Health/One Health, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Greifswald - Insel Riems, Germany
| | | | - Tamara Haerpfer
- IMTEK - Department of Microsystems Engineering, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Ivy Amanor
- University of Ghana Noguchi Memorial Institute for Medical Research, Accra, Greater Accra, Ghana
| | - Aboubacar Sylla
- Institut Pasteur de Cote d'Ivoire, Abidjan, Lagunes, Côte d'Ivoire
| | | | | | - Adingra Tano
- Institut Pasteur de Cote d'Ivoire, Abidjan, Lagunes, Côte d'Ivoire
| | - Daniel Arhinful
- University of Ghana Noguchi Memorial Institute for Medical Research, Accra, Greater Accra, Ghana
| | | | | | | | - Kennedy Kwasi Addo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Emma Michele Harding-Esch
- Clinical Research Department, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Sascha Knauf
- Institute of International Animal Health/One Health, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Greifswald - Insel Riems, Germany
| | - Oriol Mitjà
- Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Michael Marks
- Clinical Research Department, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
- Hospital for Tropical Diseases, London, UK
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Beiras CG, Marks M, Quintó L, Gavilán S, Kolmau R, Ubals M, Vall-Mayans M, Mitjà O. Yaws recurrence in children at continued risk of infection. PLoS Negl Trop Dis 2022; 16:e0010197. [PMID: 35312686 PMCID: PMC8970528 DOI: 10.1371/journal.pntd.0010197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 03/31/2022] [Accepted: 01/24/2022] [Indexed: 11/19/2022] Open
Abstract
Background
In yaws-endemic areas, children with Treponema pallidum subsp. pertenue infection may suffer recurrent episodes due to either reinfection or relapse. However, the possibility of infection with other cutaneous ulcer causative agents and difficulties in interpreting standard laboratory results challenges the estimation of yaws recurrence rates.
Methods
We estimated the rates of yaws recurrences in the Lihir Island (Papua New Guinea) using two approaches: passive surveillance based on a retrospective screening of electronic medical records of cutaneous ulcers diagnosed using serological testing between 2005 and 2016, and active surveillance conducted during a cross-sectional prevalence study which included PCR analyses of ulcers of all suspected cases of yaws. The risk of recurrent infection was assessed based on data from the passive surveillance analysis and using two Cox regression models (crude and multivariate), stratified by year of index episode. Data gathered from the active surveillance was used to characterize the recurrences and no hypothesis testing was performed.
Results
The electronic medical records included 6,125 patients (7,889 ulcer episodes) with documented serological results of cutaneous ulcers of which1,486 were diagnosed with yaws. Overall, 1,246/6,125 patients (20.3%) presented more than once with a cutaneous ulcer, and 103/1,486 (6.7%) patients had multiple episodes of yaws. The risk of yaws recurrence significantly increased with age and was higher in patients with ≥3 recurrent episodes. In the active surveillance, we identified 50 individuals with recurrent cutaneous ulcer that had PCR results available for both the index and recurrent episode. Of 12 individuals with T. pallidum in the index ulcer, 8 (66%) had T. pallidum in subsequent assessments, relapse related to macrolide-resistance was identified in two of these cases.
Conclusions
Our results confirm the need for active follow-up of yaws patients after treatment, particularly children and individuals with a history of recurrence.
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Affiliation(s)
- Camila G. Beiras
- STI and Skin NTDs Unit, Department of Infectious Diseases and Fight AIDS and Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- * E-mail:
| | - Michael Marks
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospitals, London, United Kingdom
| | - Llorenç Quintó
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Manhiça Health Research Institute (CISM), Manhiça, Mozambique
| | - Sergi Gavilán
- STI and Skin NTDs Unit, Department of Infectious Diseases and Fight AIDS and Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Reman Kolmau
- Lihir Medical Centre, International SOS, Londolovit, Papua New Guinea
| | - Maria Ubals
- STI and Skin NTDs Unit, Department of Infectious Diseases and Fight AIDS and Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Marti Vall-Mayans
- STI and Skin NTDs Unit, Department of Infectious Diseases and Fight AIDS and Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Oriol Mitjà
- STI and Skin NTDs Unit, Department of Infectious Diseases and Fight AIDS and Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Lihir Medical Centre, International SOS, Londolovit, Papua New Guinea
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
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10
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Becherer L, Knauf S, Marks M, Lueert S, Frischmann S, Borst N, von Stetten F, Bieb S, Adu-Sarkodie Y, Asiedu K, Mitjà O, Bakheit M. Multiplex Mediator Displacement Loop-Mediated Isothermal Amplification for Detection of Treponema pallidum and Haemophilus ducreyi. Emerg Infect Dis 2021; 26:282-288. [PMID: 31961303 PMCID: PMC6986840 DOI: 10.3201/eid2602.190505] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Yaws, a neglected tropical disease caused by the bacterium Treponema pallidum subspecies pertenue, manifests as ulcerative skin lesions. Nucleic acid amplification tests, like loop-mediated isothermal amplification (LAMP), are versatile tools to distinguish yaws from infections that cause similar skin lesions, primarily Haemophilus ducreyi. We developed a novel molecular test to simultaneously detect T. pallidum and H. ducreyi based on mediator displacement LAMP. We validated the T. pallidum and H. ducreyi LAMP (TPHD-LAMP) by testing 293 clinical samples from patients with yaws-like lesions. Compared with quantitative PCR, the TPHD-LAMP demonstrated high sensitivity and specificity for T. pallidum (84.7% sensitivity, 95.7% specificity) and H. ducreyi (91.6% sensitivity, 84.8% specificity). This novel assay provided rapid molecular confirmation of T. pallidum and H. ducreyi DNA and might be suitable for use at the point of care. TPHD-LAMP could support yaws eradication by improving access to molecular diagnostic tests at the district hospital level.
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Abstract
In resource-limited settings, point-of-care diagnostic devices have the potential to reduce diagnostic delays and improve epidemiologic surveillance of dermatologic conditions. We outline novel-point-of care diagnostics that have recently been developed for dermatologic conditions that primarily affect patients living in resource-limited settings, namely, Kaposi sarcoma, cutaneous leishmaniasis, leprosy, Buruli ulcer, yaws, onchocerciasis, and lymphatic filariasis. All of the technologies described in this article are prototypes, and some have undergone field testing. These devices still require validation in real-world settings and effective pricing to have a major impact on dermatologic care in resource-limited settings.
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Affiliation(s)
- Devon E McMahon
- Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, USA
| | - Linda Oyesiku
- Department of Dermatology, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, USA; University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Esther E Freeman
- Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, USA.
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12
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Gill H, Danesh-Meyer HV, Sims JL, Nisbet M, Niederer RL. Ocular syphilis in Pacific peoples-are we making misdiagnoses secondary to yaws? N Z Med J 2020; 133:53-60. [PMID: 32325468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
AIMS To determine the demographic and clinical features of patients with ocular disease consistent with syphilis and positive treponemal serology in Auckland, and to compare patients who lived in a Pacific nation before 1960 with all other patients with regard to these features, considering a possible history of yaws infection. METHODS Retrospective review of subjects seen in uveitis and neuroophthalmology clinics at Auckland District Health Board between January 2006 and June 2019. RESULTS Two thousand four hundred and ninety-three subjects were reviewed in uveitis clinics during the timeframe, of whom 45 were diagnosed with syphilitic uveitis (1.8%). Mean age was 56.2±14.8 years and 34 (75.5%) were male. Ethnicity was Caucasian in 16 (35.5%), Pacific peoples in 16 (35.5%), Māori in two (4.4%), Asian in six (13.3%) and other in five (11.1%). Pacific peoples were older at presentation (p=0.001) and 75.0% were aged >60 compared to 24.1% of non-Pacific peoples (p=0.002). Comparing Pacific people born prior to 1960 (aged >60) to the rest of the cohort, older Pacific subjects had lower RPR titres (median 3 vs 32 p=0.004), less optic nerve swelling (0% vs 28.0% eyes p=0.014) and less posterior uveitis (6.25% vs 32.0% eyes p = 0.033). No difference was observed in anterior and intermediate uveitis between the groups. No difference was observed in the resolution or recurrence of inflammation between the groups. CONCLUSION Syphilitic uveitis is common in New Zealand, occurring in 1 in 55 patients seen in consultant uveitis clinics. Clinicians should consider a history of yaws in Pacific peoples presenting with ocular inflammation and positive treponemal serology. In these cases alternative causes of ocular pathology should be included as differentials. In cases of diagnostic uncertainty, the risk of treatment versus the potentially severe sequelae of untreated syphilis need to be considered.
