Yaws is a chronic infectious disease caused by the bacterium Treponema pertenue that affects the skin, bones, and joints. It is transmitted through direct skin contact with infected individuals. The disease primarily affects children in tropical parts of Africa, Asia, South America, and the Pacific Islands. Yaws progresses through primary, secondary, latent, and tertiary stages, and can cause disfigurement if left untreated. It is diagnosed clinically or through blood tests and dark-field microscopy. Treatment involves antibiotics like benzathine penicillin or azithromycin, which can cure yaws in the early stages. Public health efforts aim to eradicate the disease by 2020 through early detection and treatment.

1. DISEASE
PRESENTATIO
N ON
YAWS –
COMMUNICABLE
DISEASE
PRESENTED BY,
KAVIYA AP
RA1522281010017
PHARM D INTERN

2.  Yaws is a common disease of children in the tropics.
 Yaws is a common chronic infectious disease that occurs mainly in warm humid regions such as the tropical areas of
Africa, Asia, South and Central Americas, plus the Pacific Islands.
 It is a chronic, relapsing infectious illness.
 It first affects the skin and later possibly the bones and joints as well.
 Yaws is caused by a bacterium, the spirochete Treponema pertenue.
 Yaws is promoted by overcrowding and poor hygiene.
 Yaws (except for tertiary yaws) may be cured by a single shot of benzathine penicillin or an oral dose of azithromycin.
FACTS - YAWS

3.  A chronic bacterial infection that affects the skin, bone and cartilage
caused by the spirochete bacterium Treponema pallidum pertenue.
 It spreads through direct contact with the skin of an infected person.
 A single, berry-like sore on the skin is the first sign of yaws. Without
treatment, sores begin to spread. Yaws may eventually cause
disfigurement and disability. The condition is treated with antibiotics.
WHAT IS YAWS ?

4. The term yaws is thought to be of Caribbean origin.
In the language of the Carib Indian people, yaya is the word for "a sore."
Alternatively, the disease term yaws may have come from Africa where the word yaw may
have meant "a berry." Because the lesions of yaws look like berries, the disease is also
called frambesia meaning "raspberry." Other older names for yaws include granuloma
tropicum, polypapilloma tropicum, and thymiosis.
Why the disease is called yaws ?

6. SIGNS AND SYMPTOMS
• The incubation period is 2-6 weeks
• The prodomal period :
• Headache
• Fever
• Chills
• Weakness
• Arthralgia
• Muscles and joint pains in night time

7. • Infections, tumors, and the body's response to trauma or injury can all lead to lumps or bumps that appear to
be located on or underneath the skin.
• Depending upon the cause, skin lumps or bumps may vary in size and be firm or soft to the touch.
• The overlying skin may be reddened or ulcerated.
• Skin bumps may or may not be painful or tender, depending upon the cause of the lesions.
• Secondary yaws occurs weeks to months after the primary infection and typically presents with multiple raised
yellow lesions or pain and swelling of long bones and fingers (dactylitis).

9. Yaws begins when T. pertenue penetrates the skin at a site where skin was scraped, cut, or otherwise
compromised.
In most cases, T. pertenue is transmitted from person to person.
At the entrance site, a painless small lesion, or bump, arises within two to eight weeks and grows.
The initial lesion is referred to as the mother yaw.
The lymph nodes in the area of the mother yaw are often swollen (regional lymphadenopathy).
When the mother yaw heals, a light-colored scar remains.
CAUSES

10. • Yaws is a member of the treponematoses, diseases caused by spiral bacteria in the genus Treponema;
besides yaws, the disease include endemic syphilis (bejel) and pinta. Of these three diseases, yaws is
the most common.
• 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.
• This primary lesion is termed the mother yaw (also termed buba, buba madre, or primary frambesioma).
• Secondary lesions, termed daughter yaws, develop in about six to 16 weeks after the primary lesion.
• Almost all cases of yaws begin in children under 15 years of age, with the peak incidence in 6- to 10-
year-old children. The incidence is about the same in males and females.
PATHOGENESIS

