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Yaws, bejel, and pinta

Authors
Oriol Mitjà, MD, PhD, DTMH
David Mabey, BM, BCh, DM, FRCP
Section Editors
Edward T Ryan, MD, DTMH
Ted Rosen, MD
Deputy Editors
Elinor L Baron, MD, DTMH
Abena O Ofori, MD

INTRODUCTION

The endemic treponematoses include yaws (Treponema pallidum subsp pertenue), bejel (T. pallidum subsp endemicum), and pinta (Treponema carateum) [1]. These are chronic bacterial infections caused by organisms that are morphologically and serologically indistinguishable from Treponema pallidum subsp pallidum, which is the causative organism of venereal syphilis [2,3]. However, they can be differentiated by the clinical manifestations of their respective diseases, by geographic distribution, and by identification of minor genetic differences [4,5].

Yaws and bejel affect skin and bones; pinta affects the skin only. Other local terms for yaws include buba, bouba, framboesia, parangi, paru, and pian [6,7]. Other terms for bejel include endemic syphilis, dichuchwa, sklerjevo, belesh, bishel, firjal, and loath. Other terms for pinta include enfermedad azul, carate, cute, and mal de pinto.

EPIDEMIOLOGY

Historic perspective — The number of endemic treponematoses cases was reduced from an estimated 50 million in 1952 to 2.5 million in 1964; this was achieved as a result of mass treatment campaigns led by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) in 46 countries. Disease was even eliminated in some regions; bejel was eliminated in Bosnia [8], and yaws was eliminated in Malaysia and Brazil [9,10].

Disease began to reemerge in the late 1970s. A World Health Assembly Resolution renewed efforts to eradicate yaws in 1978, although endemic treponematoses were generally not prioritized in many regions, and surveillance and reporting have been sporadic; an exception is the WHO South Asia region, which kept yaws on its agenda [11]. There is growing evidence in the literature that the number of cases continues to increase in some countries.

Geographic distribution — The nonvenereal treponematoses are endemic in rural areas among communities living in overcrowded conditions with poor hygiene (figure 1). Imported cases of yaws and bejel have been reported among children in Europe and the United States [12-15].

                            

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