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Affiliation(s)
- Hannah Gill
- Department of Ophthalmology, Auckland District Health Board, Auckland
| | - Helen V Danesh-Meyer
- Department of Ophthalmology, Auckland District Health Board, Auckland; Department of Ophthalmology, University of Auckland, Auckland
| | - Joanne L Sims
- Department of Ophthalmology, Auckland District Health Board, Auckland
| | - Mitzi Nisbet
- Department of Medicine, Auckland District Health Board, Auckland
| | - Rachael L Niederer
- Department of Ophthalmology, Auckland District Health Board, Auckland; Department of Ophthalmology, University of Auckland, Auckland
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Koffi AP, Yao TAK, Barogui YT, Diez G, Djakeaux S, Zahiri MH, Sopoh GE, Santos S, Asiedu KB, Johnson RC, Assé H. Integrated approach in the control and management of skin neglected tropical diseases in three health districts of Côte d'Ivoire. BMC Public Health 2020; 20:517. [PMID: 32303204 PMCID: PMC7164353 DOI: 10.1186/s12889-020-08632-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 04/01/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Neglected tropical diseases (NTDs) comprise 20 communicable diseases that are prevalent in rural poor and remote communities with less access to the health system. For effective and efficient control, the WHO recommends that affected countries implement integrated control interventions that take into account the different co-endemic NTDs in the same community. However, implementing these integrated interventions involving several diseases with different etiologies, requiring different control approaches and driven by different vertical programs, remains a challenge. We report here the results and lessons learned from a pilot test of this integrated approach based on integrated screening of skin diseases in three co-endemic health districts of Côte d'Ivoire, a West African country endemic for Buruli ulcer, leprosy and yaw. METHOD This cross-sectional study took place from April 2016 to March 2017 in 3 districts of Côte d'Ivoire co-endemic for BU, leprosy and yaws. The study was carried out in 6 stages: identification of potentially co-endemic communities; stakeholder training; social mobilization; mobile medical consultations; case detection and management; and a review meeting. RESULTS We included in the study all patients with skin signs and symptoms at the screening stage who voluntarily accepted screening. In total, 2310 persons screened had skin lesions at the screening stage. Among them, 07 cases were diagnosed with Buruli ulcer. There were 30 leprosy cases and 15 yaws detected. Other types of ulcerations and skin conditions have been identified and represent the majority of cases detected. We learned from this pilot experience that integration can be successfully implemented in co-endemic communities in Côte d'Ivoire. Health workers are motivated and available to implement integrated interventions instead of interventions focused on a single disease. However, it is essential to provide capacity building, a minimum of drugs and consumables for the care of the patients identified, as well as follow-up of identified patients, including those with other skin conditions. CONCLUSIONS The results of this study show that the integration of activities can be successfully implemented in co-endemic communities under the condition of staff capacity building and minimal care of identified patients.
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Affiliation(s)
- Aboa Paul Koffi
- Programme National de Lutte contre l’Ulcère de Buruli, Abidjan, Côte d’Ivoire
| | | | - Yves Thierry Barogui
- Centre Inter Facultaire de Formation et de Recherche en Environnement pour le Développement Durable, Université d’Abomey Calavi, BP: 2733, Abomey-Calavi, Bénin
| | | | - Simplice Djakeaux
- Programme National d’Elimination de la Lèpre, Abidjan, Côte d’Ivoire
| | | | | | | | | | - Roch Christian Johnson
- Centre Inter Facultaire de Formation et de Recherche en Environnement pour le Développement Durable, Université d’Abomey Calavi, BP: 2733, Abomey-Calavi, Bénin
- Fondation Raoul Follereau, Fondation Raoul Follereau, 31 rue de Dantzig, 75015, Paris, France
| | - Henri Assé
- Programme National de Lutte contre l’Ulcère de Buruli, Abidjan, Côte d’Ivoire
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14
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Schuenemann VJ, Kumar Lankapalli A, Barquera R, Nelson EA, Iraíz Hernández D, Acuña Alonzo V, Bos KI, Márquez Morfín L, Herbig A, Krause J. Historic Treponema pallidum genomes from Colonial Mexico retrieved from archaeological remains. PLoS Negl Trop Dis 2018; 12:e0006447. [PMID: 29927932 PMCID: PMC6013024 DOI: 10.1371/journal.pntd.0006447] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 04/12/2018] [Indexed: 12/20/2022] Open
Abstract
Treponema pallidum infections occur worldwide causing, among other diseases, syphilis and yaws. In particular sexually transmitted syphilis is regarded as a re-emerging infectious disease with millions of new infections annually. Here we present three historic T. pallidum genomes (two from T. pallidum ssp. pallidum and one from T. pallidum ssp. pertenue) that have been reconstructed from skeletons recovered from the Convent of Santa Isabel in Mexico City, operational between the 17th and 19th century. Our analyses indicate that different T. pallidum subspecies caused similar diagnostic presentations that are normally associated with syphilis in infants, and potential evidence of a congenital infection of T. pallidum ssp. pertenue, the causative agent of yaws. This first reconstruction of T. pallidum genomes from archaeological material opens the possibility of studying its evolutionary history at a resolution previously assumed to be out of reach.
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Affiliation(s)
- Verena J. Schuenemann
- Institute for Archaeological Sciences, University of Tübingen, Tübingen, Germany
- Senckenberg Center for Human Evolution and Paleoenvironment, University of Tübingen, Tübingen, Germany
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Aditya Kumar Lankapalli
- Department for Archaeogenetics, Max Planck Institute for the Science of Human History, Jena, Germany
| | - Rodrigo Barquera
- Department for Archaeogenetics, Max Planck Institute for the Science of Human History, Jena, Germany
- Molecular Genetics Laboratory, National School of Anthropology and History, Mexico City, Mexico
| | - Elizabeth A. Nelson
- Department for Archaeogenetics, Max Planck Institute for the Science of Human History, Jena, Germany
| | - Diana Iraíz Hernández
- Department for Archaeogenetics, Max Planck Institute for the Science of Human History, Jena, Germany
- Molecular Genetics Laboratory, National School of Anthropology and History, Mexico City, Mexico
| | - Víctor Acuña Alonzo
- Molecular Genetics Laboratory, National School of Anthropology and History, Mexico City, Mexico
| | - Kirsten I. Bos
- Department for Archaeogenetics, Max Planck Institute for the Science of Human History, Jena, Germany
| | | | - Alexander Herbig
- Department for Archaeogenetics, Max Planck Institute for the Science of Human History, Jena, Germany
| | - Johannes Krause
- Institute for Archaeological Sciences, University of Tübingen, Tübingen, Germany
- Senckenberg Center for Human Evolution and Paleoenvironment, University of Tübingen, Tübingen, Germany
- Department for Archaeogenetics, Max Planck Institute for the Science of Human History, Jena, Germany
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15
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Marks M, Esau T, Asugeni R, Harrington R, Diau J, Toloka H, Asugeni J, Ansbro E, Solomon AW, Maclaren D, Redman-Maclaren M, Mabey DCW. Point-of-care tests for syphilis and yaws in a low-income setting - A qualitative study of healthcare worker and patient experiences. PLoS Negl Trop Dis 2018; 12:e0006360. [PMID: 29672524 PMCID: PMC5908063 DOI: 10.1371/journal.pntd.0006360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/02/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction The human treponematoses comprise venereal syphilis and the three non-venereal or endemic treponematoses yaws, bejel, and pinta. Serological assays remain the most common diagnostic method for all treponemal infections. Point-of-care tests (POCTs) for syphilis and yaws allow testing without further development of infrastructure in populations where routine laboratory facilities are not available. Alongside the test’s performance characteristics assessed through diagnostic evaluation, it is important to consider broader issues when rolling out a POCT. Experience with malaria POCT roll-out in sub-Saharan Africa has demonstrated that both healthcare worker and patient beliefs may play a major role in shaping the real-world use of POCTs. We conducted a qualitative study evaluating healthcare worker and patient perceptions of using a syphilis/yaws POCT in clinics in the East Malaita region of Malaita province in the Solomon Islands. Prior to the study serology was only routinely available at the local district hospital. Methods The POCT was deployed in the outpatient and ante-natal departments of a district hospital and four rural health clinics served by the hospital. Each site was provided with training and an SOP on the performance, interpretation and recording of results. Treatment for those testing positive was provided, in line with Solomon Islands Ministry of Health and Medical Services’ guidelines for syphilis and yaws respectively. Alongside the implementation of the POCT we facilitated semi-structured interviews with both nurses and patients to explore individuals’ experiences and beliefs in relation to use of the POCT. Results and discussion Four main themes emerged in the interviews: 1) training and ease of performing the test; 2) time taken and ability to fit the test into a clinical workflow; 3) perceived reliability and trustworthiness of the test; and 4) level of the health care system the test was most usefully deployed. Many healthcare workers related their experience with the POCT to their experience using similar tests for malaria. Although the test was considered to take a relatively long time to perform the benefits of improved access to testing were considered positive by most healthcare workers. Qualitative data is needed to help inform better training packages to support the implementation of POCT in low-resource settings. Syphilis and yaws are closely related bacterial infections. In many countries where the diseases are found there is limited access to diagnostic testing. Recently a point of care test for both diseases has been developed. In the current study we evaluated the experience of healthcare workers and patients in using the test in the Solomon Islands. Both healthcare workers and patients valued the improved access to testing that provided by the point of care test. Experience of healthcare workers in using similar tests for other diseases, such as malaria, had both positive and negative impacts on their beliefs about the syphilis and yaws test.
