182.1 🎓 醫孞生版

182.1.0.1 📌 䞀頁重點

病 病原 地理 傳播 䞻芁 sx
Yaws T. pallidum subsp. pertenue 熱垶 (Africa, SE Asia, Pacific, S. America) Skin contact (non-sexual) 1° “mother yaw” papilloma → 2° rash + bone pain + dactylitis → late: deforming bone + gummas
Bejel (Endemic Syphilis) T. pallidum subsp. endemicum 也燥 W Africa, Middle East, Central Asia Oral contact, shared utensils Oral mucous patches → 2° rash + bone pain → late: gummas, palate destruction
Pinta Treponema carateum C/S America Skin contact 1° plaque → 2° pigmented (pintides) → late: depigmentation
  • Children䞻芁 affected (5-14 yr)
  • Non-sexual transmission (sweaty skin, abraded mucosa, shared utensils)
  • No CV / neuro involvement (unlike syphilis)
  • Serology cross-reacts: VDRL/RPR + FTA-ABS + — can’t distinguish from syphilis by serology
  • WHO Yaws Eradication 2030: single-dose azithromycin 30 mg/kg PO mass administration in endemic communities; PCG G IM backup
  • Treatment:
    • Azithromycin 30 mg/kg PO × 1 (preferred 2024)
    • Benzathine PCN G 1.2-2.4 M U IM × 1 alt

182.1.0.2 1⃣ Yaws

182.1.0.2.1 病原 + 傳播
  • T. pallidum subsp. pertenue — morphologically identical to syphilis
  • Skin-skin contact through abraded skin (kids playing, sweating)
  • NOT sexual; NOT vertical
182.1.0.2.2 流行病孞
  • 熱垶, humid (Pacific Islands, S. America, Africa, SE Asia)
  • WHO targeted 13 endemic countries 2024 (Ghana, Indonesia, Papua New Guinea, Solomon Islands, Vanuatu, etc.)
  • Mass treatment campaigns active
  • 1950s WHO/UNICEF eradication campaign — DDT-era reduced to 1 M cases; later resurgence
182.1.0.2.3 臚床
182.1.0.2.3.1 Primary (“Mother Yaw”)
  • 2-4 wk post-exposure
  • Solitary raspberry-like papilloma at site (typically lower extremity)
  • Painless, ulcerates
  • Heals 3-6 mo
182.1.0.2.3.2 Secondary
  • Months later
  • Multiple smaller papillomas (“daughter yaws”) around mother + other sites
  • Palmoplantar hyperkeratosis (“crab yaws” — painful, difficult to walk)
  • Dactylitis (finger swelling), osteoperiostitis (“gondou” / nasal swelling)
  • Bone pain — long bone, fingers
  • LAP
182.1.0.2.3.3 Latent
  • Asymptomatic, serology +
182.1.0.2.3.4 Late (Tertiary)
  • Gummas (skin, bone)
  • Gangosa: destruction of nose, palate
  • Bony deformity (saber tibia)
  • Joint contractures, disability
182.1.0.2.4 Dx
  • Clinical + dark-field microscopy (high yield from papilloma)
  • PCR — distinguishes from syphilis (different DNA sequences)
  • Serology cross-reacts syphilis
182.1.0.2.5 Treatment
  • Azithromycin 30 mg/kg PO × 1 — preferred (WHO 2014+)
  • Benzathine PCN G 1.2-2.4 M U IM × 1 — alt
  • Mass treatment (WHO Eradication Strategy 2030)

182.1.0.3 2⃣ Bejel (Endemic Syphilis)

182.1.0.3.1 病原 + 傳播
  • T. pallidum subsp. endemicum
  • Oral contact, shared eating utensils, contaminated cups
  • Children primary acquisition
  • Dry hot climates (water scarcity favors person-person mucosa contact)
182.1.0.3.2 流行病孞
  • W/N Africa (Mauritania, Senegal, Sahel)
  • Middle East (Saudi, Iraq, Syria)
  • Central Asia (rare)
182.1.0.3.3 臚床
182.1.0.3.3.1 Primary
  • Oral mucous patches (rarely seen)
  • Often missed
182.1.0.3.3.2 Secondary
  • Mucous patches oral + anogenital
  • Condylomata lata-like lesions
  • Hoarseness (laryngeal involvement)
  • Skin rash
  • Bone pain
  • LAP
182.1.0.3.3.3 Late
  • Gummas: skin, bone, palate destruction
  • Bony deformity
182.1.0.3.4 Treatment
  • Same as yaws — azithromycin or PCN G IM × 1

182.1.0.4 3⃣ Pinta

182.1.0.4.1 病原 + 傳播
  • Treponema carateum (different species from T. pallidum)
  • Skin-skin contact
  • Native populations C/S America (declining)
182.1.0.4.2 流行病孞
  • Rural Mexico, Colombia, Venezuela
  • Endemic in indigenous communities
  • Now very rare (< 100 cases/yr globally)
182.1.0.4.3 臚床
182.1.0.4.3.1 Primary
  • Plaque at site of inoculation (legs, dorsum hand)
  • Slowly enlarges
182.1.0.4.3.2 Secondary (“Pintides”)
  • Pigmented patches (pink → blue → brown)
  • Hyperpigmentation + thickening
  • 5+ years progression
182.1.0.4.3.3 Late (Tertiary)
  • Depigmentation (white) of skin
  • Atrophy
  • Disabling cosmetic / psychosocial impact
  • No visceral involvement (unique)
182.1.0.4.4 Treatment
  • Azithromycin or PCN G IM × 1

182.1.0.5 4⃣ WHO Yaws Eradication 2030 Strategy

  • Total Community Treatment (TCT): mass azithromycin to all in endemic community
  • Total Targeted Treatment (TTT): cases + contacts
  • Active surveillance + verification (no transmission > 5 yr → eradication)
  • Country progress: India eradicated 2016, Ecuador 2024
  • Challenges: drug resistance emergence (single case reports azithro-R yaws in PNG 2018), logistics, conflict zones