Yaws Osteoperiostitis Treated with Single-Dose Azithromycin

Abstract

AbstractThe etiologic agent of yaws, Treponema pallidum subsp. pertenue, causes a multistage infection transmitted by nonsexual contact with the exudates from active lesions. Bone lesions in the form of osteoperiostitis are common and occur in numerous bones simultaneously in early stages. Although a multinational eradication campaign with mass administration of intramuscular benzathine benzylpenicillin in the 1950s greatly reduced its global incidence, a resurgence of yaws has occurred since around 2000 in western and central Africa and the Pacific Islands. The finding that a single oral dose of azithromycin (30 mg/kg) was as effective as benzathine benzylpenicillin prompted renewed interest by World Health Organization in 2012 toward eradication of this infection by 2020. We previously reported the excellent response to benzathine benzylpenicillin therapy for yaws osteoperiostitis. Herein, we document a confirmed case of yaws with osteoperiostitis successfully treated with single-dose azithromycin and discuss the pathology of yaws periostitis and comment on the implications of this in light of the new campaign toward yaws eradication.

Figure 1.

(A) Nodule with yellow crust on the right leg of a patient with primary yaws. (B) Photomicrograph of skin biopsy showing yaws lesions. Spirochete organisms are stained bright red by the Treponema pallidum immunohistochemical stain (×400 magnification). (C) Loss of clarity of the cortex of the distal radius and ulna and organized periosteal reaction. (D) Resolution of bone lesions at 4 weeks after azithromycin treatment.