Treponemal Disease Research Articles

Variability of lesions and lesion patterns in possible treponematosis cases: Insights from an archaeological site in Tomar, Portugal.

Objective: This study aims to describe various types of skeletal lesions and lesion patterns observed in five potential cases of treponematosis from the same archaeological site. Material and methods: The study examines five adult skeletons recovered from Santa Maria do Olival, Tomar, Portugal. Macroscopic observations were conducted on all remains, supplemented by relevant radiographic investigations. Results: The analyzed individuals exhibited diverse types of skeletal lesions and distinct patterns of lesion distribution. Radiocarbon dating of two of these skeletons locates them chronologically close to the beginning of the colonial period (15th century). Discussion: The findings indicate considerable variation in the lesions and lesion patterns associated with treponematosis, even within the same archaeological site. The radiocarbon data implies the presence of pre-Columbian treponemal disease or a rapid progression to the tertiary phase of the disease. This study represents the oldest cases of treponematosis in Portugal and the only one with more than one individual affected from the same archaeological site. Considering Portugal's prominent role in the European Age of Exploration, the study underscores the significance of pathogen exchanges between Europeans, South Americans, Africans, and Asians. Future investigations should reassess Iberian osteological collections from this time period, given the historical importance of Portugal and Spain in the intercontinental movements.

Hypomineralization disorder in tropical Southeast Asia during the agricultural revolution: Analysis of morbidity and mortality

AbstractThis paper presents evidence for hypomineralization disorders (rickets and osteomalacia) in non‐adults at Man Bac, a Neolithic site from northern Vietnam dated to 4000–3500BP, contributing to the well‐described disease burden at the site that includes scurvy, treponemal disease, thalassemia, and malaria. Forty‐four non‐adults (<20 years of age‐at‐death) were assessed for macroscopic and radiographic evidence for hypomineralization disorders. Differential diagnosis was completed using traditional methods and three‐level standardized criteria to combat the challenges of overlapping pathological features between hypomineralization disorder and the other diseases already diagnosed at the site. In addition, a diagnostic certainty approach was applied to investigate the impact of lesion ambiguity on our findings. Kaplan–Meier and Fishers exact tests were applied to assess age‐at‐death‐related epidemiological patterns of hypomineralization disorder and co‐morbid relationships with scurvy, thalassemia, and treponemal disease. Almost 50% of the non‐adult assemblage presented with evidence for hypomineralization disorder, which was associated with decreased survivorship in childhood. Potential epidemiological relationships between scurvy and hypomineralization disorders, and thalassemia and hypomineralization disorders are described. The former relationship may be due to the likelihood of the introduction of rice resulting in multi‐micronutrient deficiency, including vitamin C and calcium deficiency, and cultural attitudes to sunlight. The latter relationship may relate to the pathophysiology of thalassemia that can result in secondary osteomalacia possibly contributing to the development of hypomineralization disorder in the thalassemic non‐adults. The findings are significant as they present possible approaches for diagnosis of disease embedded within complex disease burdens where individuals are likely suffering from co‐morbidities.

Technical note: The use and misuse of threshold diagnostic criteria in paleopathology.

Weighted threshold diagnostic criteria approaches have emerged for diseases that involve skeletal/bony tissue that are readily diagnosed in the field of paleopathology such as Vitamin C deficiency (scurvy), Vitamin D deficiency (rickets) and treponemal disease. These criteria differ from traditional differential diagnosis in that they involve standardized inclusion criteria based on the lesion's specificity to the disease. Here I discuss the limitations and benefits of threshold criteria. I argue that while these criteria will benefit from further revision such as inclusion of lesion severity, and the incorporation of exclusion criteria, threshold diagnostic approaches have considerable value in the future of diagnosis in the field.