11.  Yaws has four stages: primary, secondary, latent, and tertiary.
 The primary stage is the appearance of the mother yaw.
 Patients with yaws develop recurring ("secondary") lesions and more swollen lymph nodes. This
represents the secondary stage. These secondary lesions with rashes may be painless like the mother
yaw or they may be filled with pus, burst, and form ulcers. The affected child often experiences malaise
(feels poorly) and anorexia (loss of appetite).
 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 and/or bones. The palms of the hands and soles of the feet tend to become thickened and
painful (crab yaws).
STAGES OF YAWS

12. RISK FACTORS
 AGE - Primarily a disease of childhood and adolescense
 GENDER - M > F
 IMMUNITY - No natural immunity
 CLIMATE - Endemic in warm and humid climate
 SOCIAL FACTORS
More common in tribal people
Poor personal hygiene
Overcrowding
Low economic standard of people

13.  Most frequently the diagnosis is made on clinical findings.
 Laboratory confirmation of the diagnosis is by blood serum tests includes ;
• RPR or rapid plasma reagent test,
• VDRL test or venereal disease research laboratory test,
• TPHA or Treponema pallidum hemagglutination test,
• FTA-ABS or fluorescent treponema antibody absorption
 The reason that T. pallidum serum tests are used is that the spirochetes are so closely
related, they have similar antigens on their surfaces so that T. pallidum and T. pertenue are
cross-reactive (detected by the same serological tests).
DIAGNOSIS

14.  Special (dark-field) examination under the microscope in which technicians can actually see the spirochete
bacterium is also used to help diagnose yaws.
 The lesions (both the mother yaw and the secondary lesions) usually have many T. pertenue organisms that
can be visualized with dark-field examination of lesion scrapings.
 Other tests that detect spirochetes such as a silver stain or electron microscopy are used mainly by research
scientists.
 PCR tests can confirm yaws by detecting genetic material from organisms in samples from skin lesions.

15.  Treatment of yaws is simple and highly effective.
 Penicillin G benzathine given IM (intramuscularly) can cure the disease in the primary, secondary, and usually in
the latent phase.
 Penicillin V can be given orally for about seven to 10 days, but this route is less reliable than direct injection.
 Anyone allergic to penicillin can be treated with another antibiotic, usually erythromycin, doxycycline,
or tetracycline.
 Azithromycin (in a single oral dose of 30 mg/kg or the maximum 2 g) is the choice that the World Health
Organization (WHO) recommends because of the ease of administration.
TREATMENT

16.  Benzathine penicillin (single intramuscular dose) at 0.6 million units (children aged under 10 years)
and 1.2 million units (people aged over 10 years) can be used for patients with suspected clinical
treatment failure after azithromycin, or patients who cannot be treated with azithromycin.
 Patients should be re-examined 4 weeks after antibiotic treatment. Complete clinical healing will be
observed in over 95% of cases.
 Any individual with presumed treatment failure requires macrolide resistance testing.

17. The prognosis of yaws depends upon effective treatment so that the patient will not develop
complications. If appropriate treatment of yaws takes place before tertiary yaws develops, the
prognosis for a possible cure with little or no complications is good. However, if tertiary yaws
develops, the prognosis is worsened depending upon the severity of complications.
PROGNOSIS

18. There is no vaccine available to prevent yaws.
However, the WHO has established a yaws eradication strategy also referred to as the Morges strategy
by which the organization has established a goal of eradicating yaws by about 2020. Because this
disease is spread by person-to-person transfer and has no animal reservoir, the WHO considers this a
realistic goal.
Currently, for individuals, prevention is based on interrupting the transmission of the disease from
person to person by practicing good hygiene and by early diagnosis and rapid appropriate treatment
with azithromycin to prevent spread in the community.
Is YAWS preventable ?