Dermatologic Manifestations of Yaws Workup

  • Author: Caroline L Levine, MD; Chief Editor: William D James, MD   more...
 
Updated: Jan 31, 2012
 

Laboratory Studies

  • Microscopy: Diagnosis is made by clinical evaluation of lesions and confirmed by detection of treponemes on dark-field microscopy of serum obtained by squeezing the bases of the lesions.
  • Serologic tests
    • Serologic tests are identical to those for venereal syphilis, including rapid plasma reagent (RPR) test, Venereal Disease Research Laboratory (VDRL) test, fluorescent treponemal antibody absorption (FTA-ABS) test, T pallidum immobilization (TPI) test, and T pallidum hemagglutination assay (TPHA).
    • RPR and VDRL tests are reactive 2-3 weeks after the onset of the primary lesion; they generally remain reactive throughout all stages.
    • No serologic test can distinguish yaws from other nonvenereal treponematoses; therefore, diagnosis is ultimately based on correlation of the clinical findings, epidemiologic history, and positive serologic results that are suggestive of yaws.
Next

Imaging Studies

  • Radiologic studies are nonspecific but can include any of the following findings:
    • Surface striations (periostitis)
    • Cortical thickening with bowing (saber shin deformity)
    • Spiculated periosteal reaction
    • General osseous expansion
    • Gummatous destruction
    • Draining sinuses
    • Epiphyseal separation
    • Stellate frontal bone scans
Previous
Next

Histologic Findings

Histologic findings in early yaws include acanthosis, papillomatosis, and spongiosis. Neutrophilic exocytosis with intraepidermal microabscess formation is the most characteristic finding. The dermis has a moderate-to-dense granulomatous infiltrate mainly composed of plasma cells and lymphocytes with few histiocytes, neutrophils, and eosinophils. Unlike syphilis, endothelial proliferation is absent or low.

Late yaws has histologic findings similar to that of tertiary syphilis, including an intense dermal infiltrate composed of epithelioid cells, giant cells, lymphocytes, and fibroblasts. Caseation necrosis can also be observed. Plasma cells and histiocytes, in contrast to early yaws, are scarce.

Silver stains (Steiner) can be used to identify numerous treponemes between keratinocytes in early yaws. They are seen in a bandlike pattern or in clusters in the epidermis. Unlike T pallidum, which is found in both the epidermis and the dermis, T pallidum subsp pertenue is almost entirely epidermotropic.

Electron microscopy of early lesions demonstrates scarce treponemes in clusters in the intercellular spaces of the epidermis among inflammatory cells, within the cytoplasm of macrophages, and in the dermis.

Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Caroline L Levine, MD  Staff Physician, Department of Dermatology, Emerson Hospital, Mt Aburn Hospital

Caroline L Levine, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Donald Belsito, MD  Professor of Clinical Dermatology, Department of Dermatology, Columbia University Medical Center

Donald Belsito, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Dermatology Foundation, New York County Medical Society, New York Dermatological Society, Noah Worcester Dermatological Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Paul Krusinski, MD  Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

References

  1. Lupi O, Madkan V, Tyring SK. Tropical dermatology: bacterial tropical diseases. J Am Acad Dermatol. Apr 2006;54(4):559-78; quiz 578-80. [Medline].

  2. Gerstl S, Kiwila G, Dhorda M, et al. Prevalence study of yaws in the Democratic Republic of Congo using the lot quality assurance sampling method. PLoS One. Jul 22 2009;4(7):e6338. [Medline].

  3. Guerrier G, Marcon S, Garnotel L, Deltour R, Schinas S, Mathelin JP, et al. Yaws in Polynesia's Wallis and Futuna Islands: a seroprevalence survey. N Z Med J. Apr 29 2011;124(1333):29-31. [Medline].

  4. Mitjà O, Hays R, Ipai A, Gubaila D, Lelngei F, Kiara M, et al. Outcome predictors in treatment of yaws. Emerg Infect Dis. Jun 2011;17(6):1083-5. [Medline].

  5. Etymologia: yaws. Emerg Infect Dis. Jun 2011;17(6):1082. [Medline].

  6. Rothschild BM, Heathcote GM. Characterization of the skeletal manifestations of the treponemal disease yaws as a population phenomenon. Clin Infect Dis. Aug 1993;17(2):198-203. [Medline].

  7. Farnsworth N, Rosen T. Endemic treponematosis: review and update. Clin Dermatol. May-Jun 2006;24(3):181-90. [Medline].

  8. Mitjà O, Hays R, Ipai A, Penias M, Paru R, Fagaho D, et al. Single-dose azithromycin versus benzathine benzylpenicillin for treatment of yaws in children in Papua New Guinea: an open-label, non-inferiority, randomised trial. Lancet. Jan 28 2012;379(9813):342-7. [Medline].

  9. Backhouse JL, Hudson BJ, Hamilton PA, Nesteroff SI. Failure of penicillin treatment of yaws on Karkar Island, Papua New Guinea. Am J Trop Med Hyg. Sep 1998;59(3):388-92. [Medline].

  10. Manirakiza A, Boas SV, Beyam NE, Zadanga G, Konamna FX, Njuimo SP, et al. Clinical outcome of skin yaws lesions after treatment with benzathinebenzylpenicillin in a pygmy population in Lobaye, Central African Republic. BMC Res Notes. Dec 15 2011;4(1):543. [Medline].

  11. Agmon-Levin N, Bat-sheva PK, Barzilai O, et al. Antitreponemal antibodies leading to autoantibody production and protection from atherosclerosis in Kitavans from Papua New Guinea. Ann N Y Acad Sci. Sep 2009;1173:675-82. [Medline].

  12. Engelkens HJ, ten Kate FJ, Judanarso J, et al. The localisation of treponemes and characterisation of the inflammatory infiltrate in skin biopsies from patients with primary or secondary syphilis, or early infectious yaws. Genitourin Med. Apr 1993;69(2):102-7. [Medline].

  13. Koff AB, Rosen T. Nonvenereal treponematoses: yaws, endemic syphilis, and pinta. J Am Acad Dermatol. Oct 1993;29(4):519-35; quiz 536-8. [Medline].

  14. Sanchez MR. Endemic (Nonvenereal) Treponematoses. In: Freedberg IM, Eisen AZ, Wolff K, Austen F, Goldsmith LA, Katz S, eds. Fitzpatrick's Dermatology in General Medicine. 6th ed. New York, NY: McGraw-Hill; 2003.

  15. Sehgal VN, Jain S, Bhattacharya SN, Thappa DM. Yaws control/eradication. Int J Dermatol. Jan 1994;33(1):16-20. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.