The dark satanic mills: Evaluating patterns of health in England during the industrial revolution

Objectivethis research seeks to investigate the impact the industrial revolution had on the population of England. MaterialsPre-existing skeletal data from 1154 pre-Industrial (1066–1700 CE) and 4157 industrial (1700–1905) skeletons from 21 cemeteries (N = 5411). MethodsContext number, sex, age-at-death, stature and presence/absence of selected pathological conditions were collated. The data were compared using chi square, Kolmogorov-Smirnov, t-tests and logistic regression (α = 0.01). ResultsThere was a statistically significant increase in cribra orbitalia, periosteal reactions, rib lesions, fractures, rickets, osteoporosis, osteoarthritis, enamel hypoplasia, dental caries and periapical lesions in the industrial period. Osteomyelitis decreased from the pre-industrial to industrial period. ConclusionOur results confirm the industrial revolution had a significant negative impact on human health, however the prevalence of TB, treponemal disease, maxillary sinusitis, osteomalacia, scurvy, gout and DISH did not change, suggesting these diseases were not impacted by the change in environmental conditions. SignificanceThis is the largest study of health in the industrial revolution that includes non-adults and adults and considers age-at-death alongside disease status to date. This data supports the hypothesis that the rise of industry was associated with a significant decline in general health, but not an increase in all pathological conditions.

Identifying treponemal disease in early East Asia

ObjectivesHistoric records suggest that a virulent form of treponematosis, sexually transmitted syphilis was introduced to Asia from Europe by the da Gama crew, who landed in India in 1498. Our objective is to assess the gross pathology of human skeletal remains from the Tang dynasty of China to test the presence of treponemal infection in East Asia before 1498. We interpret this paleopathological evidence in the context of site ecology and sociocultural changes during the Tang dynasty.Materials and methodsWe examined the gross pathology of 1598 human skeletons from Xingfulindai (AD 618 to AD 1279) archeological site located on the Central Plain of China. Using the modified diagnostic criteria defined by Hackett's classical work, we classify the pathology as consistent, strongly suggestive, or pathognomonic for treponemal infection.ResultsTwelve adult individuals from Xingfulindai had bone lesions suggestive of systemic pathology. Two of these individuals displayed a combination of lesion patterns pathognomonic of treponemal disease and one had lesions consistent with treponematosis. The radiocarbon dates for the bone samples from these skeletons place them before AD 1200.ConclusionsThe location of Xingfulindai in a continental climatic zone is not typical for yaws and bejel ecology, because these strains occur in the tropics, or in hot, dry environments, respectively. The urban setting, where there is documented evidence for increased interaction between multiple ethnic groups and a developed institution of courtesans during the Tang dynasty, favors sexually transmitted syphilis as the more likely diagnosis. This study supports an earlier spread of syphilis to China than 1498.

An ancient cranium from Dmanisi: Evidence for interpersonal violence, disease, and possible predation by carnivores on Early Pleistocene Homo

Five well-preserved individuals from Dmanisi represent a paleodeme attributed to early Homo. Here we provide a case study of the D2280 adult cranium, which presents four oval-shaped lesions on the frontal, left parietal, and occipital bones. Several conditions are considered as possibly contributing to this pathology, including trauma, cysts, metastatic cancer, and infectious disease. One large but shallow depression on the left parietal bone has slightly elevated boundaries. Imaging reveals inner and outer tables that are reciprocally concave, so that the diploë is diminished or completely absent. This lesion is very likely a result of traumatic injury. Two additional depressions on the left side frontal and occipital bones may also be attributed to blunt force trauma. Such injuries stem from a variety of causes, but interpersonal violence may well be implicated. Based on the location and structure of a fourth lesion on the right-side frontal bone, we advance a possible diagnosis of treponemal disease. Lesions on the cranium and specifically on the frontal bone are common in treponemal disease. The condition develops as a periostitis, which eventually results in the destruction of the osteoperiosteal border of the cranial outer table and rarely involves the inner table. Additional perforations on the occipital bone are interpreted as perimortem damage resulting from predation by carnivores or scavenging by birds. If our reading of this cranial evidence can be confirmed, then D2280 documents one of the earliest instances of blunt force trauma in the Homo lineage. Dmanisi may also reveal the presence of treponemal disease in a population dated ca. 1.77 Ma ago. These findings bear on the social behavior of ancient humans and also the impact of infectious diseases on their survival.