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Affiliation(s)
- Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, United Kingdom
- * E-mail:
| | - Tommy Esau
- Atoifi Adventist Hospital, Atoifi, Malaita Province, Solomon Islands
| | - Rowena Asugeni
- Atoifi Adventist Hospital, Atoifi, Malaita Province, Solomon Islands
| | - Relmah Harrington
- Atoifi Adventist Hospital, Atoifi, Malaita Province, Solomon Islands
| | - Jason Diau
- Atoifi Adventist Hospital, Atoifi, Malaita Province, Solomon Islands
| | - Hilary Toloka
- Atoifi Adventist Hospital, Atoifi, Malaita Province, Solomon Islands
| | - James Asugeni
- Atoifi Adventist Hospital, Atoifi, Malaita Province, Solomon Islands
| | - Eimhin Ansbro
- Department of Noncommunicable Disease Epidemiology, Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anthony W. Solomon
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, United Kingdom
| | - David Maclaren
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | | | - David C. W. Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, United Kingdom
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16
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Marks M, Fookes M, Wagner J, Butcher R, Ghinai R, Sokana O, Sarkodie YA, Lukehart SA, Solomon AW, Mabey DCW, Thomson N. Diagnostics for Yaws Eradication: Insights From Direct Next-Generation Sequencing of Cutaneous Strains of Treponema pallidum. Clin Infect Dis 2018; 66:818-824. [PMID: 29045605 PMCID: PMC5848336 DOI: 10.1093/cid/cix892] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 10/13/2017] [Indexed: 11/23/2022] Open
Abstract
Background Yaws-like chronic ulcers can be caused by Treponema pallidum subspecies pertenue, Haemophilus ducreyi, or other, still-undefined bacteria. To permit accurate evaluation of yaws elimination efforts, programmatic use of molecular diagnostics is required. The accuracy and sensitivity of current tools remain unclear because our understanding of T. pallidum diversity is limited by the low number of sequenced genomes. Methods We tested samples from patients with suspected yaws collected in the Solomon Islands and Ghana. All samples were from patients whose lesions had previously tested negative using the Centers for Disease Control and Prevention (CDC) diagnostic assay in widespread use. However, some of these patients had positive serological assays for yaws on blood. We used direct whole-genome sequencing to identify T. pallidum subsp pertenue strains missed by the current assay. Results From 45 Solomon Islands and 27 Ghanaian samples, 11 were positive for T. pallidum DNA using the species-wide quantitative polymerase chain reaction (PCR) assay, from which we obtained 6 previously undetected T. pallidum subsp pertenue whole-genome sequences. These show that Solomon Islands sequences represent distinct T. pallidum subsp pertenue clades. These isolates were invisible to the CDC diagnostic PCR assay, due to sequence variation in the primer binding site. Conclusions Our data double the number of published T. pallidum subsp pertenue genomes. We show that Solomon Islands strains are undetectable by the PCR used in many studies and by health ministries. This assay is therefore not adequate for the eradication program. Next-generation genome sequence data are essential for these efforts.
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Affiliation(s)
- Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London
- Hospital for Tropical Diseases, London
| | - Maria Fookes
- Wellcome Trust Sanger Centre, Cambridge, United Kingdom
| | - Josef Wagner
- Wellcome Trust Sanger Centre, Cambridge, United Kingdom
| | - Robert Butcher
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London
| | - Rosanna Ghinai
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London
| | - Oliver Sokana
- Solomon Islands Ministry of Health and Medical Services, Honiara
| | - Yaw-Adu Sarkodie
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sheila A Lukehart
- Departments of Medicine and Global Health, University of Washington, Seattle
| | - Anthony W Solomon
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London
- Hospital for Tropical Diseases, London
| | - David C W Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London
- Hospital for Tropical Diseases, London
| | - Nicholas Thomson
- Wellcome Trust Sanger Centre, Cambridge, United Kingdom
- Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
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17
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Godornes C, Giacani L, Barry AE, Mitja O, Lukehart SA. Development of a Multilocus Sequence Typing (MLST) scheme for Treponema pallidum subsp. pertenue: Application to yaws in Lihir Island, Papua New Guinea. PLoS Negl Trop Dis 2017; 11:e0006113. [PMID: 29281641 PMCID: PMC5760108 DOI: 10.1371/journal.pntd.0006113] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/09/2018] [Accepted: 11/14/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Yaws is a neglected tropical disease, caused by Treponema pallidum subsp. pertenue. The disease causes chronic lesions, primarily in young children living in remote villages in tropical climates. As part of a global yaws eradication campaign initiated by the World Health Organization, we sought to develop and evaluate a molecular typing method to distinguish different strains of T. pallidum subsp. pertenue for disease control and epidemiological purposes. METHODS AND PRINCIPAL FINDINGS Published genome sequences of strains of T. pallidum subsp. pertenue and pallidum were compared to identify polymorphic genetic loci among the strains. DNA from a number of existing historical Treponema isolates, as well as a subset of samples from yaws patients collected in Lihir Island, Papua New Guinea, were analyzed using these targets. From these data, three genes (tp0548, tp0136 and tp0326) were ultimately selected to give a high discriminating capability among the T. pallidum subsp. pertenue samples tested. Intragenic regions of these three target genes were then selected to enhance the discriminating capability of the typing scheme using short readily amplifiable loci. This 3-gene multilocus sequence typing (MLST) method was applied to existing historical human yaws strains, the Fribourg-Blanc simian isolate, and DNA from 194 lesion swabs from yaws patients on Lihir Island, Papua New Guinea. Among all samples tested, fourteen molecular types were identified, seven of which were found in patient samples and seven among historical isolates or DNA. Three types (JG8, TD6, and SE7) were predominant on Lihir Island. CONCLUSIONS This MLST approach allows molecular typing and differentiation of yaws strains. This method could be a useful tool to complement epidemiological studies in regions where T. pallidum subsp. pertenue is prevalent with the overall goals of improving our understanding of yaws transmission dynamics and helping the yaws eradication campaign to succeed.
