Pian, Bejel y Pinta

Epidemiología y Etiología

Epidemiología

Pian (más común):

• Prevalente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum áreas cálidas y húmedas de:
  • Asia ASIA Spinal Cord Injuries del Sur
  • Indonesia
  • Islas del Pacífico
  • África
  • Sudamérica
• Niños > adultos

Bejel Bejel Yaws, bejel, and pinta are endemic, nonvenereal treponematoses. The causative organisms are Treponema pallidum pertenue (yaws), T. pallidum endemicum (bejel), and T. carateum (pinta). These treponematoses are generally transmitted by direct skin-to-skin contact with infected skin lesions. Yaws, Bejel, and Pinta:

• Prevalente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum regiones áridas de:
  • Oriente Medio
  • África Central y del Sur
• Niños > adultos

Pinta Pinta An infectious disease of the skin caused by treponema carateum that occurs only in the Western hemisphere. Age of onset is between 10 and 20 years of age. This condition is characterized by marked changes in the skin color and is believed to be transmitted by direct person-to-person contact. Yaws, Bejel, and Pinta:

• Muy rara
• La ocurrencia ha HA Hemolytic anemia (HA) is the term given to a large group of anemias that are caused by the premature destruction/hemolysis of circulating red blood cells (RBCs). Hemolysis can occur within (intravascular hemolysis) or outside the blood vessels (extravascular hemolysis). Hemolytic Anemia disminuido.
• Todavía puede ser endémica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum:
  • Sudamérica
  • Centroamérica
• Adolescentes y adultos > niños

Etiología

• Organismos causantes:
  • Subespecies de Treponema Treponema Treponema is a gram-negative, microaerophilic spirochete. Owing to its very thin structure, it is not easily seen on Gram stain, but can be visualized using dark-field microscopy. This spirochete contains endoflagella, which allow for a characteristic corkscrew movement. Treponemapallidum:
    • Pian: T. pallidum pertenue T. pallidum pertenue Treponema
    • Bejel Bejel Yaws, bejel, and pinta are endemic, nonvenereal treponematoses. The causative organisms are Treponema pallidum pertenue (yaws), T. pallidum endemicum (bejel), and T. carateum (pinta). These treponematoses are generally transmitted by direct skin-to-skin contact with infected skin lesions. Yaws, Bejel, and Pinta: T. pallidum endemicum T. pallidum endemicum Treponema
  • Pinta Pinta An infectious disease of the skin caused by treponema carateum that occurs only in the Western hemisphere. Age of onset is between 10 and 20 years of age. This condition is characterized by marked changes in the skin color and is believed to be transmitted by direct person-to-person contact. Yaws, Bejel, and Pinta: T. carateum T. carateum Treponema
• Características básicas del Treponema Treponema Treponema is a gram-negative, microaerophilic spirochete. Owing to its very thin structure, it is not easily seen on Gram stain, but can be visualized using dark-field microscopy. This spirochete contains endoflagella, which allow for a characteristic corkscrew movement. Treponema:
  • Espiroqueta ( en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum forma de espiral)
  • Gram-negativa
  • Longitud media: 6-15 μm; anchura media: 0,1-0,2 μm

Patogénesis

Reservorio

Los LOS Neisseria humanos son el único reservorio.

Transmisión

• Pian: contacto de piel con piel con las lesiones
• Bejel Bejel Yaws, bejel, and pinta are endemic, nonvenereal treponematoses. The causative organisms are Treponema pallidum pertenue (yaws), T. pallidum endemicum (bejel), and T. carateum (pinta). These treponematoses are generally transmitted by direct skin-to-skin contact with infected skin lesions. Yaws, Bejel, and Pinta:
  • Contacto de piel con piel con las lesiones
  • Contacto de boca con boca con las lesiones bucales
  • Fómites (e.g., utensilios para comer y beber)
• Pinta Pinta An infectious disease of the skin caused by treponema carateum that occurs only in the Western hemisphere. Age of onset is between 10 and 20 years of age. This condition is characterized by marked changes in the skin color and is believed to be transmitted by direct person-to-person contact. Yaws, Bejel, and Pinta: contacto de piel con piel con las lesiones