A treponemal genome from an historic plague victim supports a recent emergence of yaws and its presence in 15th century Europe

Developments in techniques for identification of pathogen DNA in archaeological samples can expand our resolution of disease detection. Our application of a non-targeted molecular screening tool for the parallel detection of pathogens in historical plague victims from post-medieval Lithuania revealed the presence of more than one active disease in one individual. In addition to Yersinia pestis, we detected and genomically characterized a septic infection of Treponema pallidum pertenue, a subtype of the treponemal disease family recognised as the cause of the tropical disease yaws. Our finding in northern Europe of a disease that is currently restricted to equatorial regions is interpreted within an historical framework of intercontinental trade and potential disease movements. Through this we offer an alternative hypothesis for the history and evolution of the treponemal diseases, and posit that yaws be considered an important contributor to the sudden epidemic of late 15th century Europe that is widely ascribed to syphilis.

Treponematosis in a pre-Columbian hunter-gatherer male from Antofagasta (1830 ± 20 BP, Northern Coast of Chile)

ObjectiveThis paper reports a new case of treponemal disease in a pre-Columbian hunter-gatherer inhabiting the desert coast of South America. MaterialsA well-preserved adult male skeleton from the “Vertedero Municipal” archaeological cemetery, located near the city of Antofagasta (Northern Chile). MethodsThe skeleton was radiocarbon dated, and isotopic analyses were performed to assess diet and mobility. Lytic and proliferative lesions identified were evaluated macroscopically and radiologically. ResultsA radiocarbon date of 1830 ± 20 BP and isotopic values indicating a marine diet and coastal residence were obtained. The cranium shows reactive changes as focal superficial cavitation, radial scarring and nodular cavitation, while the ribs, sternum, clavicles, and scapulae exhibit multiple lytic and proliferative lesions. The right femur has a node while both tibiae show mild anterior cortical thickening with a narrowed medullary cavity. ConclusionsCranial lesions are pathognomonic for treponemal disease while postcranial changes are typical, and highly consistent with this pathology. SignificanceThe type, morphology, and pattern of lesions make this case a good candidate for venereal syphilis. The case is relevant to the origin of venereal syphilis due to the lifestyle, temporal and ecological context of the individual. LimitationsDiagnosis of venereal syphilis is based on skeletal lesions; thus, it must be confirmed by molecular analysis. Suggestions for Further ResearchA comprehensive review of cases of pre-Columbian treponemal disease in South America as well as molecular studies are needed to confirm the presence of venereal syphilis in the New World before European contact.

Advancing the understanding of treponemal disease in the past and present.

Syphilis was perceived to be a new disease in Europe in the late 15th century, igniting a debate about its origin that continues today in anthropological, historical, and medical circles. We move beyond this age-old debate using an interdisciplinary approach that tackles broader questions to advance the understanding of treponemal infection (syphilis, yaws, bejel, and pinta). How did the causative organism(s) and humans co-evolve? How did the related diseases caused by Treponema pallidum emerge in different parts of the world and affect people across both time and space? How are T. pallidum subspecies related to the treponeme causing pinta? The current state of scholarship in specific areas is reviewed with recommendations made to stimulate future work. Understanding treponemal biology, genetic relationships, epidemiology, and clinical manifestations is crucial for vaccine development today and for investigating the distribution of infection in both modern and past populations. Paleopathologists must improve diagnostic criteria and use a standard approach for recording skeletal lesions on archaeological human remains. Adequate contextualization of cultural and environmental conditions is necessary, including site dating and justification for any corrections made for marine or freshwater reservoir effects. Biogeochemical analyses may assess aquatic contributions to diet, physiological changes arising from treponemal disease and its treatments (e.g., mercury), or residential mobility of those affected. Shifting the focus from point of origin to investigating who is affected (e.g., by age/sex or socioeconomic status) and disease distribution (e.g., coastal/ inland, rural/urban) will advance our understanding of the treponemal disease and its impact on people through time.

