Jaundice - Causes, symptoms and treatment. MF.

Jaundice is one of the forgotten tropical diseases affecting skin, bone and cartilage tissues. The disease is caused by a bacterium belonging to the same group of organisms that cause venereal syphilis;However, the transfer of yaws occurs in an irregular way.

Frameless can be eliminated, as people are the only reservoir. In a recent study, it was shown that a single dose of azithromycin antibiotic taken orally can completely cure yaws, which opens the prospect for large-scale therapeutic interventions for the populations that are affected by this disease.

Ecuador and India are among the two countries that once were endemic, which reported the discontinuation of the transmission of the disease in 2003.By 2014, 12 endemic countries need support to implement a new WHO strategy to eliminate the disease.

Jaundice forms a group of chronic bacterial infections caused by treponema, which include endemic syphilis( beige) and pint, and which are commonly known as endemic treponematoses. Yaws are the most common of these infections.

Disease is common in the poor in Africa, Asia, Latin America and the Pacific with a warm, important climate and in tropical forest areas.

Causes of yawing

The disease is also known as framboesia( in German or Dutch) and called pian( in French) and affects the skin, bone and cartilage tissues. The disease is caused by the microorganism T. pallidum subspecies pertenue. This organism belongs to the same group of bacteria that cause venereal syphilis.

Transmission mechanism. Yaws are transmitted directly through non-sexual contact( from person to person) with biological fluid from the lesion focus of the infected person. Most of the lesions are in the limbs. At the site of the initial defeat with yaws is a large number of bacteria. Contact with fluid from this lesion, especially if it occurs in children who play and receive minor abrasions, leads to transmission of the infection.

The incubation period of is 9-90 days( an average of 21 days).

About 75% of infected children are children under 15 years of age( the peak incidence is noted in children aged 6 to 10 years).Men and women are equally affected.

Overpopulation and unsatisfactory socio-economic conditions contribute to the spread of yaws. Without treatment, infection can lead to chronic disfigurement and disability.

Campaign to eliminate the disease in 1952-1964.were conducted in 46 countries. Since 1990, official reporting within the framework of WHO on yaws was terminated due to the closure of programs to eliminate yaws in many countries. Only in some countries yaws were part of the public health action program.

The study of documents that have remained since the 1950s shows that at least 90 countries in the tropical belt, located 20 degrees to the north and 20 degrees to the south of the equator, were considered to be endemic for yaws. However, only 12 are currently considered to be endemic for yaws, while for the two countries, Ecuador and India, which state that the transmission of the disease was stopped in 2003, verification is necessary. In addition, WHO also plans to check the status of yaws in 76 countries that were previously endemic.

Reporting on yaws is not mandatory, therefore the available data published in the latest edition of the Weekly Epidemiological Record are only indicative of the global spread of this disease.

Symptoms of yaws

There are two main stages of yaws: the early stage( infectious) and the late stage( non-infectious).

In the early stage of yaws, the initial papilloma develops at the site of penetration of the bacterium( round, dense swelling of the skin without visible discharge of fluid).This papilloma is filled with bacteria and can persist for 3-6 months and culminate in a natural recovery. In addition, bone pain and bone damage can also be observed at an early stage. Further, polymorphous skin rashes, an increase and soreness of the lymph nodes may appear.

Late manifestations of yaws occur 5 years after the initial infection and are characterized by disfiguration of the nose and bones, thickening of the palms and soles of the feet and the appearance of cracks in them( yaw-borne hyperkeratosis).These complications on the soles of the feet make it difficult for patients to walk. The disease lasts for many years, without leading to death.

In the field, the diagnosis is mainly based on the results of clinical and epidemiological surveys.

Diagnosis of yaws

To diagnose treponemal infections( eg, syphilis and yaws), serological tests are widely used.

However, rapid tests can not distinguish between active yaws and the treated infection. New, on site treatment, double, non-treponemal and treponemal syphilitic rapid tests give hope for a quick confirmation of the active form of yaws in the field. Studies to evaluate this new test kit are being conducted in Ghana, Papua New Guinea, the Solomon Islands and Vanuatu.

Analysis based on polymerase chain reaction( CRP).For the final confirmation of yaws, a genomic analysis based on polymerase chain reaction( PCR) can be used. The PIU method can also be used to detect resistance to azithromycin by analyzing smears taken from the jaw-affected areas.

Treatment of yaws

Two antibiotics can be used to treat yaws. Azithromycin( one oral dose) at a rate of 30 mg per kilogram of weight( maximum 2 grams).Benzathine penicillin( one intramuscular dose) at a rate of 1.2 million units( for adults) and 600,000 units( for children).

Complications of

Without treatment, approximately 10% of yawless people develop disfiguring or disabling complications after 5 years - deformity of the limbs and nose.

Prevention of yaws

Vaccines against yaws do not exist. Preventive work consists in timely diagnostics and treatment. An important component of prevention is personal hygiene and the exclusion of direct contact with the patient. With the occurring contact, a single preventive administration of bicillin is justified.

Resumption of the elimination of the disease

The WHO roadmap for the control of neglected tropical diseases and resolution WHA 66.12 define 2020 as the year of elimination of yaws in countries that are still endemic.

Scrambling can be eliminated, since its only reservoir are people. If all at-risk populations through large-scale treatment programs deliver oral azithromycin, the transmission of the disease will be interrupted and the disease will be eradicated in the area. The offensive move aimed at achieving this is gaining momentum and WHO, together with partners, is leading more vigorous efforts to eliminate yaws. To ensure the smooth implementation of activities to achieve the 2020 goals, the provision of azithromycin in sufficient quantities, the availability of diagnostic rapid tests and the necessary funding is crucial.

WHO Media Center