Chapter 171- Endemic (Nonvenereal) Treponematoses

Question 1

Important diff of endemic treponematoses and syphilis (4):

Answer 1

1. Nonvenereal form of transmission
2. Endemic
3. Tendency to affect children
4. Less likely risk for congenital transmission

Question 2

Chronic infectious and contagious disease recognized as neglected tropical disease

Answer 2

Pinta

Question 3

Most benign form of endemic treponematosis with clinical manifestations limited to the skin

Answer 3

Pinta

Question 4

Treatment for Pinta

Answer 4

Long acting benzathine penicillin 1.2 M units for adults, 0.6 M units for children

Question 5

Other names for pinta (3)

Answer 5

Azula
Carate
Mal de pinto

Question 6

First to occur in humans

Answer 6

Pinta

Question 7

Early serology test for syphilis positive in majority of cases of pinta

Answer 7

Wassermann test

Question 8

Late stage pinta cannot be reinfected while patients with early stage pinta who has been cured can be reinfected.
True or False

Answer 8

True

Question 9

Pinta can be cured spontaneously.

True or False

Answer 9

False, cell mediated immunity is not completely effective hence persists indefinitely

Question 10

Primary stage of pinta is divided into (2)

Answer 10

1. Early phase or initial period

2. Secondary phase or period of cutaneous dissemination

Question 11

Initial period appears ___ days after treponema inoculation and secondary phase occurs ___ after first lesions’ appearance. Late or tertiary lesion occurs ___ after the first lesion

Answer 11

7 to 20 days
6 months to 2-3 years
5 years

Question 12

Pinta spares (3)

Answer 12

Groin
Genitals
Inner and upper parts of the thighs

Question 13

Early lesions are irreversible.

True or False

Answer 13

False, late lesions giving permanent ‘vitiligo like’ appearance

Question 14

Reservoir of pinta? MOT?

Answer 14

Humans

Spread via direct contact with infected person or fomites

Question 15

Cornerstone of diagnosis of pinta

Answer 15

Serology

Question 16

Reflect disease activity for nonvenereal treponematoses

Answer 16

RPR/VDRL

Question 17

Serology can distinguish endemic treponematoses from syphilis.
True or False

Answer 17

False, cannot

Question 18

Stains for treponemes

Answer 18

Warthin Starry

Question 19

Mass treatment of __ in communities to prevent spread of endemic treponematoses

Answer 19

Azithromycin 1g oral dose

Question 20

Most prevalent of endemic treponematoses

Answer 20

Yaws

Question 21

Countries with highest number of yaws (3)

Answer 21

Papua New Guinea
Solomon Islands
Ghana

Question 22

Eroded or hyperkeratotic palmoplantar lesions with fissuring inducing a crablike gait

Answer 22

Crab yaws

Question 23

Effective in treatment of patients with yaws (2)

Answer 23

Penicillin
Azithromycin 2g (30mkday) single dose

Question 24

Matching type

1. Papillomatous
2. Moist and papillomatous (frambesiomas)
3. Dry and papulosquanous (pianides)
4. Ulcer
5. Bilateral
6. Hematogenous spread
7. Lymphatic spread

A. Primary
B. Secondary

Answer 24

A
B
B
A
B
B
B

Question 25

Other terms for primary yaws (3)

Answer 25

Mother yaws Maman pian Buba madre

Question 26

Primary lesion of yaws may resolve spontaneously in 3 to 6 months leaving a pigmented scar. True or False

Answer 26

True

Question 27

Most representative lesion of yaws

Answer 27

Resembling raspberries

Question 28

Multiple, generalized with annular or discoid morphology with squamous collarette grouped in corymbose pattern

Answer 28

Tinea yaws

Question 29

Tender or painful acral lesions resulting to peculiar gait

Answer 29

Crab yaws

Question 30

Paronychia originating from hyperkeratotic lesions in the nail folds

Answer 30

Pianic onychia

Question 31

Secondary yaws resolves spontaneously with or without scarring. True or False

Answer 31

True

Question 32

Relapsing yaws localizes in (3) for as long as __ after initial infection

Answer 32

Perioral Perianal Axillary 5 years

Question 33

Most common manifestation of late stage of yaws

Answer 33

Simultaneous skin and bone involvement

Question 34

Complete destruction of nasal cartilage and collapse of nasal pyramid

Answer 34

Gangosa

Question 35

Yaws present with ff noncutaneous findings (6)

Answer 35

``` Osteoperiostitis Ghoul hand Rhinopharyngitis obliterans/ gangosa Goundou Optic atrophy Sabre shins ```

Question 36

Late yaws is similar to late syphilis and presents with cV or neurologic manifestations. True or False

Answer 36

False, opposite, does not

Question 37

Fusiform swelling of finger affecting 2 proximal phalanges

Answer 37

Ghoul hand

Question 38

Central face deformity

Answer 38

Rhinopharyngitis obliterans | Gangosa

Question 39

Exostosis of paranasal area

Answer 39

Goundou

Question 40

T. Pallidum ssp pertenue is sensitive to

Answer 40

Tetracycline Penicillin Erythromycin

Question 41

Response to T. Pallidum ssp. Pertenue

Answer 41

Humoral and cellular

Question 42

Important difference of yaws with syphilis (2)

Answer 42

1. Does not induce vascular changes or (2) endothelial obliteration

Question 43

Radiographic findings of yaws in periostitis

Answer 43

``` Onion latering (periosteal reaction) Loss of clarity of cortex ```

Question 44

Treatment of choice of yaws

Answer 44

Single dose long acting benzathine penicillin 1.2 M units for more than 10, 0.6 M units for less than 10

Question 45

Yaws lesions become noninfectious in ___, joint pain disappears in ___, lesions resolve within ___ after therapy

Answer 45

24 hours 24 to 48 hours 2 to 4 weeks

Question 46

RPR and VDRL decreases to a minimum in ___ and becomes negative in ___

Answer 46

6 to 12 months | Next 2 years

Question 47

Who eardication program for yaws include yearly serologic surveys in children younger than __

Answer 47

5years

Question 48

Peak incidence of yaws

Answer 48

6 - 10 years old