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Affiliation(s)
- Charmie Godornes
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Lorenzo Giacani
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Alyssa E. Barry
- Division of Population Health and Immunity, Walter and Eliza Hall Institute, Parkville, Australia
- Department of Medical Biology, University of Melbourne, Parkville, Australia
| | - Oriol Mitja
- Barcelona Institute for Global Health, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
- Division of Public Health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
- Lihir Medical Center, International SOS-Newcrest Mining, Lihir Island, Papua New Guinea
| | - Sheila A. Lukehart
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
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Fitzpatrick C, Asiedu K, Sands A, Gonzalez Pena T, Marks M, Mitja O, Meheus F, Van der Stuyft P. The cost and cost-effectiveness of rapid testing strategies for yaws diagnosis and surveillance. PLoS Negl Trop Dis 2017; 11:e0005985. [PMID: 29073145 PMCID: PMC5658197 DOI: 10.1371/journal.pntd.0005985] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 09/21/2017] [Indexed: 11/29/2022] Open
Abstract
Background Yaws is a non-venereal treponemal infection caused by Treponema pallidum subspecies pertenue. The disease is targeted by WHO for eradication by 2020. Rapid diagnostic tests (RDTs) are envisaged for confirmation of clinical cases during treatment campaigns and for certification of the interruption of transmission. Yaws testing requires both treponemal (trep) and non-treponemal (non-trep) assays for diagnosis of current infection. We evaluate a sequential testing strategy (using a treponemal RDT before a trep/non-trep RDT) in terms of cost and cost-effectiveness, relative to a single-assay combined testing strategy (using the trep/non-trep RDT alone), for two use cases: individual diagnosis and community surveillance. Methods We use cohort decision analysis to examine the diagnostic and cost outcomes. We estimate cost and cost-effectiveness of the alternative testing strategies at different levels of prevalence of past/current infection and current infection under each use case. We take the perspective of the global yaws eradication programme. We calculate the total number of correct diagnoses for each strategy over a range of plausible prevalences. We employ probabilistic sensitivity analysis (PSA) to account for uncertainty and report 95% intervals. Results At current prices of the treponemal and trep/non-trep RDTs, the sequential strategy is cost-saving for individual diagnosis at prevalence of past/current infection less than 85% (81–90); it is cost-saving for surveillance at less than 100%. The threshold price of the trep/non-trep RDT (below which the sequential strategy would no longer be cost-saving) is US$ 1.08 (1.02–1.14) for individual diagnosis at high prevalence of past/current infection (51%) and US$ 0.54 (0.52–0.56) for community surveillance at low prevalence (15%). Discussion We find that the sequential strategy is cost-saving for both diagnosis and surveillance in most relevant settings. In the absence of evidence assessing relative performance (sensitivity and specificity), cost-effectiveness is uncertain. However, the conditions under which the combined test only strategy might be more cost-effective than the sequential strategy are limited. A cheaper trep/non-trep RDT is needed, costing no more than US$ 0.50–1.00, depending on the use case. Our results will help enhance the cost-effectiveness of yaws programmes in the 13 countries known to be currently endemic. It will also inform efforts in the much larger group of 71 countries with a history of yaws, many of which will have to undertake surveillance to confirm the interruption of transmission. Yaws is a non-venereal treponemal infection. The disease is targeted by WHO for eradication by 2020. Testing is envisaged for diagnosis to confirm of clinical cases during treatment campaigns and for surveillance to certify the interruption of transmission. However resources available to the global eradication programme are severely limited and the cost of testing must be contained. Testing requires simultaneous detection of antibodies to both treponemal and non-treponemal antigens for diagnosis of active infection. Currently, there is one commercially available rapid diagnostic test for yaws that can do just that. However, it is considerably more expensive than the available syphilis tests detecting treponemal antibodies only. We evaluate the cost and cost-effectiveness of a sequential testing strategy (using the treponemal test first, before the combined test), relative to a combined testing strategy (using only the combined test). We consider the two use cases: individual diagnosis and community surveillance. We find that the sequential strategy is cost-saving for both diagnosis and surveillance in most relevant settings. Yaws eradication programme should consider adopting the sequential strategy. Still, a cheaper trep/non-trep RDT is needed, costing no more than US$ 0.50–1.00. Our results will help enhance the cost-effectiveness of yaws programmes in the 13 countries known to be currently endemic. It will also inform efforts in the much larger group of 71 countries with a history of yaws, many of which will have to undertake surveillance to confirm the interruption of transmission.
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Affiliation(s)
- Christopher Fitzpatrick
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
- * E-mail:
| | - Kingsley Asiedu
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Anita Sands
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Tita Gonzalez Pena
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, United States of America
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Oriol Mitja
- Barcelona Institute for Global Health, Hospital Clinic -University of Barcelona, Barcelona, Spain
| | - Filip Meheus
- Unit of Epidemiology and Control of Neglected Tropical Diseases, Institute of Tropical Medicine, Antwerp, Belgium
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
| | - Patrick Van der Stuyft
- Unit of General Epidemiology and Disease Control, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Public Health, Ghent University, Ghent, Belgium
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Houinei W, Godornes C, Kapa A, Knauf S, Mooring EQ, González-Beiras C, Watup R, Paru R, Advent P, Bieb S, Sanz S, Bassat Q, Spinola SM, Lukehart SA, Mitjà O. Haemophilus ducreyi DNA is detectable on the skin of asymptomatic children, flies and fomites in villages of Papua New Guinea. PLoS Negl Trop Dis 2017; 11:e0004958. [PMID: 28489855 PMCID: PMC5425006 DOI: 10.1371/journal.pntd.0004958] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 08/08/2016] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Haemophilus ducreyi and Treponema pallidum subsp. pertenue are major causes of leg ulcers in children in Africa and the Pacific Region. We investigated the presence of DNA (PCR positivity) from these bacteria on asymptomatic people, flies, and household linens in an endemic setting. METHODOLOGY/PRINCIPAL FINDINGS We performed a cross-sectional study in rural villages of Lihir Island, Papua New Guinea during a yaws elimination campaign. Participants were asymptomatic subjects recruited from households with cases of leg ulcers, and from households without cases of leg ulcers. We rubbed swabs on the intact skin of the leg of asymptomatic individuals, and collected flies and swabs of environmental surfaces. All specimens were tested by PCR for H. ducreyi and T. p. pertenue DNA. Of 78 asymptomatic participants that had an adequate specimen for DNA detection, H. ducreyi-PCR positivity was identified in 16 (21%) and T. p. pertenue-PCR positivity in 1 (1%). In subgroup analyses, H. ducreyi-PCR positivity did not differ in participants exposed or not exposed to a case of H. ducreyi ulcer in the household (24% vs 18%; p = 0.76). Of 17 cultures obtained from asymptomatic participants, 2 (12%) yielded a definitive diagnosis of H. ducreyi, proving skin colonization. Of 10 flies tested, 9 (90%) had H. ducreyi DNA and 5 (50%) had T. p. pertenue DNA. Of 6 bed sheets sampled, 2 (33%) had H. ducreyi DNA and 1 (17%) had T. p. pertenue DNA. CONCLUSIONS/SIGNIFICANCE This is the first time that H. ducreyi DNA and colonization has been demonstrated on the skin of asymptomatic children and that H. ducreyi DNA and T. p. pertenue DNA has been identified in flies and on fomites. The ubiquity of H. ducreyi in the environment is a contributing factor to the spread of the organism.
