Neglected Yaws Disease - Changing Oral Antibiotic Administration Might Help Eliminate It

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Academic Journal
Main Category: Infectious Diseases / Bacteria / Viruses
Article Date: 12 Jan 2012 - 6:00 PST


A tropical bacterial disease of the skin, bones and joints called Yaws has re-emerged in rural, tropical parts of Africa, Asia, and South America. According to a study by Dr Oriol Mitja at the Lihir Medical Center in Papua New Guinea published Online First in The Lancet, a simple regimen of oral azithromycin has proven to be just as effective at clearing infection as a traditional penicillin injection. The oral administration of azithromycin also omits the need for injection equipment and medically trained personnel and therefore switching to this regime could allow countries to finally eradicate the disease.

Yaws, a neglected re-emerging tropical disease, is caused by the spirochete bacterium Treponema pallidum pertenue and belongs to the same treponema family as syphilis, which can also be treated effectively with oral azithromycin. Yaws has re-emerged in the above named regions four decades after the disease was almost eradicated in a worldwide control program. The disease naturally consists of a primary, secondary, and tertiary stage, and unless it is diagnosed and treated at an early stage, it can become a chronic, recurring disease, which, in the long term can result in severe deforming bone lesions.

Researchers at the Lihir Medical Center randomized 124 children aged from 6 months to 15 years with confirmed yaws in a controlled trial to receive one oral dose of azithromycin and 126 children to receive an intramuscular injection of penicillin. They observed that 96% of children in the azithromycin group were cured compared with 93% in the penicillin group, which confirms that the treatments are comparable. The number of drug-related mild or moderate adverse events was comparable in both groups with 8% in the azithromycin group compared with 7% in the penicillin group.

The researchers declare:

"With yaws re-emerging, treatment with an effective drug that can be easily administered on a large scale is the preferred method for treatment, prevention, and, eventually, elimination worldwide."

They summarize the results and conclude:

"Our findings provide clear evidence that one high dose of oral azithromycin is non-inferior to injectable penicillin for treatment of yaws. If further studies confirm our findings, the next step is to attempt elimination and possibly eradication of the disease in the remaining endemic countries with mass drug administration programs under WHO's leadership."

Dr David Mabey at the London School of Hygiene and Tropical Medicine in London, UK, stresses in a linked comment that a single dose oral treatment for yaws is a major advance that should facilitate its eradication providing that no resistance is developed to azithromycin. He highlights that in high-income and some middle-income countries resistance to azithromycin has emerged in Treponema pallidum, the cause of syphilis, but adds this:

"does not necessarily imply that resistance in the closely related T pallidum subsp pertenue, which causes yaws, will become prevalent in rural areas in the developing countries where yaws remains endemic. More studies, such as that done by Mitjà and colleagues, are needed in other regions, and careful follow up will be needed to ensure that clinically significant resistance to azithromycin does not develop in T pallidum subsp pertenue."

Written by Petra Rattue
Copyright: Medical News Today
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