Fisiopatología

• Contacto de la piel con una lesión infectada → la espiroqueta se adhiere a la piel o las membranas mucosas
• Producción de hialuronidasa → permite la invasión tisular
• Los LOS Neisseria organismos se recubren con la fibronectina del huésped → previene la fagocitosis y el reconocimiento por parte del sistema inmunitario
• Viaja a los LOS Neisseria ganglios linfáticos → diseminación a través del torrente sanguíneo
• Respuesta inmunitaria del huésped → manifestaciones de la enfermedad

Presentación Clínica

Pian

Fase primaria:

• Pápula localizada en el lugar de la inoculación (“buba madre”):
  • Ocurre con mayor frecuencia en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las extremidades inferiores
  • Indoloras
  • Pueden ser pruriginosas
• Evolución:
  • Progresa a un nódulo amarillo grande
  • Posible ulceración con tejido de granulación rojo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la base de la úlcera
  • Involuciona espontáneamente a una cicatriz hiperpigmentada

Fase secundaria:

• Lesiones secundarias:
  • Después de la diseminación linfática de la bacteria Bacteria Bacteria are prokaryotic single-celled microorganisms that are metabolically active and divide by binary fission. Some of these organisms play a significant role in the pathogenesis of diseases. Bacteriology
  • Aparece de semanas hasta 2 años después de la fase primaria
• Morfología:
  • Nódulos solitarios y ulcerados que se asemejan a la buba madre
  • Múltiples nódulos más pequeños
• Papilomas o placas palmares y plantares dolorosos
• Artralgias
• Osteoperiostitis Osteoperiostitis Yaws, Bejel, and Pinta:
  • Dolor Dolor Inflammation nocturno de huesos
  • Dactilitis

Fase terciaria:

• Rara
• Lesiones tardías que se forman ≥ 5 años después de la infección inicial
• Lesiones gomatosas (destructivas, granulomatosas) de:
  • Piel
  • Huesos
• Las lesiones destructivas y mutilantes pueden provocar:
  • Malformaciones de huesos largos (e.g., tibia Tibia The second longest bone of the skeleton. It is located on the medial side of the lower leg, articulating with the fibula laterally, the talus distally, and the femur proximally. Knee Joint: Anatomy arqueada)
  • Lesiones cutáneas o subcutáneas yuxtaarticulares
  • Ulceraciones de la nasofaringe y el paladar (“rinofaringitis mutilante”)
  • Exostosis de la porción nasal del maxilar (“goundou”)

Bejel Bejel Yaws, bejel, and pinta are endemic, nonvenereal treponematoses. The causative organisms are Treponema pallidum pertenue (yaws), T. pallidum endemicum (bejel), and T. carateum (pinta). These treponematoses are generally transmitted by direct skin-to-skin contact with infected skin lesions. Yaws, Bejel, and Pinta

Fase primaria:

• Pápula, parche o úlcera pequeña y primaria en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la mucosa oral
• No se observa comúnmente debido a su pequeño tamaño
• Se resuelve espontáneamente

Fase secundaria:

• Úlceras o parches indoloros:
  • Puede afectar:
    • Membranas mucosas
    • Piel (regiones particularmente cálidas y húmedas)
  • Se vuelven condilomatosos antes de curar finalmente
• Periostitis Periostitis Inflammation of the periosteum. The condition is generally chronic, and is marked by tenderness and swelling of the bone and an aching pain. Acute periostitis is due to infection, is characterized by diffuse suppuration, severe pain, and constitutional symptoms, and usually results in necrosis. Reactive Arthritis → dolor Dolor Inflammation de huesos
• Laringitis → disfonía
• Úlceras nasofaríngeas
• Posible úlcera genital similar a la observada en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la sífilis

Fase terciaria:

• Lesiones gomatosas de:
  • Piel
  • Huesos
• Las lesiones destructivas resultan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum:
  • Deformidades óseas
  • Destrucción nasofaríngea
  • Nódulos yuxta-articulares

Pinta Pinta An infectious disease of the skin caused by treponema carateum that occurs only in the Western hemisphere. Age of onset is between 10 and 20 years of age. This condition is characterized by marked changes in the skin color and is believed to be transmitted by direct person-to-person contact. Yaws, Bejel, and Pinta

Fase primaria:

• Pápula o placa roja inicial:
  • Pruriginosa
  • Tipo escamosa
  • ≥ 10 cm de diámetro
  • Comúnmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las extremidades inferiores
  • Puede haber lesiones satélites.
• Linfadenopatía regional

Fase secundaria:

• Píntidas
  • Aparecen meses después de la fase primaria
  • Varias placas pruriginosas
  • Experimentan un cambio de color de rojo a gris a negro.
• Similar a la lesión cutánea inicial de la fase primaria

Fase terciaria o tardía:

• Decoloración y despigmentación de la piel
• Atrofia

Diagnóstico y Tratamiento

Diagnóstico

Debido a que estas especies treponémicas son morfológicamente indistinguibles, el diagnóstico se basa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la combinación de datos demográficos, región geográfica, presentación clínica y hallazgos de laboratorio.

Serología:

• Pruebas no treponémicas:
  • Opciones:
    • Reagina plasmática rápida
    • Prueba de laboratorio de investigación de enfermedades venéreas ( VDRL VDRL Treponema, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)
  • Los LOS Neisseria títulos deben disminuir después del tratamiento.
• Pruebas treponémicas:
  • Opciones:
    • Prueba de absorción de anticuerpos treponémicos fluorescentes
    • Prueba de microhemaglutinación para anticuerpos contra T. pallidum
    • Prueba de aglutinación de partículas de T. pallidum
    • Inmunoensayo enzimático de T. pallidum
    • Inmunoensayo de quimioluminiscencia
  • No se puede diferenciar entre la infección actual y la anterior ( los LOS Neisseria títulos permanecen positivos después del tratamiento)

Métodos directos:

• Reacción en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cadena de la polimerasa ( PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR), por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés):
  • Detecta el ADN del Treponema Treponema Treponema is a gram-negative, microaerophilic spirochete. Owing to its very thin structure, it is not easily seen on Gram stain, but can be visualized using dark-field microscopy. This spirochete contains endoflagella, which allow for a characteristic corkscrew movement. Treponema
  • Muestra: hisopados de una úlcera
• Microscopía de campo oscuro:
  • Una técnica de microscopía que ilumina las muestras contra un fondo oscuro
  • Se verán espiroquetas móviles.

Tratamiento

El tratamiento es el mismo para todas estas infecciones. Las opciones incluyen:

• Penicilina G benzatínica intramuscular (preferida con bejel Bejel Yaws, bejel, and pinta are endemic, nonvenereal treponematoses. The causative organisms are Treponema pallidum pertenue (yaws), T. pallidum endemicum (bejel), and T. carateum (pinta). These treponematoses are generally transmitted by direct skin-to-skin contact with infected skin lesions. Yaws, Bejel, and Pinta y pinta Pinta An infectious disease of the skin caused by treponema carateum that occurs only in the Western hemisphere. Age of onset is between 10 and 20 years of age. This condition is characterized by marked changes in the skin color and is believed to be transmitted by direct person-to-person contact. Yaws, Bejel, and Pinta)
• Azitromicina oral