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Affiliation(s)
- Wendy Houinei
- Disease Control Branch, National Department of Health, Port Moresby, Papua New Guinea
| | - Charmie Godornes
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - August Kapa
- Lihir Medical Centre– International SOS, Newcrest Mining, Lihir Island, Papua New Guinea
| | - Sascha Knauf
- German Primate Center, Leibniz-Institute for Primate Research, Pathology Unit, Working Group Neglected Tropical Diseases, Göttingen, Germany
| | - Eric Q. Mooring
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Ronald Watup
- Lihir Medical Centre– International SOS, Newcrest Mining, Lihir Island, Papua New Guinea
| | - Raymond Paru
- Lihir Medical Centre– International SOS, Newcrest Mining, Lihir Island, Papua New Guinea
| | - Paul Advent
- Lihir Medical Centre– International SOS, Newcrest Mining, Lihir Island, Papua New Guinea
| | - Sivauk Bieb
- Disease Control Branch, National Department of Health, Port Moresby, Papua New Guinea
| | - Sergi Sanz
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic-University of Barcelona, Barcelona, Spain
| | - Quique Bassat
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic-University of Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Stanley M. Spinola
- Departments of Microbiology and Immunology, Medicine, and Pathology and Laboratory Medicine Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Sheila A. Lukehart
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Oriol Mitjà
- Lihir Medical Centre– International SOS, Newcrest Mining, Lihir Island, Papua New Guinea
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic-University of Barcelona, Barcelona, Spain
- Division of Public Health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
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Marks M, Sokana O, Nachamkin E, Puiahi E, Kilua G, Pillay A, Bottomley C, Solomon AW, Mabey DC. Prevalence of Active and Latent Yaws in the Solomon Islands 18 Months after Azithromycin Mass Drug Administration for Trachoma. PLoS Negl Trop Dis 2016; 10:e0004927. [PMID: 27551787 PMCID: PMC4994934 DOI: 10.1371/journal.pntd.0004927] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/25/2016] [Indexed: 11/30/2022] Open
Abstract
Introduction Both yaws and trachoma are endemic in the Pacific. Mass treatment with azithromycin is the mainstay of the WHO strategy for both the eradication of yaws and the elimination of trachoma as a public health problem, but the dose recommended for trachoma is lower than that for yaws. In countries where both diseases are endemic, there is a potential for synergy between yaws and trachoma control programs if mass treatment with the lower dose of azithromycin was shown to be effective for the treatment of yaws. In an earlier study, we demonstrated a profound reduction in the clinical and serological prevalence of yaws following a single round of mass treatment with azithromycin 20 mg/kg undertaken for the purposes of trachoma elimination. Methods This survey was conducted 18 months following a single round of azithromycin mass treatment in the same communities in which we had conducted our previous six-month follow-up survey. We examined children aged 1–14 years and took blood and lesion samples for yaws diagnosis using the Treponema pallidum particle agglutination assay (TPPA) and the non-treponemal Rapid Plasma Reagin (RPR) test. Results A total of 1,284 children were enrolled in the study. Amongst children aged 5–14 years, 223 had a positive TPPA (27.5%, 95% CI 13.6–47.7%). The TPPA seroprevalence amongst this age group did not differ significantly from either our pre-mass treatment survey or our initial follow-up survey. Thirty-five children had positive TPPA and positive RPR (4.3%, 95% CI 2.1–8.7%), and this did not differ significantly from our initial post-mass drug administration (MDA) follow-up survey (4.3% versus 3.5%, p = 0.43) but remained significantly lower than our initial pre-MDA survey (4.3% vs 21.7%, p <0.0001). Village-level MDA coverage was strongly associated with dual-seropositivity (p = 0.005). Amongst children aged 1–4 years, 16 had a positive TPPA (3.5%, 95% CI 1.6–7.1%). This did not differ significantly from the seroprevalence in this age group that had been predicted based on our previous surveys (3.5% vs 5%, p = 0.11). Fourteen children (1.1%) were considered to have a skin lesion clinically consistent with yaws, but none of these individuals was seropositive for yaws. Of nine cases where a swab could be collected for PCR, all were negative for Treponema pallidum subsp. pertenue DNA. Discussion In this study we have shown that the benefit of a single round of mass treatment with azithromycin 20mg/kg appears to extend to 18 months without any further intervention. The lack of a significant change in seroprevalence from 6 to 18 months after mass treatment might suggest that interventions could be spaced at yearly intervals without a significant loss of impact, and that this might facilitate integration of yaws eradication with other neglected tropical disease (NTD) control programmes. MDA coverage above 90% was associated with significantly better outcomes than coverages lower than this threshold, and strategies to improve coverage at all stages of yaws eradication efforts should be investigated. Yaws is a neglected tropical disease caused by a bacterium closely related to the agent of syphilis. Mass treatment is recommended by WHO for the control of both yaws and the blinding eye disease trachoma, but the dose used for trachoma is lower (20 mg/kg versus 30 mg/kg). We have previously shown that a single round of mass treatment with azithromycin for trachoma had a significant impact on the number of cases of yaws in a community, suggesting that the lower dose of azithromycin might be effective for yaws and that trachoma and yaws programmes in the Pacific might be integrated. We repeated our survey 18 months following the initial round of mass treatment to see if the benefit seen at 6 months had persisted. In this study, the number of yaws cases remained significantly lower than before mass treatment even without any additional public health interventions taking place in the 18 months between MDA and this follow-up. This might suggest that annual mass treatment could be used rather than the current recommendation of six monthly treatment. An annual treatment strategy might facilitate integrating yaws eradication efforts with other NTD control programmes.
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Affiliation(s)
- Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Hospital for Tropical Diseases, London, United Kingdom
- * E-mail:
| | - Oliver Sokana
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Eli Nachamkin
- Molecular Diagnostics & Typing Laboratory, Laboratory Reference & Research Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Elliot Puiahi
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Georgina Kilua
- World Health Organization, Western Pacific Region Office, Honiara, Solomon Islands
| | - Allan Pillay
- Molecular Diagnostics & Typing Laboratory, Laboratory Reference & Research Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Christian Bottomley
- Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anthony W. Solomon
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Hospital for Tropical Diseases, London, United Kingdom
| | - David C. Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Hospital for Tropical Diseases, London, United Kingdom
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Affiliation(s)
- Anthony W. Solomon
- World Health Organization, Department of Control of Neglected Tropical Diseases, Geneva, Switzerland
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Hospital for Tropical Diseases, London, United Kingdom
| | - Diana L. Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alexei Mikhailov
- World Health Organization, Department of Control of Neglected Tropical Diseases, Geneva, Switzerland
| | - Rebecca M. Flueckiger
- International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia, United States of America
| | - Oriol Mitjà
- Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Hospital Clinic, University of Barcelona, Barcelona, Spain
- Lihir Medical Centre—International SOS, Newcrest Mining, Lihir Island, Papua New Guinea
| | - Kingsley Asiedu
- World Health Organization, Department of Control of Neglected Tropical Diseases, Geneva, Switzerland
| | - Jean Jannin
- World Health Organization, Department of Control of Neglected Tropical Diseases, Geneva, Switzerland
| | - Dirk Engels
- World Health Organization, Department of Control of Neglected Tropical Diseases, Geneva, Switzerland
| | - David C. W. Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Hospital for Tropical Diseases, London, United Kingdom
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Marks M, Mitjà O, Vestergaard LS, Pillay A, Knauf S, Chen CY, Bassat Q, Martin DL, Fegan D, Taleo F, Kool J, Lukehart S, Emerson PM, Solomon AW, Ye T, Ballard RC, Mabey DCW, Asiedu KB. Challenges and key research questions for yaws eradication. Lancet Infect Dis 2015; 15:1220-1225. [PMID: 26362174 PMCID: PMC4668588 DOI: 10.1016/s1473-3099(15)00136-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/08/2015] [Accepted: 06/10/2015] [Indexed: 01/02/2023]
Abstract
Yaws is endemic in west Africa, southeast Asia, and the Pacific region. To eradicate yaws by 2020, WHO has launched a campaign of mass treatment with azithromycin. Progress has been made towards achievement of this ambitious goal, including the validation of point-of-care and molecular diagnostic tests and piloting of the strategy in several countries, including Ghana, Vanuatu, and Papua New Guinea. Gaps in knowledge need to be addressed to allow refinement of the eradication strategy. Studies exploring determinants of the spatial distribution of yaws are needed to help with the completion of baseline mapping. The finding that Haemophilus ducreyi causes lesions similar to yaws is particularly important and further work is needed to assess the effect of azithromycin on these lesions. The integration of diagnostic tests into different stages of the eradication campaign needs investigation. Finally, studies must be done to inform the optimum mass-treatment strategy for sustainable interruption of transmission.
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Affiliation(s)
- Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK.