A Rare Case of Congenital Syphilis and a Supernumerary Fourth Molar in an Early 20th Century African American Woman

Congenital syphilis is a disease recognized for interfering with odontogenesis, producing specificdental characteristics including Hutchinson’s incisor, Moon’s molar, Fournier’s molar and mulberry molar,while its past treatments including mercury are known to affect amelogenesis. Supernumerary teeth, mainly associatedwith syndromes, are not commonly found in cases of congenital syphilis. A rare case of congenitalsyphilis in an individual (P000707) treated with mercury and a mandibular left fourth molar with normal morphologyis presented.Materials and Methods: During a systematic examination of 28 skeletons with treponemal disease at the Smithsonianmuseum in Washington, DC, a supernumerary mandibular distomolar in one individual (P000707) wasrevealed.Results: P000707 was an African American female, 26 years of age. Dentition showed severe enamel hypoplasiaof the maxillary and mandibular incisors, left canine, and upper first molars, consistent with the effects of treatmentof congenital syphilis by mercurial compounds. Crown of the left mandibular distomolar has typical molarmorphology but is smaller in size than other permanent molars. Arrangement of grooves resembles the +4 pattern,but is complex due to crenulation. Oblique x-ray revealed that the fourth molar had one root with a pulpchamber extending towards the apex, suggesting taurodontism. No other distomolar teeth were present.Conclusions: Congenital syphilis and treatment containing mercury may not influence the development of supernumeraryteeth due to: (1) the age at which the development of the fourth molar takes place, (2) the stage ofthe infection at the time of development and (3) the age at which treatments containing mercury are administeredto patients with congenital syphilis.

Determining onset of significant facial pathology using dental wear and microwear texture analysis: a case study from the Middle Archaic (~5,500 BP) of Indiana.

Paleopathologists face complicated presentations of osteological conditions that ac-crued over a considerable period of ill-health. Determining the relative sequence of symptoms and how long the individual lived with them is critical to understanding disease onset and progression in the body and may help to identify a specific disease. This paper describes an atypical presentation of the dentition associated with a 5,000-year-old case of treponemal disease. This circumstance led to a cessation of macrowear, which allowed for an estimation of the age when the jaw began to profoundly deform. This paper also summarizes molar microwear texture analysis (DMTA) that was employed in order to determine if the diet of the victim prior to death was con-sistent with other people from the site.

Endemic treponemal disease in late pre-Columbian prehistory: New parameters, new insights

Pre-Columbian frequencies of bone-disseminated non-venereal treponemal disease (yaws, treponarid) increase with the shift to food production. This increase is associated with two subsistence corollaries: sedentism and settlement aggregation. The later prehistory of East Tennessee includes two socio-politically distinct maize-intensive sedentary agriculturalist phases: Dallas (1300–1550CE) and Mouse Creek (1400–1600CE). The Dallas phase is widely distributed across both steep-sided narrow and broad river valleys within the catchment areas of three reservoirs (Tellico, Melton Hill, Chickamauga). The Mouse Creek phase is confined to a single reservoir (Chickamauga) and differs from Dallas in social status/role and settlement organization. Physiographic differences (affecting population density and agricultural productivity) and changes in settlement organization potentially affect treponemal disease prevalence. This study tests these variables in ten sites segregated by phase and geographically by the three reservoirs. Treponemal disease was considered minimally present in a sample based on two levels of diagnostic reliability (i.e., pathognomonic and indicative). Results indicate that physiography does not consistently impact treponemal disease visibility. Negating the role of settlement organization, temporal differences occur only within the Chickamauga Reservoir, suggesting other testable epidemiological influences of extrinsic (e.g., internal Dallas cultural diversity, regionally varying sex roles) and intrinsic (i.e., frailty, disease synergisms) variables.

Treponemal disease in the Old World? Integrated palaeopathological assessment of a 9th–11th century skeleton from north-central Spain

The hypothesis of an American origin of acquired (venereal) syphilis and other infectious diseases carried by Columbus’s crew has been considered for a long time as the most plausible one, and has been supported recently by considerable anthropological and molecular evidence. According to this line of thought, it can be argued that Spain would have been the gateway of acquired syphilis, which quickly expanded after the return of Columbus in the late 15th century. However, the hypothesis that syphilis previously existed in Europe but went unrecognized has also been considered by many authors. The present work reports one Pre-Columbian putative case of venereal syphilis found in a Spanish necropolis and radiocarbon dated to the 9th–11th century. The complexities of carrying out accurate diagnoses in remains from archaeological timeframes are addressed by the combined use of palaeopathological, medical, and histological techniques. The results, which point toward third-stage acquired syphilis, spark discussion about the need to revisit or complement the theories and hypothesis on the origin of syphilis in the light of a growing body of cases from European historical populations.

