yaws

The yaws is a non-venereal infectious disease of tropical countries caused by the bacterium Treponema pertenue. The disease, which is contagious through skin contact, is one of the treponematoses and can be easily treated with antibiotics. If left untreated, the skin disease develops in four stages, begins with raspberry-like papules and leads to damage to the bones and joints in the fourth stage over a period of usually more than ten years.

What is yaws?

The infection occurs mainly through skin contact and smear infections. In exceptional cases, infections from insect bites should also occur.
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Frambosie is a non-venereal skin disease of tropical countries that is contagious through skin contact and droplet infection and, like venereal and non-venereal syphilis, belongs to the group of treponematoses. The term frambösie is derived from the French framboise for raspberry, because the disease is noticeable in the first stage through raspberry-like papules on the skin.

Many other names like Framboesia tropica or Raspberry disease are used synonymously for the disease. The pathogen, the bacterium Treponema pertenue, belongs to the spirochetes. These are thin, helical, gram-negative bacteria that can actively move even via internal flagella.

The main distribution area of ​​the yaws are humid tropical countries of Southeast Asia, Africa and Latin America. The disease typically progresses - untreated - in four stages, with the third stage, which can last five to ten years, is symptom-free and can give the deceptive impression that the chronic disease has been overcome.

causes

The bacterium Treponema pertenue, which particularly loves warm and humid tropical climates, is responsible for the chronic skin disease yam. The infection occurs mainly through skin contact and smear infections. In exceptional cases, infections from insect bites should also occur.

The tightness of the house among the rural population, which often occurs in tropical and humid areas, combined with inadequate hygienic conditions, increases the risk of infection. In the regions where the yaw bosom is endemic, most people become infected in childhood.

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Symptoms, ailments & signs

The yeast has an incubation period of three to four weeks and typically presents with one or more “raspberry-like” papules on the skin, preferably on the lower leg. Such papules also develop on the breast in breastfeeding women. The itchy and oozing papules are painless, but cause swelling of the “responsible” lymph nodes. The papules heal - even if left untreated - and new papules develop after a few weeks.

In this second stage, also called the secondary stage, the palms and soles of the feet are particularly affected. These newly appeared papules also disappear again after a while and a third, deceptive rest phase follows, which gives five to ten years of symptom-free treatment. Only then does the fourth or tertiary stage appear.

The term tertiary stage means that the long asymptomatic phase is not counted as a separate phase. Changes in bones and joints occur during the tertiary stage. Tough skin lumps that feel rubbery develop in the skin and inflammation of the bones and periosteum occurs. Skeletal changes and the so-called gangosa, a visually disfiguring reconstruction of the nasopharynx, are particularly serious.

diagnosis

An initial diagnosis is made based on the anamnesis and the conspicuous external signs that accompany the yaws. A morphological differentiation between the four different treponemas known as pathogenic is very complex and not always reliable.

The symptomatic signs of the disease should be sufficient for a diagnosis that is considered certain, especially since treatment would be possible with less effort than a laboratory-based diagnosis. The course of the disease can - as described above - be divided into four phases or three stages, with the last phase only starting five to ten years after the original infection.

Complications

If left untreated, the yaw bosom can lead to severe complications and damage to the bones and joints. This damage usually only occurs after a few years and is not immediately visible. With yaws, papules appear on the patient's skin after about four weeks.

Due to the relatively long incubation time, the yaw bosom can only be discovered relatively late by a doctor. The papules continue to spread on the hands and feet and usually disappear again after a short time. There are initially no complications. However, the yaw becomes noticeable again after about five years.

This creates strong lumps on the skin and inflames the bones. This leads to severe pain in most patients. Ordinary everyday life is no longer possible due to the yaw arch. The skeleton changes and those affected are disfigured by malformations on the nose.

Treatment can be done by adding penicillin and combats yaws with early treatment. If the yaw bosom is not detected until the last stage, healing is usually no longer possible and death occurs. The life expectancy is reduced by the yaws.

When should you go to the doctor?

Treatment must always be given in the case of yaws. Self-healing does not occur and the symptoms usually worsen if the disease is not treated. A doctor should be consulted if papules develop on the skin. These take on a reddish color and can also be affected by itching. Furthermore, swellings can also indicate the yaw bosom and should be examined.

The papules themselves can disappear again without treatment, but then usually reappear after a few weeks. In the further course, inflammations on the nodules also point to the yaws. These are usually noticeable in the form of very strong bone pains that must be examined by a doctor.