| | - Oriol Mitjà
- ISGlobal, Barcelona Centre for International Health Research, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Lihir Medical Centre, International SOS, Newcrest Mining, Lihir Island, Papua New Guinea
| | - Lasse S Vestergaard
- Division for Communicable Diseases, Regional Office for the Western Pacific, World Health Organization, Manila, Philippines
| | - Allan Pillay
- Molecular Diagnostics and Typing Laboratory, Laboratory Reference and Research Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sascha Knauf
- German Primate Center, Leibniz-Institute for Primate Research, Pathology Unit, Working Group Neglected Tropical Diseases, Göttingen, Germany
| | - Cheng-Yen Chen
- Molecular Diagnostics and Typing Laboratory, Laboratory Reference and Research Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Quique Bassat
- ISGlobal, Barcelona Centre for International Health Research, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Diana L Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David Fegan
- World Health Organization Consultant, Springhill, Brisbane, Queensland, Australia
| | | | - Jacob Kool
- World Health Organization, Vanuatu Country Office, Port Vila, Vanuatu
| | - Sheila Lukehart
- Departments of Medicine and Global Health, University of Washington, Seattle, WA, USA
| | - Paul M Emerson
- International Trachoma Initiative, The Task Force for Global Health, Decatur, GA, USA
| | - Anthony W Solomon
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK; Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Tun Ye
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ronald C Ballard
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David C W Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK
| | - Kingsley B Asiedu
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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23
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Marks M, Katz S, Chi KH, Vahi V, Sun Y, Mabey DC, Solomon AW, Chen CY, Pillay A. Failure of PCR to Detect Treponema pallidum ssp. pertenue DNA in Blood in Latent Yaws. PLoS Negl Trop Dis 2015; 9:e0003905. [PMID: 26125585 PMCID: PMC4488379 DOI: 10.1371/journal.pntd.0003905] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 06/13/2015] [Indexed: 11/18/2022] Open
Abstract
Yaws, caused by Treponema pallidum ssp. pertenue, is a neglected tropical disease closely related to venereal syphilis and is targeted for eradication by 2020. Latent yaws represents a diagnostic challenge, and current tools cannot adequately distinguish between individuals with true latent infection and individuals who are serofast following successful treatment. PCR on blood has previously been shown to detect T. pallidum DNA in patients with syphilis, suggesting that this approach may be of value in yaws. We performed real-time PCR for Treponema pallidum ssp. pertenue on blood samples from 140 children with positive T. pallidum Particle Agglutination (TPPA) and Rapid Plasma Reagin (RPR) tests and 7 controls (negative serology), all collected as part of a prospective study of yaws in the Solomon Islands. All samples were also tested by a nested PCR for T. pallidum. 12 patients had clinical evidence of active yaws whilst 128 were considered to have latent yaws. 43 children had high titre rapid plasma reagins (RPRs) of ≥1:32. PCR testing with both assays gave negative results in all cases. It is possible that the failure to detect T. pallidum ssp. pertenue in blood reflects lower loads of organism in latent yaws compared to those in latent infection with T. pallidum ssp. pertenue, and/or a lower propensity for haematogenous dissemination in yaws than in syphilis. As the goal of the yaws control programme is eradication, a tool that can differentiate true latent infection from individuals who are serofast would be of value; however, PCR of blood is not that tool. Yaws is a bacterial infection closely related to syphilis. The WHO has launched a worldwide campaign to eradicate yaws by 2020. For each clinically apparent case, many close contacts are infected but do not show clinical signs, which is called latent yaws. Currently, diagnosis for these patients relies on the detection of antibodies using syphilis serology. Reliance on detection of antibodies for diagnosis of latent yaws is problematic as the test may remain positive with a low titre despite successful treatment. This makes the interpretation of surveillance data in a post-mass treatment setting difficult for programme managers. In syphilis, PCR can detect T. pallidum ssp. pallidum in the blood of patients with latent disease. We used similar techniques to try and detect the yaws bacterium in the blood of patients seen as part of a study of yaws in the Solomon Islands. Although many people had positive antibodies for yaws consistent with latent yaws, we were unable to detect the bacterium in the blood. This may reflect the lower virulence of the yaws bacterium compared to syphilis. Currently available molecular techniques are therefore not able to aid programme managers in conducting post-mass drug administration surveillance for latent yaws. The development of alternative diagnostic tests should be considered.
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Affiliation(s)
- Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Hospital for Tropical Diseases, London, United Kingdom
- * E-mail:
| | - Samantha Katz
- Laboratory Reference and Research Branch, Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kai-Hua Chi
- Laboratory Reference and Research Branch, Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ventis Vahi
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Yongcheng Sun
- Laboratory Reference and Research Branch, Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - David C. Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Hospital for Tropical Diseases, London, United Kingdom
| | - Anthony W. Solomon
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Hospital for Tropical Diseases, London, United Kingdom
| | - Cheng Y. Chen
- Laboratory Reference and Research Branch, Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Allan Pillay
- Laboratory Reference and Research Branch, Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Mitjà O, Houinei W, Moses P, Kapa A, Paru R, Hays R, Lukehart S, Godornes C, Bieb SV, Grice T, Siba P, Mabey D, Sanz S, Alonso PL, Asiedu K, Bassat Q. Mass treatment with single-dose azithromycin for yaws. N Engl J Med 2015; 372:703-10. [PMID: 25693010 DOI: 10.1056/nejmoa1408586] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mass treatment with azithromycin is a central component of the new World Health Organization (WHO) strategy to eradicate yaws. Empirical data on the effectiveness of the strategy are required as a prerequisite for worldwide implementation of the plan. METHODS We performed repeated clinical surveys for active yaws, serologic surveys for latent yaws, and molecular analyses to determine the cause of skin ulcers and identify macrolide-resistant mutations before and 6 and 12 months after mass treatment with azithromycin on a Papua New Guinean island on which yaws was endemic. Primary-outcome indicators were the prevalence of serologically confirmed active infectious yaws in the entire population and the prevalence of latent yaws with high-titer seroreactivity in a subgroup of children 1 to 15 years of age. RESULTS At baseline, 13,302 of 16,092 residents (82.7%) received one oral dose of azithromycin. The prevalence of active infectious yaws was reduced from 2.4% before mass treatment to 0.3% at 12 months (difference, 2.1 percentage points; P<0.001). The prevalence of high-titer latent yaws among children was reduced from 18.3% to 6.5% (difference, 11.8 percentage points; P<0.001) with a near-absence of high-titer seroreactivity in children 1 to 5 years of age. Adverse events identified within 1 week after administration of the medication occurred in approximately 17% of the participants, included nausea, diarrhea, and vomiting, and were mild in severity. No evidence of emergence of resistance to macrolides against Treponema pallidum subspecies pertenue was seen. CONCLUSIONS The prevalence of active and latent yaws infection fell rapidly and substantially 12 months after high-coverage mass treatment with azithromycin, with the reduction perhaps aided by subsequent activities to identify and treat new cases of yaws. Our results support the WHO strategy for the eradication of yaws. (Funded by Newcrest Mining and International SOS; YESA-13 ClinicalTrials.gov number, NCT01955252.).
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Affiliation(s)
- Oriol Mitjà
- From Lihir Medical Center, International SOS, Newcrest Mining, Lihir Island (O.M., P.M., A.K., R.P.), the Disease Control Branch, National Department of Health, Port Moresby (W.H., S.V.B.), and the Papua New Guinea Institute of Medical Research, Goroka, Eastern Highland Province (P.S.) - all in Papua New Guinea; Barcelona Institute for Global Health, Barcelona Center for International Health Research, Hospital Clinic, University of Barcelona, Barcelona (O.M., S.S., P.L.A., Q.B.); the College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD (R.H.), and the Centre for Social Responsibility in Mining, Sustainable Minerals Institute, University of Queensland, Brisbane (T.G.) - both in Australia; the Departments of Medicine (S.L., C.G.) and Global Health (S.L.), University of Washington, Seattle; the Department of Clinical Research, London School of Hygiene and Tropical Medicine, London (D.M.); and the Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva (K.A.)
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Marks M, Goncalves A, Vahi V, Sokana O, Puiahi E, Zhang Z, Dalipanda T, Bottomley C, Mabey D, Solomon AW. Evaluation of a rapid diagnostic test for yaws infection in a community surveillance setting. PLoS Negl Trop Dis 2014; 8:e3156. [PMID: 25211018 PMCID: PMC4161315 DOI: 10.1371/journal.pntd.0003156] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 07/22/2014] [Indexed: 11/18/2022] Open
Abstract
Yaws is a non-venereal treponemal infection caused by Treponema pallidum ssp. pertenue. The WHO has launched a worldwide control programme, which aims to eradicate yaws by 2020. The development of a rapid diagnostic test (RDT) for serological diagnosis in the isolated communities affected by yaws is a key requirement for the successful implementation of the WHO strategy. We conducted a study to evaluate the utility of the DPP test in screening for yaws, utilizing samples collected as part of a community prevalence survey conducted in the Solomon Islands. 415 serum samples were tested using both traditional syphilis serology (TPPA and quantitative RPR) and the Chembio DPP Syphilis Screen and Confirm RDT. We calculated the sensitivity and specificity of the RDT as compared to gold standard serology. The sensitivity of the RDT against TPPA was 58.5% and the specificity was 97.6%. The sensitivity of the RDT against RPR was 41.7% and the specificity was 95.2%. The sensitivity of the DPP was strongly related to the RPR titre with a sensitivity of 92.0% for an RPR titre of >1/16. Wider access to DPP testing would improve our understanding of worldwide yaws case reporting and the test may play a key role in assessing patients presenting with yaws like lesions in a post-mass drug administration (MDA) setting.