Metaanalysis of the Performance of a Combined Treponemal and Nontreponemal Rapid Diagnostic Test for Syphilis and Yaws.

The human treponematoses are important causes of disease. Mother-to-child transmission of syphilis remains a major cause of stillbirth and neonatal death. There are also almost 100 000 cases of endemic treponemal disease reported annually, predominantly yaws. Rapid diagnostic tests (RDTs) would improve access to screening for these diseases. Most RDTs cannot distinguish current and previous infection. The Dual Path Platform (DPP) Syphilis Screen & Confirm test includes both a treponemal (T1) and nontreponemal (T2) component and may improve the accuracy of diagnosis. We conducted a metaanalysis of published and unpublished evaluations of the DPP-RDT for the diagnosis of syphilis and yaws. We calculated the sensitivity, specificity, and overall agreement of the test compared with reference laboratory tests. Nine evaluations, including 7267 tests, were included. Sensitivity was higher in patients with higher titer rapid plasma reagin (≥1:16) for both the T1 (98.2% vs 90.1%, P < .0001) and the T2 component (98.2% vs 80.6%, P < .0001). Overall agreement between the DPP test and reference serology was 85.2% (84.4%-86.1%). Agreement was highest for high-titer active infection and lowest for past infection. The RDT has good sensitivity and specificity of the treponemal and nontreponemal components both in cases of suspected syphilis and yaws, although the sensitivity is decreased at lower antibody titers.

002.4 Field evaluation of standard diagnostics duo hiv and syphilis test among female sex-workers in johannesburg

Introduction Point-of-care tests (POCT) for STI/HIV provide immediate results with the opportunity for same day treatment, counselling and partner notification. Combination POCTs for HIV and syphilis are particularly beneficial for pregnant women and key populations as treating these infections early reduces vertical and community transmission. Methods We evaluated Standard Diagnostics’ Duo HIV and Syphilis Test (SD bioline) among female sex-workers (FSW) in the inner-city of Johannesburg. SD bioline was conducted on-site using whole blood according to manufacturer’s instructions and compared to Genscreen HIV 1/2 V2 – 3 rd and Vironostika Ag/Ab – 4 th generation assays for HIV and to the T. pallidum particle agglutination (TPPA) test for syphilis. A Rapid Plasma Reagin (RPR) test was conducted in the laboratory to assist with classification of treponemal disease. Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) were calculated Participants with HIV were referred to HIV services and those with syphilis were managed according to national guidelines. The study received ethics approval. Results We recruited 263 FSW, 14 (5.3%) declined an HIV test and were excluded. Among the remaining 249 FSW 187 (75.1%) women were HIV positive and 51 (20.5%) had evidence of syphilis with 7 (2.8%) having active syphilis. For HIV sensitivity was 98.9% (95% CI: 95.8–99.8), specificity was 100% (95% CI: 92.7–100), PPV was 100% (95% CI: 97.5–100%) and NPV was 96.9% (95% CI: 88.2–99.5). For treponemal antibody detection, sensitivity was 66.7% (CI: 52.0–78.9), specificity was 98.0% (CI: 94.5–99.3), PPV was 89.5 (CI: 74.3–96.6) and NPV was 91.9% (CI: 87.2–95.1). Sensitivity increases to 85.7% for active syphilis (RPR > 1:4). Conclusion Although the SD bioline performs well for HIV diagnosis, the assay has lower sensitivity for syphilis detection in our field setting compared to published laboratory evaluations. Using the test in screening programmes will detect both HIV and active syphilis but will result in overtreatment for syphilis. Disclosure of interest statement The study was funded by USAID/PEPFAR and AIDS Fonds. SD bioline tests were provided by SD diagnostics.