The first diagnosis is made by the dermatologist or the general practitioner. For further treatment, patients are dependent on taking antibiotics to relieve the symptoms of the disease. In most cases the disease progresses positively and the disease can be well limited.

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Treatment & Therapy

As mentioned above, the chronic infectious disease occurs only in warm, humid tropical regions in which the rural population often has to live under inadequate hygienic conditions and, as a rule, only has very limited financial resources. The standard treatment that has been found to be effective is a single intramuscular injection of penicillin.

As a result, the disease was able to be greatly reduced within WHO campaigns in the 1950s and 1960s and fell out of focus in the years that followed until it is now on the rise again. In a small study by the University of Barcelona, ​​which was carried out in Papua New Guinea in 2013/2014 on over 200 sick children, it was shown that the effect between a single injection of penicillin did not differ from a single oral administration of the antibiotic azithromycin.

In the "penicillin group" 105 of 113 patients were cured and in the "azithromycin group" 106 of 110 patients. This could mean that the disease could be curbed again across the board or even completely overcome in the future through broad-based, inexpensive treatments with the antibiotic azithromycin.

Outlook & forecast

Thanks to the well-developed and modern medical possibilities, the yaw bosom has a favorable prognosis. If the diagnosis is made early and treatment is started quickly, the patient will recover completely. The triggering of the disease can be killed off by giving medication.

It is then removed from the body. The affected person already experiences an improvement in health a short time after the start of therapy and is considered to have recovered after a few weeks of the healing process. If there is no damage to the bone structure, no consequential damage is to be expected from the yaw bosom.

If left untreated, the bacterium can continue to spread in the body unhindered. The prognosis worsens in these patients. There is a gradual increase in skin changes and swelling. At an advanced stage of the disease, symptoms of the bones and joints appear. If the person concerned does not take any treatment even after a few weeks or months, permanent impairment of the skeletal system occurs.

Inflammation develops, the immune system is weakened overall, and the patient's health gradually deteriorates. Optical changes occur in the face that are irreparable. Existing pain increases in intensity and prevents participation in everyday life. Psychological problems and a drastic decline in wellbeing are to be expected.

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prevention

The extremely long course of untreated yaws means that the sick are a constant source of infection from which people in the immediate vicinity - especially children - can be infected. As a preventive measure that can protect a little against infection, it is important to observe a minimum hygienic standard.

Small and large injuries to the skin, which the bacteria can use as a gateway, are particularly at risk of infection. The best prevention would be if the sick people could be treated with the appropriate antibiotic penicillin or azithromycin. That would not only cure the sick, but also protect them from re-infection because the sources of infection are eliminated.

Aftercare

The options for follow-up care are severely limited in the case of a yambo. The focus is on the medical treatment of this disease by a doctor, as self-healing cannot occur. For this reason, early diagnosis with early treatment is very important to prevent further complications and to avoid premature death of the person affected.

In most cases, the yaw bosom is treated with medication, usually with antibiotics. The person concerned must ensure that the antibiotics are taken correctly and regularly and follow the instructions of the doctor. Furthermore, alcohol should not be taken together with antibiotics, as alcohol can weaken the effect of the medication.

Further aftercare measures are not necessary if the disease is cured in time through the use of medication. With a complete healing, the life expectancy of the person affected is not reduced. During the treatment, the patient should not exert himself unnecessarily and should spare his body. A healthy lifestyle with a balanced diet can have a positive effect on the further course of the disease.

You can do that yourself

Yaws is very contagious. If you suspect an infection, it is necessary to consult a doctor immediately. As a rule, the disease can then be easily treated with an antibiotic. Education and compliance with hygiene measures are essential and prevent further spread.

There are few things you can do yourself to make life with this condition a little easier for yourself. A general healthy diet, exercise in the fresh air and stress management strengthen the immune system and thus the defenses, which can then contribute to better health.

Unfortunately, self-healing cannot occur; on the contrary, the symptoms only worsen and the infection spreads further. Due to the long incubation time, it makes sense to have yourself tested if you suspect it and to avoid physical contact during this time.

After taking the antibiotic, a quick healing is usually achieved, with which no accompanying measures are necessary. If the disease has progressed, it depends on the degree of the secondary disease and the corresponding restrictions in order to determine what would make everyday life easier. Since the infectious disease usually spreads in impoverished regions, the supply is very limited.