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Affiliation(s)
- Michael Marks
- Clinical Research Department, Faculty of Tropical and Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, Mortimer Market, London, United Kingdom
| | - Adriana Goncalves
- Clinical Research Department, Faculty of Tropical and Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ventis Vahi
- Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Oliver Sokana
- Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Elliot Puiahi
- Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Zaixing Zhang
- World Health Organization, Western Pacific Region Office, Honiara, Solomon Islands
| | - Tenneth Dalipanda
- Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Christian Bottomley
- Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - David Mabey
- Clinical Research Department, Faculty of Tropical and Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, Mortimer Market, London, United Kingdom
| | - Anthony W. Solomon
- Clinical Research Department, Faculty of Tropical and Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, Mortimer Market, London, United Kingdom
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Krishnakumar G. Endemic yaws in early 20th century Kerala. J Assoc Physicians India 2014; 62:335-336. [PMID: 25327037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Paugh K. Yaws, syphilis, sexuality, and the circulation of medical knowledge in the British Caribbean and the Atlantic world. Bull Hist Med 2014; 88:225-252. [PMID: 24976161 DOI: 10.1353/bhm.2014.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This history of the disease categories "yaws" and "syphilis" explores the interplay between European and African medical cultures in the early modern Atlantic world. The assertion made by both early modern and modern medical authorities, that yaws and syphilis are the same disease, prompts a case study of the history of disease that reflects on a variety of issues in the history of medicine: the use of ideas about contagion to demarcate racial and sexual difference at sites around the British Empire; the contrast between persistently holistic ideas about disease causation in the Black Atlantic and the growth of ontological theories of disease among Europeans and Euro-Americans; and the controversy over the African practice of yaws inoculation, which may once have been an effective treatment but was stamped out by plantation owners who viewed it as a waste of their enslaved laborers' valuable time.
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Abstract
Improved understanding of the differential diagnosis of endemic treponematoses is needed to inform clinical practice and to ensure the best outcome for a new global initiative for the eradication of yaws, bejel, and pinta. Traditionally, the human treponematoses have been differentiated based upon their clinical manifestations and epidemiologic characteristics because the etiologic agents are indistinguishable in the laboratory. Serological tests are still considered standard laboratory methods for the diagnosis of endemic treponematoses and new rapid point-of-care treponemal tests have become available which are extremely useful in low-resource settings. In the past ten years, there has been an increasing effort to apply polymerase chain reaction to treponematoses and whole genome fingerprinting techniques have identified genetic signatures that can differentiate the existing treponemal strains; however, definitive diagnosis is also hampered by widespread unavailability of molecular diagnostics. We review the dilemmas in the diagnosis of endemic treponematoses, and advances in the discovery of new diagnostic tools.
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Affiliation(s)
- Oriol Mitjà
- Barcelona Centre for International Health Research, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Lihir Medical Centre-InternationalSOS, Lihir Island, Papua New Guinea
| | - David Šmajs
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Quique Bassat
- Lihir Medical Centre-InternationalSOS, Lihir Island, Papua New Guinea
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Abstract
Yaws is an infectious disease caused by Treponema pallidum pertenue-a bacterium that closely resembles the causative agent of syphilis-and is spread by skin-to-skin contact in humid tropical regions. Yaws causes disfiguring, and sometimes painful lesions of the skin and bones. As with syphilis, clinical manifestations can be divided into three stages; however, unlike syphilis, mother-to-child transmission does not occur. A major campaign to eradicate yaws in the 1950s and 1960s, by mass treatment of affected communities with longacting, injectable penicillin, reduced the number of cases by 95% worldwide, but yaws has reappeared in recent years in Africa, Asia, and the western Pacific. In 2012, one oral dose of azithromycin was shown to be as effective as intramuscular penicillin in the treatment of the disease, and WHO launched a new initiative to eradicate yaws by 2020.
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Affiliation(s)
- Oriol Mitjà
- Barcelona Centre for International Health Research, Hospital Clinic, University of Barcelona, Barcelona, Spain
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30
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de Caprariis PJ, Della-Latta P. Serologic cross-reactivity of syphilis, yaws, and pinta. Am Fam Physician 2013; 87:80. [PMID: 23317070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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31
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Yaws, a non-venereal treponemal infection. Still endemic in some parts of the world. Prescrire Int 2012; 21:217-9. [PMID: 23016260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Yaws is an infection that mainly affects the poorest populations living in humid tropical areas. We reviewed the literature on yaws, the most common non-venereal treponemal infection, using the standard Prescrire methodology. Yaws is often transmitted directly from person to person. It starts as a single lesion, later leading to multiple contagious lesions. Yaws mainly affects children. The infection remains asymptomatic for several years. In about 10% of cases, late reactivation leads to bone lesions, deformities and disability. Diagnosis of yaws is based on the clinical and epidemiological context. Serological tests cannot distinguish between yaws and syphilis or other non-venereal treponematoses. Curative treatment consists of a single injection of benzathine benzylpenicillin. The results of a randomised trial suggest that a single oral dose of azithromycin is as effective as penicillin. In India, yaws was successfully eradicated through a programme based on providing information to the population at risk, screening and treatment.
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Smajs D, Norris SJ, Weinstock GM. Genetic diversity in Treponema pallidum: implications for pathogenesis, evolution and molecular diagnostics of syphilis and yaws. Infect Genet Evol 2012; 12:191-202. [PMID: 22198325 PMCID: PMC3786143 DOI: 10.1016/j.meegid.2011.12.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 12/05/2011] [Accepted: 12/07/2011] [Indexed: 02/08/2023]
Abstract
Pathogenic uncultivable treponemes, similar to syphilis-causing Treponema pallidum subspecies pallidum, include T. pallidum ssp. pertenue, T. pallidum ssp. endemicum and Treponema carateum, which cause yaws, bejel and pinta, respectively. Genetic analyses of these pathogens revealed striking similarity among these bacteria and also a high degree of similarity to the rabbit pathogen, Treponema paraluiscuniculi, a treponeme not infectious to humans. Genome comparisons between pallidum and non-pallidum treponemes revealed genes with potential involvement in human infectivity, whereas comparisons between pallidum and pertenue treponemes identified genes possibly involved in the high invasivity of syphilis treponemes. Genetic variability within syphilis strains is considered as the basis of syphilis molecular epidemiology with potential to detect more virulent strains, whereas genetic variability within a single strain is related to its ability to elude the immune system of the host. Genome analyses also shed light on treponemal evolution and on chromosomal targets for molecular diagnostics of treponemal infections.
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Affiliation(s)
- David Smajs
- Department of Biology, Faculty of Medicine, Masaryk University, Kamenice 5, Building A6, 625 00 Brno, Czech Republic.
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33
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Mitjà O, Hays R, Ipai A, Gubaila D, Lelngei F, Kirara M, Paru R, Bassat Q. Outcome predictors in treatment of yaws. Emerg Infect Dis 2011; 17. [PMID: 21749808 PMCID: PMC3363320 DOI: 10.3201/eid1706.101575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To estimate failure rates after treatment with benzathine penicillin and to identify determinants of failure that affected outcomes for yaws, we conducted a cohort study of 138 patients; treatment failed in 24 (17.4%). Having low initial titers on Venereal Disease Research Laboratory test and living in a village where yaws baseline incidence was high were associated with increased likelihood of treatment failure.
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Affiliation(s)
- Oriol Mitjà
- Lihir Medical Centre, Lihir Island, Papua New Guinea.
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34
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Guerrier G, Marcon S, Garnotel L, Deltour R, Schinas S, Mathelin JP, Chouvin C, Metge O, Daronat JM. Yaws in Polynesia's Wallis and Futuna Islands: a seroprevalence survey. N Z Med J 2011; 124:29-31. [PMID: 21750592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We carried out a serological and clinical survey to determine the prevalence and clinical presentation of yaws on two twin islands in Polynesia: Wallis and Futuna. A total of 264 serum samples were tested for specific Treponema pallidum haemagglutinations assay and non-specific rapid plasma reagin: 52 were positive for one or both tests; only one young adult had skin lesion consistent with yaws; and there were no observed cases of secondary or tertiary yaws. Our results contrast with findings in neighbouring islands, such as Vanuatu, where yaws has been reported to resurge. This difference might be explained by better availability and accessibility of healthcare on Wallis and Futuna, thus allowing widespread use of antibiotics for other bacterial diseases.
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Affiliation(s)
- Gilles Guerrier
- Department of Medicine, Sia Hospital, Mata’Utu, Wallis and Futuna.
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35
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36
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Affiliation(s)
- Joshua B Young
- Division of Emergency Medicine, Stanford University Medical Center, Palo Alto, California, USA
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37
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Morand JJ, Simon F, Garnotel E, Mahé A, Clity E, Morlain B. [Overview of endemic treponematoses]. Med Trop (Mars) 2006; 66:15-20. [PMID: 16615610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
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.
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Affiliation(s)
- J J Morand
- Service de dermatologie, HIA Laveran, 13998 Marseille Armées, France.
