Yaws is a non-venereal treponemal disease caused by Treponema pallidum pertenue that primarily affects children under 15 in tropical areas. It is transmitted through direct skin-to-skin contact and presents initially as a painless bump that develops into a lesion resembling a raspberry. Secondary lesions and swollen lymph nodes may develop weeks later. Diagnosis is by microscopic examination of lesions or blood tests, and treatment is with antibiotics like benzathine penicillin. Mass treatment programs using oral azithromycin aim to interrupt transmission and eradicate the disease.

1. FRAMBESIA

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OUTLINE
• INTRODUCTION
• EPIDEMIOLOGY
• TRANSMISSION
• CLINICAL MANIFESTATION
• DIAGNOSIS
• DIFFERENTIALS
• TREATMENT
• PREVENTION

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INTRODUCTION
Yaws is the most prevalent infectious, nonvenereal
treponemal disease and is causedby Treponema
pallidum pertenue.Yaws ,endemic syphilis and pinta
collectively constitute the endemic treponematoses
This organism belongs to the same group of bacteria
that causes venereal syphilis

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EPIDEMIOLOGY
• YAWS PRIMARILY AFFECTS CHILDREN AGED UNDER 15 YEARS WHO LIVE IN
POOR COMMUNITIES IN WARM, HUMID AND TROPICAL FORESTED AREAS OF
AFRICA, ASIA, LATIN AMERICA AND THE PACIFIC ISLANDS
• SINCE 1990, REPORTING OF YAWS TO WHO IS NOT MANDATORY AND
THEREFORE THE DATA AVAILABILITY MAY BE LIMITED. ONLY 14 OUT OF THE 90
COUNTRIES AND TERRITORIES HAVE RECENT DATA ON YAWS BASED ON THE
ROUTINE SURVEILLANCE SYSTEM; HOWEVER, THESE FIGURES MAY JUST BE
AN INDICATION OF THE PRESENCE OF THE DISEASE AND NOT ITS FULL EXTENT

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TRANSMISSION
• YAWS IS SPREAD THROUGH DIRECT SKIN-TO-SKIN, NONSEXUAL CONTACT
WITH EXUDATIVE SKIN LESIONS
• OPEN LESIONS MAY HARBOR THE INFECTIOUS SPIROCHETE FOR UP TO SIX
MONTHS AND SPONTANEOUSLY INVOLUTE.
• VARIABLE RELAPSE CAN OCCUR AFTER LATENT PERIODS, ALLOWING
FURTHER TRANSMISSION. IN ENDEMIC REGIONS WITH OSCILLATING WET AND
DRY SEASONS,
• COMPARED TO SYPHILIS, YAWS DOES NOT CROSS THE PLACENTA AND
THEREFORE IS NOT TRANSMITTED IN UTERO, NOR DOES IT PENETRATE THE
CENTRAL NERVOUS SYSTEM.

7. CLINICAL
FEATURES • YAWS USUALLY FEATURES LESIONS THAT
APPEAR AS BUMPS ON SKIN , FACE,
HANDS,FEET GENITAL AREA.
• THE DISEASE MOST OFTEN STARTS AS A
SINGLE LESION THAT BECOMES SLIGHTLY
ELEVATED, DEVELOPS A CRUST THAT IS
SHED, LEAVING A BASE THAT RESEMBLES
THE TEXTURE OF A RASPBERRY OR
STRAWBERRY

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• PRIMARY LESION IS TERMED THE MOTHER YAW OR PRIMARY
FRAMBESIOMA.
• SECONDARY LESIONS, TERMED DAUGHTER YAWS, DEVELOP IN
ABOUT SIX TO 16 WEEKS AFTER THE PRIMARY LESION. ALMOST
ALL CASES OF YAWS.
• SWOLLEN LYMPH NODES ARE PRESENT
• THESE SECONDARY LESIONS WITH RASHES MAY BE PAINLESS
LIKE THE MOTHER YAW OR THEY MAY BE FILLED WITH PUS,
BURST, AND FORM ULCERS
• BEGIN IN CHILDREN UNDER 15 YEARS OF AGE, WITH THE PEAK
INCIDENCE IN 6- TO 10-YEAR-OLD CHILDREN

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• THE AFFECTED CHILD OFTEN FEELS ANOREXIC .
• THE LATENT STAGE OCCURS WHEN THE DISEASE SYMPTOMS
ABATE, ALTHOUGH AN OCCASIONAL LESION MAY OCCUR.
• IN THE TERTIARY STAGE, YAWS CAN DESTROY AREAS OF THE
SKIN, BONES, AND JOINTS AND DEFORM THEM WITH PAINS IN
THE JOINTS OR BONES. THE PALMS OF THE HANDS AND SOLES
OF THE FEET TEND TO BECOME THICKENED AND PAINFUL (CRAB
YAWS).

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DIAGNOSIS
• STAGE 1 AND STAGE 2
• BY MICROSCOPIC EXAMINATION OF TISSUE SAMPLES
(DARKFIELD EXAMINATION) FROM THE SKIN LESIONS OF
AFFECTED INDIVIDUALS.
• STAGE 3
• DIAGNOSED BY SPECIALIZED BLOOD TESTS (I.E.,
VDRL AND TREPONEMAL ANTIBODIES).

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DIFFERENTIAL DIAGNOSIS
• DIFFERENTIAL DIAGNOSIS OF YAWS LESIONS IS WIDE AND
INCLUDES SYPHILIS, LEISHMANIASIS, LEPROSY AND BURULI ULCER, AS
WELL AS NON-INFECTIOUS CAUSES

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TREATMENT
• STAGE 1 AND 2 YAWS IS TREATED WITH ANTIBIOTICS, ESPECIALLY
WITH BENZATHINE PENICILLIN G.
• A SINGLE LARGE DOSE OF THESE MEDICATIONS USUALLY HEALS
THE SKIN LESIONS AND ELIMINATES THE ORGANISM. THESE
ANTIBIOTIC DRUGS MAY ALSO BE USED TO PREVENT THIS
DISEASE IN FAMILY MEMBERS AND OTHERS WHO ARE IN
FREQUENT CONTACT WITH AFFECTED INDIVIDUALS.
• AT THE PRESENT TIME, THERE IS NO TREATMENT FOR THE
DESTRUCTIVE BONE LESIONS OR SCARS ASSOCIATED WITH
STAGE 3 YAWS.

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PREVENTION AND CONTROL
• THE ERADICATION APPROACH CONSISTS OF MASS TREATMENT
• ORAL AZITHROMYCIN (30 MG/KG, MAXIMUM 2 G) IS ADMINISTERED TO THE
ENTIRE POPULATION (MINIMUM 90% COVERAGE) IN AREAS KNOWN TO
HARBOUR YAWS.
• TWO OR THREE ROUNDS OF MASS TREATMENT MAY INTERRUPT
TRANSMISSION .

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• YAWS WAS ONE OF THE FIRST DISEASES TARGETED FOR
ERADICATION IN THE 1950S. WHO RENEWED GLOBAL EFFORTS
TO ERADICATE YAWS IN 2012.
• THERE ARE 15 COUNTRIES CURRENTLY KNOWN TO BE
ENDEMIC FOR YAWS.

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