Treatment Of Yaws Research Articles

Advances in the Treatment of Yaws.

Yaws is one of the three endemic treponematoses and is recognised by the World Health Organization as a neglected tropical disease. Yaws is currently reported in 15 countries in the Pacific, South-East Asia, West and Central Africa, predominantly affects children, and results in destructive lesions of the skin and soft tissues. For most of the twentieth century penicillin-based treatment was the standard of care and resistance to penicillin has still not been described. Recently, oral azithromycin has been shown to be an effective treatment for yaws, facilitating renewed yaws eradication efforts. Resistance to azithromycin is an emerging threat and close surveillance will be required as yaws eradication efforts are scaled up globally.

Knowledge, attitudes and practices towards yaws and yaws-like skin disease in Ghana.

IntroductionYaws is endemic in Ghana. The World Health Organization (WHO) has launched a new global eradication campaign based on total community mass treatment with azithromycin. Achieving high coverage of mass treatment will be fundamental to the success of this new strategy; coverage is dependent, in part, on appropriate community mobilisation. An understanding of community knowledge, attitudes and practices related to yaws in Ghana and other endemic countries will be vital in designing effective community engagement strategies.MethodsA verbally administered questionnaire was administered to residents in 3 districts in the Eastern region of Ghana where a randomised trial on the treatment of yaws was being conducted. The questionnaire combined both quantitative and qualitative questions covering perceptions of the cause and mechanisms of transmission of yaws-like lesions, the providers from which individuals would seek healthcare for yaws-like lesions, and what factors were important in reaching decisions on where to seek care. Chi-square tests and logistic regression were used to assess relationships between reported knowledge, attitudes and practices, and demographic variables. Thematic analysis of qualitative data was used to identify common themes.ResultsA total of 1,162 individuals participated. The majority of individuals (n = 895, 77%) reported that “germs” were the cause of yaws lesions. Overall 13% (n = 161) of respondents believed that the disease was caused by supernatural forces. Participants frequently mentioned lack of personal hygiene, irregular and inefficient bathing, and washing with dirty water as fundamental to both the cause and the prevention of yaws. A majority of individuals reported that they would want to take an antibiotic to prevent the development of yaws if they were asymptomatic (n = 689, 61.2%), but a substantial minority reported they would not want to do so. A majority of individuals (n = 839, 72.7%) reported that if they had a yaws-like skin lesion they would seek care from a doctor or nurse. Both direct and indirect costs of treatment were reported as key factors affecting where participants reported they would seek care.DiscussionThis is the first study that has explored community knowledge, attitudes and practices in relation to yaws in any endemic population. The belief that ‘germs’ are in some way related to disease through a variety of transmission routes including both contact and dirty water are similar to those reported for other skin diseases in Ghana. The prominent role of private healthcare providers is an important finding of this study and suggests engagement with this sector will be important in yaws eradication efforts. Strategies to address the substantial minority of individuals who reported they would not take treatment for yaws if they were currently asymptomatic will be needed to ensure the success of yaws eradication efforts. The data collected will be of value to the Ghana Health Service and also to WHO and other partners, who are currently developing community mobilisation tools to support yaws eradication efforts worldwide.

Recall of symptoms and treatment of syphilis and yaws by healthy blood donors screening positive for syphilis in Kumasi, Ghana.

To describe the recalled medical history, clinical manifestations, and treatment of yaws and syphilis by syphilis seroreactive blood donors in Kumasi, Ghana. Of the blood donors at Komfo Anokye Teaching Hospital, Kumasi, Ghana tested with the syphilis rapid diagnostic test (RDT) and later by rapid plasma reagin (RPR) test, 526 were seroreactive. Four hundred and seventy-one (89.5%) of these subjects were confirmed with the Ortho-Vitros Syphilis TP test as the gold standard and were interviewed to determine past or present clinical manifestations of yaws and syphilis. Of the 471 respondent donors, 28 (5.9%) gave a history of skin lesions and sores; four (14.3%) of these subjects, who were all male and RPR-positive, recalled a diagnosis of syphilis. All four reported having had skin lesions/bumps with slow-healing sores, but only one of them had had these symptoms before the age of 15 years. A small proportion of confirmed seroreactive donors in this sample had any recall of symptoms or treatment for yaws or syphilis. These data suggest that clinical questioning adds little further information to the current screening algorithm. The relative contribution of yaws and syphilis to frequent positive tests in endemic areas remains speculative.

Yaws.