Diagnosis and evaluation of causative factors for the presence of endemic treponemal disease in a Japanese sub-tropical island population from the Tokugawa period

We present a description and differential diagnosis of pathological lesions observed on skeletal elements found during surface surveys of the Nagabaka site on Miyako-jima Island, Japan. The Nagabaka site served as a bone depository during the Early Modern period (c. AD 1600–1870). We evaluated remains via macroscopic inspection to classify infectious lesions according to criteria in Weston (2008). We also obtained CT scans of three bone elements for more extensive lesion analysis and carried out a differential diagnosis utilizing paleopathological literature. Subsequent investigation yielded convincing evidence of treponemal infection on 23 skeletal elements. Based on known geographical spread and morphological comparisons of lesion patterning, we identified yaws as the pathogen most likely responsible, but refrained from calculating site-wide prevalence due to the taphonomical nature of the sample. Lastly, we review treponemal infection rates in other archaeological sites throughout Southeast Asia and Oceania, and assess similar ecological and cultural factors contributing to the observed pathologies. Nagabaka is the northernmost site in the world where yaws has so far been identified. Located between sites between Mainland China and Western Micronesia where this infection has been previously identified, Miyako-jima holds an important geographical position for research into the historical spread of pathogens.

A Case of Multiple Epidermolytic Acanthoma of the Scrotum: Is the Human Papillomavirus a Culprit?

Dear Editor: Epidermolytic acanthoma is a rare benign tumor that was first described in 1970 by Shaprio and Baraf. It usually presents in adulthood as an asymptomatic tumor <1 cm in diameter with a verrucous surface1. Herein, we report a very uncommon case of multiple epidermolytic acanthoma localized on the scrotum. A 60-year-old man visited our clinic with asymptomatic scrotal dermatosis that was discovered several months ago. He had no significant medical history and denied any triggering factors such as trauma, immunosuppressive therapy, or radiation exposure. Physical examination revealed multiple well-demarcated gray to whitish round papules on the scrotum (Fig. 1). Laboratory tests, including complete blood count, chemical battery, and screening tests for HIV and treponemal disease such as syphilis, were performed. No abnormal finding was found. Skin biopsy showed hyperkeratosis without parakeratosis and a hypertrophic granular layer with numerous keratohyalin granules. Separation and edematous changes in the spinous layer were also observed (Fig. 2). The histopathological findings were consistent with epidermolytic acanthoma. The differential diagnosis included epidermolytic verrucous nevus, bullous congenital ichthyosiform erythroderma, and Vorner's palmoplantar keratoderma with a rather distinct clinical aspect. Seborrhoreic keratoses, solar keratoses, or Bowen's disease could also show some focal changes of epidermolytic hyperkeratosis. We also tested for the presence of the human papillomavirus (HPV) genome by using a novel HPV DNA chip (GG HPVCHIP; Goodgene Inc., Seoul, Korea). The lesion was HPV 16 positive2. Fig. 1 Multiple well-demarcated <5 mm gray to whitish round papules on the scrotum. Fig. 2 Compact hyperkeratosis with acanthosis. Perinuclear vacuolization, of variable size, of the keratinocytes in the stratum spinosum and stratum granulosum. The keratinocytes exhibited non-well-defined limits that gave the epidermis a reticulate appearance. ... Epidermolytic acanthoma is a benign, asymptomatic tumor that usually presents as a solitary papule in adulthood. The multiple or disseminated form was also reported as a rare variant1. The pathogenesis of epidermolytic acanthoma is not clear. Various contributing factors have been reported, such as HPV, other viral infections, ultraviolet radiation, immunosuppression, trauma, and mutations of genes encoding for keratin 1 and 103. Although some authors have suggested the role of HPV in the pathogenesis, immunohistochemical and molecular studies had failed to detect a viral genome in the lesions4. However, the authors used a conventional method: polymerase chain reaction followed by dot-blot analysis with specific radiolabeled detection probes, which have limitations in detecting and typing HPV. The HPV DNA chip arrayed by using multiple oligonucleotide probes for 42 types of HPV and human β-globin gene, which we used in our case, was recently developed and has been found to be a highly sensitive tool for identifying HPV2. In our case, doubt exists about whether the presence of HPV 16 was only a coincidence, because HPV can be detected in otherwise normal genital skin. Although we could not clarify the possible pathogenic role of HPV in epidermolytic acanthoma, our case is important because it is the first reported case of HPV detected on skin affected by epidermolytic acanthoma. Although larger studies including several cases are required to prove the possibility, several facts imply the role of HPV in the pathogenesis of epidermolytic acanthoma: its site of predilection is the genital area; it usually has a verrucous surface; and, in a recent report, epidermolytic acanthomas were successfully treated with topical imiquimod, which is also used to treat HPV-induced lesions5.

