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Yaws in Adult
Other Resources UpToDate PubMed

Yaws in Adult

Contributors: Susan Burgin MD, Edith Lederman MD, Noah Craft MD, PhD
Other Resources UpToDate PubMed

Synopsis

Yaws, also known as framboesia, pian, buba, parangi, and paru, is an endemic treponemal infection caused by the spirochete Treponema pallidum ssp pertenue. It is found in rural areas of Central and South America, equatorial Africa, the Caribbean, and the equatorial islands of Southeast Asia, including Papua New Guinea. It is considered a disease of children, with a peak incidence between the ages of 2 and 10 years. The disease is spread by person-to-person contact, and risk factors include broken skin, overcrowding, and poor sanitation.

Clinical features can be categorized into early (primary and secondary), latent, and late (tertiary) stages. After an incubation period of 3 weeks (9-90 days), yaws presents as a small papule that rapidly enlarges to a size of around 2-5 cm. Termed the mother yaw, or frambesioma, this primary lesion is teeming with spirochetes, very pruritic, and extremely infectious.

The mother yaw may persist for 3-6 months before spontaneous resolution (sometimes with scarring or hypopigmentation, sometimes without). During the primary stage, the organism disseminates hematogenously and via the lymphatic system to give rise to secondary yaws weeks to months later.

In secondary yaws, scaly or moist papules, plaques, and nodules in localized, intertriginous, or generalized distributions occur. Oral mucous patches may be seen. This may be accompanied by fever, malaise, and generalized nonsuppurative lymphadenitis. Osteitis, periostitis, and dactylitis may also be seen at this stage. The cutaneous lesions last for weeks to months and resolve completely or with residual hypo- or hyperpigmentation.

Ten percent of individuals develop late-stage yaws after a latent period of 5-10 years. Recurrent self-healing skin and oral lesions may occur during this latent period. Late-stage yaws is marked by chronic skin ulcers (gummas) and painful, destructive bony changes.

Codes

ICD10CM:
A66.9 – Yaws, unspecified

SNOMEDCT:
70647001 – Yaws

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Primary:
  • Nonbullous impetigo
  • Ecthyma
  • Chancroid
  • Blastomycosis (Paracoccidioidomycosis, Blastomycosis)
  • Common wart
  • Pinta – Usually slower growing
  • Primary syphilis
  • Cutaneous tuberculosis – Tuberculous chancre
  • Cutaneous leishmaniasis
  • Arthropod bite or sting
  • Sporotrichosis
  • Atypical mycobacterial infection
  • Tungiasis
  • Coccidioidomycosis
  • Talaromyces marneffei infection
  • Cryptococcosis
  • Halogenoderma (Iododerma, Bromoderma)
  • Nodular basal cell carcinoma – Pearly rolled border; unlikely in children
  • Cutaneous squamous cell carcinoma – More keratotic early; unlikely in children
Secondary:
  • Endemic syphilis
  • Pinta
  • Secondary syphilis, including condyloma lata
  • Genital wart
  • Tinea corporis – Potassium hydroxide (KOH) positive
  • Nonbullous impetigo – Honey-crusted and occasionally Bullous impetigo
  • Blastomycosis (Paracoccidioidomycosis, Blastomycosis)
  • Cutaneous leishmaniasis – More inflammatory and crusted
  • Atypical mycobacterial infection
  • Mycetoma
  • Cutaneous tuberculosis – Lupus vulgaris or tuberculosis verrucosa cutis
  • Coccidioidomycosis
  • Talaromyces marneffei infection
  • Cryptococcosis – Sometimes umbilicated
  • Halogenoderma (Iododerma, Bromoderma)
  • Reactive arthritis
  • Lichen planus
  • Psoriasis
Tertiary:
  • Tertiary syphilis
  • Ecthyma
  • Chancroid
  • Stasis ulcer
  • Ischemic ulcer
  • Martorell hypertensive leg ulcer
  • Pyoderma gangrenosum
  • Atypical mycobacterial infection
  • Reactive arthritis
  • Noma
  • Histoplasmosis, African histoplasmosis

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:07/29/2019
Last Updated:07/18/2023
Copyright © 2024 VisualDx®. All rights reserved.
Yaws in Adult
A medical illustration showing key findings of Yaws (Primary) : Ankle, Lower leg, Smooth papule, Red
Clinical image of Yaws - imageId=2051484. Click to open in gallery.  caption: 'A purulent ulcer on an extremity.'
A purulent ulcer on an extremity.
Copyright © 2024 VisualDx®. All rights reserved.