Yaws is a non-venereal endemic treponemal infection caused by Treponema pallidum sub-species pertenue, a spirochaete bacterium closely related to Treponema pallidum ssp. pallidum, the agent of venereal syphilis. Yaws is a chronic, relapsing disease predominantly affecting children living in certain tropical regions. It spreads by skin-to-skin contact and, like syphilis, occurs in distinct clinical stages. It causes lesions of the skin, mucous membranes and bones which, without treatment, can become chronic and destructive. Treponema pallidum ssp. pertenue, like its sexually-transmitted counterpart, is exquisitely sensitive to penicillin. Infection with yaws or syphilis results in reactive treponemal serology and there is no widely available test to distinguish between these infections. Thus, migration of people from yaws-endemic areas to developed countries may present clinicians with diagnostic dilemmas. We review the epidemiology, clinical presentation and treatment of yaws.

Endemic treponemal diseases.

The endemic treponemal diseases, consisting of yaws, bejel (endemic syphilis) and pinta, are non-venereal infections closely related to syphilis, and are recognized by WHO as neglected tropical diseases (NTDs). Despite previous worldwide eradication efforts the prevalence of yaws has rebounded in recent years and the disease is now a major public health problem in 14 countries. Adequate data on the epidemiology of bejel and pinta is lacking. Each disease is restricted to a specific ecological niche but all predominantly affect poor, rural communities. As with venereal syphilis, the clinical manifestations of the endemic treponemal diseases are variable and can be broken down in to early stage and late stage disease. Current diagnostic techniques are unable to distinguish the different causative species but newer molecular techniques are now making this possible. Penicillin has long been considered the mainstay of treatment for the endemic treponemal diseases but the recent discovery that azithromycin is effective in the treatment of yaws has renewed interest in these most neglected of the NTDs, and raised hopes that global eradication may finally be possible.

Outcome Predictors in Treatment of Yaws

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.

Outcome Predictors in Treatment of Yaws

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.

Failure of penicillin treatment of yaws on Karkar Island, Papua New Guinea.

The endemic treponematosis yaws remains a significant cause of morbidity in many tropical countries, despite mass treatment campaigns to eradicate it. An outbreak of yaws in Marup village on Karkar Island, Papua New Guinea in 1988 provided an opportunity to monitor the outcome of treatment with penicillin over an extended period. Thirty-nine children with clinical yaws (6% of 632 examined) were monitored clinically and serologically, for nearly two years after mass treatment of all villagers with the World Health Organization recommended dosages of benzathine penicillin. Lesions resolved within one month of treatment in all but four (10%) children, three of whom were initially successfully retreated. Before treatment, the Venereal Disease Research Laboratory (VDRL) test result was reactive in 67% of the children and treponema-specific IgM antibody test results were reactive in 41%. Within six months of treatment, of those reactive, the VDRL titer decreased significantly in 25 (96%) of 26 and IgM antibody test results became negative in 13 (81%) of 16 children. However, by the end of follow-up, 11 (28%) of the 39 children had developed clinical and/or serologic evidence of relapse. In these children, response to further treatment was slow and, in three, evidence of active infection persisted or recurred, despite repeated courses. Exogenous reinfection was unlikely in this isolated community, in which the occurrence of yaws was closely monitored after universal treatment. Treatment failure was most likely to have been due to reduced susceptibility to penicillin of Treponema pallidum subsp. pertenue.

Radiological and dermatological findings in two patients suffering from early yaws in Indonesia.

Two children suffering from early yaws in Indonesia are presented. Apart from skin lesions and a positive treponemal serology in both patients, involvement of tubular bones, particularly of the hands, was revealed by radiological examination. In one patient involvement of a distal phalanx was remarkable. Early diagnosis and treatment of yaws is important since a delay in treatment may result in severe and irreversible bone deformities of the late stage of the disease. This report illustrates that radiological changes, although rare, can still be detected in the early stage of yaws in areas where yaws is resurgent nowadays.

Bismuth salicylate in the treatment of yaws

Bismuth salicylate in the treatment of yaws

Terramycin in the treatment of yaws and tropical ulcer

Terramycin in the treatment of yaws and tropical ulcer

Aureomycin in the treatment of yaws.

Aureomycin in the treatment of yaws.

Chloramphenicol in the treatment of yaws and tropical ulcer

Journal Article Chloramphenicol in the treatment of yaws and tropical ulcer Get access O. Ampofo, O. Ampofo Mampong-Akwapin, Gold Coast and Pharmacological Laboratories, School of Pharmacy, Bloomsbury Square, London, UK Search for other works by this author on: Oxford Academic PubMed Google Scholar G.M. Findlay G.M. Findlay Mampong-Akwapin, Gold Coast and Pharmacological Laboratories, School of Pharmacy, Bloomsbury Square, London, UK Search for other works by this author on: Oxford Academic PubMed Google Scholar Transactions of The Royal Society of Tropical Medicine and Hygiene, Volume 44, Issue 3, December 1950, Pages 315–318, https://doi.org/10.1016/0035-9203(50)90059-9 Published: 01 December 1950