Mapping the epidemiology of yaws in the Solomon Islands: a cluster randomized survey.

Yaws, a non-venereal treponemal disease, is targeted for eradication by 2020 but accurate epidemiological data to guide control programs remain sparse. The Solomon Islands reports the second highest number of cases of yaws worldwide. We conducted a cluster randomized survey of yaws in two provinces of the Solomon Islands. One thousand four hundred and ninety-seven (1,497) children 5–14 years of age were examined. Clinical signs of active yaws were found in 79 children (5.5%), whereas 140 children (9.4%) had evidence of healed yaws lesions. Four hundred and seventy (470) (31.4%) children had a positive Treponema pallidum particle agglutination assay (TPPA). Two hundred and eighty-five (285) children (19%) had a positive TPPA and rapid plasma regain assay. Risk of yaws increased with age and was more common in males. The prevalence of yaws at village level was the major risk factor for infection. Our findings suggest the village, not the household, should be the unit of treatment in the World Health Organization (WHO) yaws eradication strategy.

A Palaeopathological Assessment of the Late 19th and Early 20th Century Khoesan

AbstractSince the arrival of Dutch colonists in the Cape of Good Hope, South Africa, Khoesan populations were subjected to severe political and economic marginalisation and often fell prey to racial conflict. These circumstances persisted until the early 20th century, during which an astonishing number of Khoesan skeletons were transported from South Africa to various locations in Europe, as at the time, different institutions competed to obtain these remains. The purpose of this study was to assess the health status of the late 19th and early 20th century Khoesan. Skeletal remains housed in two different European institutions were studied. The sample comprised 140 specimens from the Rudolf Pöch Skeletal Collection in Vienna, Austria, and 15 specimens from the Musée de l'Homme in Paris, France. These individuals represent both sexes and were aged between newborn and 75 years, with 54 being younger than 20 years of age. Results indicated high levels of typical disease conditions associated with groups under stress, such as periostitis, cribra orbitalia and porotic hyperostosis. Treponemal disease, rickets, osteoarthritis and trauma were also encountered amongst other more specific indicators of health and disease. This study provided additional knowledge on the health status and lives of the Khoesan people during this turbulent period and created new awareness regarding a group of severely mistreated individuals. Copyright © 2014 John Wiley &amp; Sons, Ltd.

Towards eradication of yaws disease by 2020 using a single dose of azithromycin in mass treatment

Background: Yaws is a disfiguring non-venereal treponemal disease, one of the neglected tropical diseases continued to be prevalent in isolated pockets in some of the tropical countries in African, Asia andWestern Pacific Regions of theWorldHealthOrganization (WHO). It is a disease commonly seen amongmarginalized poor section of the most neglected population. More than 50% of the cases occur in children. Generally, it is said “yaws begins where the road ends”. Between 1952 and 1964, the WHO and the UNICEF embarked on global treponema control campaigns to administer a single dose long-acting benzathine penicillin to all yaws cases and their contacts. About 50millionpeoplewere treated in46endemic countries during the campaign. As a result, the burden the disease reduced by more than 95 percent from 50million to 2.5 million. Subsequently, yaws lost its priority in the light of emerging other priority disease control programmers and the goal of eradication was not reached. MethodsM 12 countries of them reported new yaws cases 56 223 (2008) and 47 800 (2012) (WHO 2012). Encouraged by the recent evidence of efficacy of a single oral dose of azithromycin in curing yaws disease in Papua New Guinea and Ghana, WHO recommended single dose azithromycin-based treatment strategy (Morges strategy 2012). Initially, a single dose of azithromycin to entire yaws endemic community followed by targeted treatment of cases and contacts. Conclusion: Yaws endemic countries met in Geneva, Switzerland in 2012 and 2013 and drafted operational guidelines to implement the new treatment strategy. Ghana, Papua New Guinea, Solomon Islands and Vanuatu implemented pilot projects to gain more experience in 2013. World Health Assembly resolution in 2013 included yaws for eradication by 2020.