Yaws Clinical Presentation

  • Author: Natalie C Klein; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Aug 12, 2011
 

History

  • Primary lesions, also called mother yaw, develop at the site of inoculation after an incubation period of 3 weeks (range, 9-90 d) (as seen in the image below). Initial papilloma, also called mother yaw or primaInitial papilloma, also called mother yaw or primary frambesioma (from Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta. Geneva, Switzerland: World Health Organization; 1984.).
  • The primary lesion often appears at a site of prior skin injury or an insect bite.
  • During the incubation period, T pertenue invades the subcutaneous lymphatics and disseminates hematogenously.
  • The initial yaws lesion is a papule that enlarges to become a papilloma or frambesioma.
  • The yaws papilloma resolves spontaneously after 3-6 months.
  • Secondary yaws lesions may occur near primary lesions or elsewhere on the body.
  • Secondary yaws lesions may last for more than 6 months.
  • Macules, papules, nodules, and hyperkeratotic lesions may appear (as seen in the image below).Plantar papillomata with hyperkeratotic macular plPlantar papillomata with hyperkeratotic macular plantar early yaws (ie, crab yaws) (from Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta.Geneva, Switzerland: World Health Organization; 1984.).
  • Hyperkeratosis, referred to as crab yaws, may appear on palms and soles.
  • Lesions may ulcerate.
  • Bone and joint involvement may occur in early disease and may cause pain and swelling.
  • Climate influences the morphology and the number of lesions.
  • In the dry season, lesions are fewer and macular in appearance. Papillomas are found in moist areas of axilla, skin folds, and mucosal surfaces.
  • Secondary lesions heal spontaneously.
  • During latent periods, skin lesions may relapse for as long as 5 years after infection.
  • Most patients remain in a noninfectious latent stage for their lifetime.
  • Late yaws develops in 10% of cases, usually 5-10 years after disease onset.
  • Characteristic deformities, called saber shins (as seen in the image below), result from chronic untreated osteoperiostitis of the tibia. Osteoperiostitis of the tibia and fibula in early Osteoperiostitis of the tibia and fibula in early yaws (from Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta. Geneva, Switzerland: World Health Organization; 1984.).
  • Other lesions observed in patients with late yaws include monodactylitis, juxta-articular nodules, and gangosa (also called rhinopharyngitis mutilans), in which nasal cartilage is destroyed.
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Physical

  • Early yaws lesions
    • Papilloma
    • Serpiginous papilloma
    • Ulceropapillomata
    • Squamous macules (as seen in the image below)Squamous macular palmar yaws (from Perine PL, HopkSquamous macular palmar yaws (from Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta. Geneva, Switzerland: World Health Organization; 1984.).
    • Maculopapules
    • Nodules
    • Plaques
    • Hyperkeratosis of palms and soles
    • Bone and joint lesions
    • Generalized lymphadenopathy (may occur)
  • Late yaws lesions
    • Hyperkeratosis
    • Nodular scars
    • Gangosa
    • Saber tibia
    • Goundou
    • Monodactylitis
    • Juxta-articular nodules
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Causes

  • T pertenue is the causative agent.
  • T pertenue cannot be distinguished from T pallidum or Treponema carateum with morphology or laboratory tests.
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Contributor Information and Disclosures
Author

Natalie C Klein  MD, PhD, Associate Director, Infectious Disease Division, Associate Professor of Medicine, The School of Medicine at Stony Brook University Medical Center

Natalie C Klein is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and New York County Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Gary L Gorby, MD  Associate Professor, Departments of Internal Medicine and Medical Microbiology and Immunology, Division of Infectious Diseases, Creighton University School of Medicine; Associate Professor of Medicine, University of Nebraska Medical Center; Associate Chair, Omaha Veterans Affairs Medical Center

Gary L Gorby, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and New York Academy of Sciences

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Richard B Brown, MD, FACP  Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine

Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

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Initial papilloma, also called mother yaw or primary frambesioma (from Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta. Geneva, Switzerland: World Health Organization; 1984.).
Plantar papillomata with hyperkeratotic macular plantar early yaws (ie, crab yaws) (from Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta.Geneva, Switzerland: World Health Organization; 1984.).
Osteoperiostitis of the tibia and fibula in early yaws (from Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta. Geneva, Switzerland: World Health Organization; 1984.).
Early yaws papillomata (from Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta. Geneva, Switzerland: World Health Organization; 1984.).
Early ulceropapillomatous yaws on the leg (from Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta. Geneva, Switzerland: World Health Organization; 1984.).
Squamous macular palmar yaws (from Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta. Geneva, Switzerland: World Health Organization; 1984.).
 
 
 
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