Bone Yaws
Introduction
Introduction to osteomyel disease Yaws (yaws) is a chronic contagious disease caused by yaws, a tropical infectious disease. The clinical manifestations are similar to syphilis, but not attributed to disease, no hereditary. It does not invade important internal organs and central nervous system, mainly involving the skin, and can invade bones in the late stage. Young people and children are more common. The disease is prevalent in the tropical regions of Central Africa, South Asia, South America, etc. There are a few cases in the southern part of China, but it has basically disappeared. basic knowledge The proportion of illness: 0.001% Susceptible people: more common in young people and children Mode of infection: contact spread Complications: periostitis
Cause
Cause of osteomyelopathy
Etiology
The disease is caused by the invasion of the snail by the epidermis. The shape of the yaw spiral is similar to that of the syphilis, but the infectivity is weak. The main route of infection is close contact, which is transmitted through the skin, and the early stage is mainly skin damage. The papules, pus, granulomatous or gums are destroyed, while the bones are the later manifestations. The incidence rate is about 4.5% to 6.5% of yaws in China, and there are also reports that about 10% to 20% are concurrent. Osteoarticular lesions.
Pathological change
The pathological changes are mainly the proliferation of fibrous tissue between the trabecular bone and the extensive necrosis of the periorbital tissue. The necrotic tissue is surrounded by the fibrous tissue which is significantly proliferated. There are lymphocytes, neutral polynuclear leukocytes and plasma cells infiltrating to form a gelatinous swelling. The morphology, bone lesions are mostly located in the humerus, radius and humerus, but the frontal bone, mandible, femur, metacarpal, scapula and ribs can also be affected. The same patient may have multiple bone involvement, and the lesion may be periostitis. Osteitis or osteomyelitis, periostitis is mainly the proliferation of periosteum, osteoporosis is mainly characterized by extensive osteoporosis, with multiple small round or oval bone destruction absorption area, some damage is very serious, can cause disease Rational fractures, if the joints are involved, the elbow joints, hip joints and ankle joints are often seen, and occasionally the upper jaw perforation and nasal bone destruction.
Prevention
Osteopath prevention
Yaws (Yaw s), also known as tropical berry rash and contact infection, systemic granuloma, etc., is a contagious disease, more common in children and adolescents, tropical humid, average temperature above 27 ° C, human skin damage and contact with pathogens There are two necessary conditions for the spread of yaws, and there are still diseases in rural areas in Africa, America, Southeast Asia and the equatorial line. In the 1940s and 1950s, there was a regional epidemic in the vicinity of Shanghai's northern Jiangsu. In the mid-term, the disease has disappeared in China. The sultry and humid climate in tropical countries, especially the rainy season from June to September, is more popular in the epidemic season. The main point of prevention of this disease lies in the formation of two necessary conditions for the disease and the elimination of the source of infection. Cutting off the route of transmission can prevent this disease very well.
Complication
Osteopathic complications Complications periostitis
In stage I, the disease can affect the periosteum, bone, formation of localized or diffuse periostitis, as well as subperiosteal new bone deposition, calcification, in stage II, severe cases can even invade the face, nasal bone, hard tibia, but The trunk bone is rarely involved, and the ulcerated granuloma nodules are mainly caused in the late stage, as well as the skin and bone gums, the skin is covered with deep and shallow ulcers and the pigmentation is atrophic and scarred, and the bones of the limbs are invaded and even deformed.
Symptom
Symptoms of yaws disease common symptoms rash papillary lymphadenopathy bone destruction periosteal reaction fever osteosclerosis periostitis blush scarring
Due to close contact, family members often have a history of mutual infection. Their clinical symptoms and performance are similar to those of syphilis. They can be divided into three phases:
1. The first phase is called the mother ya stage, 2 to 3 weeks after infection, red small macules appear in contact with the skin, and then can develop up to about 2 to 3 cm above the skin surface, and the number of diameters is 1 to 10 cm. Ulcer, the bottom of which is a bayberry-like granulation tissue, which touches hard rubber, but is easy to bleed. There is a large amount of serum exudation and scarring. There is redness around the periorbital period. Generally, it can heal itself. About 2 to 3 months, local lymph nodes can be swollen. Large, does not invade bones and joints.