Diagnóstico Diferencial

• Sífilis: una infección bacteriana de transmisión sexual causada por T. pallidum subespecie pallidum. La sífilis tiene 3 estadios. La sífilis primaria se presenta con una úlcera genital indolora llamada chancro. La sífilis secundaria se presenta con erupción difusa, condiloma lata y síntomas similares a los LOS Neisseria de la gripe. La sífilis terciaria se presenta con afectación neurológica y cardíaca. El diagnóstico se realiza con pruebas serológicas treponémicas y no treponémicas. El pilar del tratamiento es la penicilina G benzatínica intramuscular.
• Chancroide: una infección de transmisión sexual causada por Haemophilus ducreyi Haemophilus ducreyi A species of Haemophilus that appears to be the pathogen or causative agent of the sexually transmitted disease, chancroid. Haemophilus. El chancroide se presenta con úlceras genitales dolorosas y linfadenopatía inguinal supurativa (bubones). El diagnóstico es generalmente clínico, aunque la PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR) y los LOS Neisseria cultivos pueden ayudar (si están disponibles). El tratamiento consiste en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum antibióticos macrólidos.
• Leishmaniasis Leishmaniasis Leishmania species are obligate intracellular parasites that are transmitted by an infected sandfly. The mildest form is cutaneous leishmaniasis (CL), characterized by painless skin ulcers. The mucocutaneous type involves more tissue destruction, causing deformities. Visceral leishmaniasis (VL), the most severe form, presents with hepatosplenomegaly, anemia, thrombocytopenia, and fever. Leishmania/Leishmaniasis: una infección causada por especies de Leishmania Leishmania Leishmania species are obligate intracellular parasites that are transmitted by an infected sandfly. The disease is endemic to Asia, the Middle East, Africa, the Mediterranean, and South and Central America. Clinical presentation varies, dependent on the pathogenicity of the species and the host’s immune response. Leishmania/Leishmaniasis, que son parásitos intracelulares obligados transmitidos por flebótomos. La forma más leve es la leishmaniasis Leishmaniasis Leishmania species are obligate intracellular parasites that are transmitted by an infected sandfly. The mildest form is cutaneous leishmaniasis (CL), characterized by painless skin ulcers. The mucocutaneous type involves more tissue destruction, causing deformities. Visceral leishmaniasis (VL), the most severe form, presents with hepatosplenomegaly, anemia, thrombocytopenia, and fever. Leishmania/Leishmaniasis cutánea, que se caracteriza por úlceras cutáneas indoloras. El tipo mucocutáneo implica mayor destrucción tisular y deformidades. La leishmaniasis Leishmaniasis Leishmania species are obligate intracellular parasites that are transmitted by an infected sandfly. The mildest form is cutaneous leishmaniasis (CL), characterized by painless skin ulcers. The mucocutaneous type involves more tissue destruction, causing deformities. Visceral leishmaniasis (VL), the most severe form, presents with hepatosplenomegaly, anemia, thrombocytopenia, and fever. Leishmania/Leishmaniasis visceral se presenta con hepatoesplenomegalia, anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types, trombocitopenia y fiebre. El tratamiento se basa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la severidad clínica. Se necesita tratamiento sistémico (anfotericina B) para la leishmaniasis Leishmaniasis Leishmania species are obligate intracellular parasites that are transmitted by an infected sandfly. The mildest form is cutaneous leishmaniasis (CL), characterized by painless skin ulcers. The mucocutaneous type involves more tissue destruction, causing deformities. Visceral leishmaniasis (VL), the most severe form, presents with hepatosplenomegaly, anemia, thrombocytopenia, and fever. Leishmania/Leishmaniasis visceral.
• Lepra: una infección bacteriana crónica causada por el complejo Mycobacterium leprae Mycobacterium leprae A species of gram-positive, aerobic bacteria that causes leprosy in man. Its organisms are generally arranged in clumps, rounded masses, or in groups of bacilli side by side. Mycobacterium. Los LOS Neisseria síntomas afectan principalmente la piel y los LOS Neisseria nervios periféricos, dando lugar a manifestaciones cutáneas (e.g., máculas hipopigmentadas) y neurológicas (e.g., pérdida de la sensibilidad). El diagnóstico se establece clínicamente y se respalda con una biopsia de piel. El tratamiento incluye combinaciones de antibióticos de múltiples medicamentos a largo plazo.