Yaws
Introduction
Introduction to yaws disease Yaws (yaws), also known as frambesiatropica, is a contact skin infection caused by the fine subspecies of Treponema pallidum. It is mainly prevalent in some tropical rural areas, mostly in children and adolescents. China's Jiangsu, Guangdong, Fujian, Guangxi, Taiwan and other regions have been scattered or regionally popular. However, the disease was eradicated by the mid-1960s, and the disease is still prevalent in the Africa, Central and South America, Southeast Asia and Oceania equatorial lines. basic knowledge The proportion of illness: 0.005% Susceptible people: mostly in children and adolescents Mode of transmission: contact sexual transmission Complications: periostitis
Cause
Cause of yaws
Pathogen infection (35%):
The pathogen of yaws is the T. subspecies of Treponema pallidum, also known as yaspose, which belongs to the genus Treponema of Treponema pallidum and Pinus pallidum. It is morphological, sports, difficult to color and cannot be in vitro. In terms of biological characteristics such as culture, the three spirochetes are basically the same, and the serological reactions are also indistinguishable from each other.
Pathogenesis
The main pathological feature of yaws disease is skin damage. Aspirin enters the blood from the damaged skin, which is slower than syphilis, causing bone, lymph nodes and distant skin to be affected. Early damage is thickening of the skin epidermis, and the dermis has cell infiltration and hyperplasia. , edema, formation of microabscess, a large number of yaws in the spinous layer, nipple hyperplasia, nipple thickening, epithelial hyperkeratosis, epidermal ulceration, overlying dry exudate, diffuse periostitis and long cortical loosening Early yaws, endometritis can be seen in advanced lesions, ulcerative granulomatous nodules, gums of skin and bone, and bone lesions can cause extensive deformities.
Prevention
Yass disease prevention
Since the disease is a contact infectious disease, contact with patients with yaws should be avoided, and skin trauma and insect bites should be prevented. Stay optimistic and happy. Long-term mental stress, anxiety, irritability, pessimism and other emotions will make the balance of the cerebral cortex excitatory and inhibition process imbalance, so you need to maintain a happy mood.
Complication
Yaw disease complications Complications periostitis
Destructive nasopharyngitis, rhinojeccosis, multiple finger (toe) osteitis, finger arthritis, humeral periostitis (sabre).
Symptom
Symptoms of yaws symptoms Common symptoms chills and papules, wet lymph nodes, periostitis, body phlegm
The disease mainly affects children, and is more common in school-age children. Its clinical characteristics are skin damage like bayberry, rash is not infiltrated and soft, clinically similar to syphilis and mild, and can cause skin and bone destruction and disfigurement in the late stage. The disease can have a false positive reaction to syphilis serum, which is indistinguishable from latent syphilis.
The incubation period of this disease is about 3 to 4 weeks, and the clinical process is divided into three phases.
The first phase: yas period, after the incubation period of 3 to 4 weeks after infection, the mother yaw appears in the entry part of the spirochete, and there may be mild systemic symptoms such as fever, headache, fatigue, etc. during the incubation period, but often does not cause the patient's attention. The mother and the yaw are often one, mostly located at the exposed part, especially on both sides of the limbs, the face, starting from a papule, and soon develop into a nodule, the surface is damp, and it is dark brown, and the surface is reddish granules after removing the mites. The unevenness is a bayberry-like shape, soft and non-infiltrated. Satellite-like damage can occur around the contact of the mother yez pus. The shape is the same as that of the mother yaw, but the mother yashi can expand or merge with the surrounding satellite damage into a ring or a circle. The ulcer is thick and thick, and it can heal naturally after a few months, leaving a slight concave atrophic scar or hypopigmentation. The mother and the baby can still be transmitted to the mother's breast and torso, perianal and external genitalia. It can also be involved but less, and the lymph nodes near the mother and the yaw can be swollen, not sticky, and not broken.
A small number of patients did not have a mother yas and went directly to the second phase.
The second period: Ziya period, 1 to 3 months after the occurrence of the mother Ya Shi, there is a wide range of yaw rash, equivalent to the second stage of syphilis, at this time, some of the mother and the yaw have not healed, often accompanied by the fear of pioneering symptoms Cold, fever, lack of appetite, body aches, etc., the shape of Ziya is similar to that of the mother, and the small nodules are large, high in leather, round or irregular, and the surface is rough and dry. Sparsely distributed symmetrically on the torso limbs, large nodules such as bayberry, often round, elliptical or slightly irregular, are brown or yellow thick, and after removing the red bayberry-like moist surface, there is a little Exudation or hemorrhage, mainly distributed in the scalp and the outside of the extremities, has a tendency to cluster, asymmetric distribution, and the clusters of nodules are sometimes arranged in a ring shape, resembling body sputum, the perianal nodules are moist like flattened genital warts, palmar damage Generally, no ulcers are formed to form keratinized plaques. The yaw rash can have a second-stage recurrence rash like syphilis. After the yaw rash subsides, new nodules appear in a period, but they do not occur at the same time, but occur one after another. The new rash is coming out again, new Damage exist, stage of disease for too long, usually from six months to three years.
The third phase: nodular ulcer yas period, yaws disease is mostly in the second phase, some patients enter the third phase, mainly for larger nodules, several or more than a string or ring, some merge into plaque Similar to syphilis, the gum is swollen, the nodules are broken into ulcers, the edges are steep or under the edge, and the nodular ulcers are mostly distributed in the flexor side of the extremities. The ulcer surface is exuded or thick, and the ulcer remains after healing. Large atrophic or bright hypertrophic scars, nodular ulcers can occur in the nasal bones and hard palate, destroying the pharynx, leaving a deformity, called destructive nasopharyngitis.
The third phase of yase can invade the bone and periosteum, causing rhinitis, causing the nose to be thick and thick like a mass, invading the metacarpal and proximal phalanx, causing multiple finger (toe) osteitis, finger arthritis, and humeral periostitis (Sabre ), often near joint nodules, nodules larger, multiple, more common in the elbows and ankles.
Examine
Examination of yaws
1. Helical examination: find the pathogen from the rash exudate, remove the skin blunt knife and scrape it, take the serum with a glass slide, stain the flakes with silver nitrate or use the black ray method. Under the microscope, many spirochetes, yasprobes can be seen under the microscope. The morphology is similar to that of Treponema pallidum, but there is no special movement.
2. Serological examination: The serum reaction (Fahrenheit, Kang's reaction and spiral brake test) was positive after 1 to 2 months of onset.
3. It is very similar to the pathology of syphilis. Silver staining can be used to detect a large number of yasprobids in the first and second stage of the damaged epidermis. The main difference between yaw and syphilis in histopathology lies in the dermis damaged dermis. The change is milder than syphilis, or no vascular changes.
4. According to clinical needs, choose X-ray chest X-ray, X-ray bone film, electrocardiogram and B-ultrasound.
Diagnosis
Diagnosis and identification of yaws disease
The main points of diagnosis are: in the epidemic area, adolescents or children, the exposed part, the mother yashi often one, after the sputum is like a bayberry, the exudate can be found under the dark field microscope, the syphilis after 1 to 2 months Seropositive.
The differential diagnosis with syphilis mainly relies on clinical, syphilis is sexual contact infection, the disease is general skin contact infection, hard chancre is mostly in the external genitalia, mother yates are in the exposed part, and the second stage syphilis is mainly rash, maculopapular rash. The second phase of yaw is a bayberry-like nodule with exudate or sputum.