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38
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Mafart B. Regarding Mohamed, facial lesions resembling to leprosy. Int J Lepr Other Mycobact Dis 2002; 70:126-7. [PMID: 12211899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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39
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Maier H, Césaire R, Bera O, Kerob-Bauchet B, Ould Amar AK, Desbois N, Follea G. [The role of yaws in the serologic screening of treponematoses in blood donors in Martinique]. Transfus Clin Biol 2001; 8:403-9. [PMID: 11729394 DOI: 10.1016/s1246-7820(01)00191-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Using TPHA instead of VDRL for syphilis blood-screening since 1995 showed an important increase of positive blood donors in Martinique. Yaws, another treponema disease, has been present on the island until 1975-1980. Usual tests are unable to identify which type--venereal or non venereal--of treponema is involved. Our study, carried out from January 1995 to May 1999, compares actual serological and epidemiological characteristics of TPHA reactive donors to former studies. In our results, the frequency of reactive TPHA is about 1.04% in blood donations. Donors are carrying serological tracks of a past treponema disease with very low rate of antibodies, sometimes linked to yaws. Among donors aged 18 to 30, prevalence is low and is going to become similar to the rate observed in Continental France. This means that this problem will disappear in new donor generations. We suggest the possibility for them to continue blood donation, if their personal preliminary enquiry fits the admission criteria for blood giving.
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Affiliation(s)
- H Maier
- Etablissement français du sang, hôpital Pierre-Zobda Quitman, BP 666, 97261, Fort-de-France, Martinique
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Mohamed KB. Facial lesions resembling leprosy. Int J Lepr Other Mycobact Dis 2001; 69:35-7. [PMID: 11480315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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41
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Sandhu R, Khooshabeh R. Eccentric disciform lesions: a marker of treponemal disease? Eye (Lond) 2001; 15:104-7. [PMID: 11318270 DOI: 10.1038/eye.2001.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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42
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Affiliation(s)
- J L Parish
- Department of Dermatology, Tulane University School of Medicine, New Orleans, Louisiana 70112, USA
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43
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Naafs B. Tropical holiday memories. Eur J Dermatol 1999; 9:500-5; quiz 506. [PMID: 10610236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- B Naafs
- Leiden University Medical Centre, The Netherlands.
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44
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Parra J, Peiró C, Galiano R, Castillo A, Láinez JM, Sancho J. [A case of optic neuritis due to Treponema pallidum and treatment with megadoses of corticosteroids]. Rev Neurol 1999; 28:342. [PMID: 10714308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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45
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Buchwald D, Collier AC, Lukehart SA, Kith P, Goldstein E, Hooton TM. Evaluation of cerebrospinal fluid in Southeast Asian refugees with reactive serologic tests for syphilis. West J Med 1996; 165:289-93. [PMID: 8993199 PMCID: PMC1303845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
To determine the prevalence of cerebrospinal fluid abnormalities in Southeast Asian refugees with reactive serologic tests for syphilis, we evaluated 65 patients, 36 prospectively and 29 retrospectively, in a primary care clinic. Information was collected on history of treponemal infections, neurologic symptoms and signs, and total protein concentration, leukocyte count, and the VDRL test in the cerebrospinal fluid. Neurologic symptoms were reported by all patients for whom data were available. Abnormal neurologic signs were found or noted in medical records in 15 (42%) prospectively evaluated patients and 9 (64%) of 14 retrospectively evaluated patients for whom data were available. No patient had evidence of congenital or non-neurologic sequelae such as cutaneous or cardiovascular manifestations of syphilis. No patient had a positive cerebrospinal fluid VDRL test, 1 had more than 5 x 10(6) leukocytes per liter (5 leukocytes per mm3), and 6 (9%) had elevated total protein levels in the cerebrospinal fluid. Previous therapy for syphilis was not associated with lower serum VDRL reactions, neurologic symptoms and signs, or cerebrospinal fluid findings. In the absence of other indications, routine examination of the cerebrospinal fluid in seropositive Southeast Asian refugees who have nonspecific neurologic symptoms has a low yield, perhaps because of the high prevalence of yaws in this population, and may not be warranted.
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Affiliation(s)
- D Buchwald
- Department of Medicine, Harborview Medical Center, University of Washington School of Medicine, Seattle, USA
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46
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Abstract
A commercially available enzyme immunoassay (EIA), the Captia Syphilis-G immunoglobulin G (IgG) EIA, for the detection of IgG antibodies to Treponema pallidum was evaluated for use as a screening test for yaws (Treponema pallidum subsp. pertenue). The IgG EIA was compared with the fluorescent treponemal antibody absorption (FTA-ABS) test. All sera were also examined by the T. pallidum hemagglutination test and the Venereal Disease Research Laboratory test. Serum samples from 271 subjects (23 control serum samples from an area nonendemic for yaws, 58 control serum samples from an area endemic for yaws, and 190 serum samples from yaws patients and contacts) were investigated. The overall agreement between the IgG EIA and the FTA-ABS test was 90%, the sensitivity was 99%, and the specificity was 70.2%. The specificity fell as the endemicity of the disease increased: from 94.4% in the nonendemic area controls to 86.4% in the endemic area controls and to 52.3% in the yaws contacts. There was no difference in specificity between children and adults within each of the three groups. Fifteen children with clinical yaws were monitored for 9 months after treatment. The level of treponemal antibody fell consistently in 9 of the 15 children as measured by the antibody index (ratio of absorbance of the test serum to the mean absorbance of the low-titer-positive controls). Reinfection was seen in three children, with the antibody index rising with the Venereal Disease Research Laboratory test titer. The Captia Syphilis-G test is a sensitive assay for the detection of treponemal antibodies in yaws patients. However, the apparent low specificity of the test in the yaws endemic area limits its use as a screening test for yaws.
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Affiliation(s)
- J L Backhouse
- Department of Clinical Microbiology, Westmead Hospital, New South Wales, Australia
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Abstract
Assigning responsibility for the origins of treponemal disease has been complicated because of the (diagnostic) impreciseness of the historical written record and the inability to microbiologically distinguish among the treponematoses. Bedouin skeletal remains of individuals from the Negev area of Israel who had bejel, skeletons from the Todd human skeleton collection of individuals in whom syphilis was diagnosed, and skeletal remains from Guam of individuals who had yaws were analyzed to quantitatively assess their skeletal damage. The osseous reactions, although reproducible for each variety of treponemal disease, are not uniform among these skeletons. Examination of population frequency, demographics, character, and skeletal distribution of osseous treponemal damage in these skeletal sites provides clear, reproducible clues to the identity of the underlying treponematosis: bejel and yaws are common (> 20% according to skeletal findings) in the population. Syphilis and bejel usually spare the hands and feet. Yaws tends to be more polyostotic. Analysis of these parameters as population phenomena in pre-Columbian archeological sites should afford the opportunity to define the origins of the various treponemal disorders.
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Affiliation(s)
- B M Rothschild
- Arthritis Center of Northeast Ohio, Youngstown 44512, USA
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48
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Affiliation(s)
- V N Sehgal
- Department of Dermatology and Venereology, Lady Hardinge Medical College and Associated SK and KSC Hospitals, New Delhi, India
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49
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Bumann D, Bruns J. [Tertiary yaws--skeletal manifestations at the distal tibia]. Aktuelle Radiol 1994; 4:46-8. [PMID: 8136393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We describe the case of a 16-year old male patient from African presenting tertiary yaws at the distal tibia. Clinical signs, biochemical results and the different diagnostic imaging methods are demonstrated. Differential diagnosis and therapy are described.
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Affiliation(s)
- D Bumann
- Institut für Röntgendiagnostik, Universitäts-Krankenhaus Eppendorf, Hamburg
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50
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Abstract
The nonvenereal treponematoses--yaws, endemic syphilis, and pinta--constitute a major health concern for many third world countries. These diseases are caused by an organism that is morphologically and antigenically identical to the causative agent of venereal syphilis, Treponema pallidum. Nonvenereal treponematoses differ significantly in their modes of transmission, epidemiology, and clinical presentation from venereal syphilis. Like venereal syphilis, they have a chronic relapsing course and have prominent cutaneous manifestations. Recently, several cases of imported yaws and endemic syphilis have been described in Europe. With the escalating U.S. military presence in many remote areas of the world and ever-increasing world-wide travel, the diagnosis of the nonvenereal treponematoses must be considered in appropriate clinical and historical situations.
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Affiliation(s)
- A B Koff
- Department of Dermatology, Baylor College of Medicine, Houston, TX 77030
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