The treatment of yaws by aureomycin

The treatment of yaws by aureomycin

Aureomycin in the Treatment of Yaws and Tropical Ulcer in Africa

AMONG the diseases which fill the out-patient departments of hospitals and dispensaries in tropical Africa, yaws and tropical ulcer are undoubtedly the most time-consuming. Up to the present, yaws has been treated solely by injections of bismuth, arsenicals or penicillin. The two former compounds are by no means free from toxic effects, and though penicillin is of low toxicity its use necessitates daily intramuscular injections which are not popular with the small children who form the bulk of patients treated for yaws. If a drug were effective in yaws when given by oral administration it would obviously be of very great value.

PENICILLIN THERAPY OF YAWS AND SEROLOGIC RESULTS

SOON after Mahoney, Arnold and Harris 1 demonstrated the efficacy of penicillin therapy in early syphilis, reports appeared in the literature attesting to a similar beneficial role in the treatment of yaws. The earlier publications 2 (table 1) indicated rapid clinical cure with relatively small doses of penicillin, but only a few patients attained seronegativity with the tests employed. In a preliminary report 2g published by us, the short term results of treatment of 500 patients with early yaws infections in Haiti were discussed. Penicillin was observed to hold definite promise as a therapeutic agent, but the serologic response at the end of three and six month intervals wassurprisingly disappointing. The present report deals in detail with evaluation of the serologic results obtained in the entire group treated at the end of twelve months' observations. METHOD Five hundred patients with primary and secondary yaws were selected for this study

Evaluation of Penicillin in the Treatment of Yaws

Summary An analysis of the results of treatment of 500 cases of primary and secondary yaws infections with penicillin, in aqueous solution and in oil with beeswax, is presented. Follow-up clinical and serologic observations were made on 446 of these patients for varying lengths of time up to 12 months. Three hundred and twenty (71.7 per cent) were followed for a period of 10 to 12 months after treatment. Clinical response to treatment was uniformly excellent, but serologic response was not. Only 16.6 per cent of the 446 patients were considered to show “apparent cure.” An additional 75.1 per cent showed “satisfactory progress”, totaling 91.7 per cent. The remaining 8.3 per cent of the patients showed “unsatisfactory progress.” In the latter group were included cases of “reinfection”, “clinical relapse”, and “serologic relapse.” The per cent of “apparent cures” was higher, 26.7, in the group of hospitalized patients treated over a four-day period with penicillin in aqueous solution than in the two groups treated with penicillin in oil with beeswax on an ambulatory basis over two days, 11.0, and one day, 6.4. However, there was a correspondingly higher proportion of cases showing “satisfactory progress” in the latter two groups of patients so that when one combines cases of “apparent cure” with those showing “satisfactory progress”, the total per cent is almost identical in the three groups of patients, 90.2, 92.9, and 92.8, respectively. It is appreciated that follow-up observations over a period of 10 to 12 months after treatment are not sufficient to permit a comprehensive evaluation of the efficacy of penicillin in the treatment of yaws. Also, it is not possible to make a strict comparison of the results of treatment of penicillin in aqueous solution with penicillin in oil with beeswax, because of the difference in treatment schedules employed. However, it is felt that penicillin is probably the present-day drug of choice in the treatment of yaws, and that penicillin in oil with beeswax is of considerable public health value in countries such as Haiti where large numbers of patients must be treated on an ambulatory basis in rural clinics. Its use can be expected to successfully control cutaneous lesions and therefore prevent the spread of infection.

Preliminary Report on the Evaluation of Penicillin in the Treatment of Yaws *

Summary In summary it may be said that penicillin holds definite promise as a therapeutic agent in yaws. Its use in doses of 1,200,000 O. U. in adults and proportionate doses for children given over periods of four, two and one days respectively resulted in rapid clinical cures. The serologic response was not as striking as the clinical, but until more follow-up figures are obtained a full evaluation is n ot possible. The oil-beeswax preparation of penicillin made it possible to treat patients on an ambulatory basis over one and two days with the same dose of penicillin given in aqueous solution to hospitalized patients over four days. The immediate clinical and serologic results obtained with pencillin in oil with beeswax appeared to be as good as those of the aqueous solution. The development of a successful one-day treatment schedule would be of great practical value in a country such as Haiti where large numbers of patients must be treated on an ambulatory basis in rural clinics. A report on 12 months follow-up observations will be made at a later date.

The incidence and treatment of yaws in the Western Solomon Islands

The incidence and treatment of yaws in the Western Solomon Islands

The treatment of yaws

The treatment of yaws