2. The second phase is called yashi rash. After 1 to 3 months after the appearance of early rash, symptoms such as soreness, fever, headache and other symptoms of the joints may occur. This period is the systemic infection period, and the lymph nodes are swollen, but the patient is generally in good condition. The skin lesions are mostly ulcerative papules, the diameter can reach more than 10cm, and scars are formed after healing. The skin lesions are exposed to many parts such as face, limbs, children's buttocks, etc., while the perineum is rare, and the mucosa is not damaged. Skin lesions can last for several months to 2 to 3 years. This period can invade bones and change for periostitis and bone processes. It is mainly caused by bone hyperplasia, which can invade the entire backbone, and the formation of new bone under the periosteum, resulting in thickening of the bones. Extensive periostitis changes in the second phase of yaws are typical manifestations.
3. The third stage is called nodular ulcer type yaw or late yaw, generally 6 to 10 years after infection. Most lesions of yaws are terminated in the second stage, and the third stage is less developed. The joint lesions are about 10% to 20%, mainly manifested by the enlargement and deepening of the skin ulcer and the destruction of the bone under the ulcer. When the outer edge of the cortical bone is destroyed, the edge of the cortical bone is irregularly deformed. If the inner edge is damaged, It is characterized by multiple transparent areas of saccular bone density reduction, and bone destruction around bone destruction, periosteal reaction is lighter or no, the more obvious local ulcer, the more severe the bone destruction, the lesions in the skull are mostly around Osteoporosis and the center showed a cystic destruction zone. In the humerus, bone hyperplasia and periosteal hyperplasia were dominant, with medullary stenosis, and the appearance was "waist-like" change.
Examine
Examination of osteomyel disease
The auxiliary examination methods for this disease mainly include the following:
1. Smear examination: A large amount of yasprobid can be found on the smear in the exudate of skin ulcer.
2. The serum Huakang reaction of yashi patients was positive or strongly positive, but the Huakang reaction of cerebrospinal fluid was negative, indicating that the spirochete did not invade the central nervous system.
4, X-ray examination: the X-ray performance of the middle and late yaws has the following characteristics: X
(1) Multiple bone involvement, multiple bones of the extremities can be invaded, showing localized or diffuse periostitis.
(2) The lesion mainly occurs in the long bone backbone, and the metaphysis and epiphysis are rarely involved.
(3) Localized periosteum and bone hyperplasia, fusion, thickening of the cortical bone, blurred or disappeared bone marrow cavity.
(4) Diffuse long bone sclerosis, bone cortex sees a bone-like destruction defect, cancellous bone worm-like bone destruction.
(5) There is very little dead bone formation in the diseased bone.
Diagnosis
Diagnosis and diagnosis of ya ya disease
diagnosis
The diagnosis should be detailed in the history of the disease, careful attention and analysis of clinical manifestations, smear examination in the ulcer exudate to find yaspase can be diagnosed, there is a close contact with the patient before the disease, or the history of the epidemic area, with a typical rash, diagnosis It is not difficult, one or two stages of damage can be found in the spiral, serum VDRL or USR after 1 to 2 months of onset is helpful for diagnosis.
Differential diagnosis
(1) bone syphilis: both are infectious diseases caused by spirochetes. They have similar manifestations in skin lesions and bone lesions. Both serum and Fahrenheit reactions are positive, but as long as careful analysis of their characteristics, such as yaws For young people and children, syphilis is more common in infants and adults; jasmine patients and their parents have no history of sexually transmitted diseases, only history of contact with infection and history of living in the affected area, syphilis patients and their parents are different, the two lesions are also different, such as the initial syphilis The lower jaw is often located in the external genitalia, and the genital genital disease is rare in the external genital tract. The mucosa is often not damaged. The second stage of syphilis has a small endovascular inflammation in the biopsy, and there is no yaw disease in the syphilis. Periosteal hyperplasia, less bone destruction, etc., is similar to the X-ray of yaws disease, but syphilitic osteitis or gum swelling spreads to the bone end, there is articular cartilage erosion, and Charcot arthrosis appears on the X-ray. "Characteristics, spine, skull have bone destruction or hardening. In addition, the age of onset is too large. In addition to the skin of the extremities, there are papular ulcers of the external genitalia, history of sexually transmitted diseases, and nerves. System and visceral damage are obvious, and there are differences between the two.
(2) Septic osteomyelitis: mainly occurs in the metaphysis, bone destruction and hyperplasia, a large number of new periosteal bones, surrounded by the original backbone, "bone-crust" signs, while showing large dead bones and Abscess formation, combined with clinical manifestations and laboratory tests, can be identified.
