Frambesia is a rare infectious disease, the causative agent of which affects the skin, tendons and bones of a person. Frambesia is found exclusively in the tropical zone of the planet, therefore in the medical literature it is often called "tropical syphilis" due to some similarity of symptoms and course. We will tell you how infection occurs, what symptoms accompany the disease, and how to treat it.
After 1-3 months, the second stage of the disease begins - papules spread throughout the human body. They often appear in the vagina, anus, and oral cavity. In addition, rashes on the palms and feet are characteristic. Such a rash is most often benign. Sometimes the lymph nodes increase significantly, fatigue, headaches and fever occur. As a result of combing due to severe itching, other skin infections often arise. Over time, inflammation of the periosteum begins, changes in bones and joints appear.
The described disease is caused by the bacterium Treponema pallidum pertenue, which belongs to the group of pathogenic microorganisms that provoke the development of syphilis. A feature of the pathogen can be called the fact that the only biological focus is the person himself. In other words, in nature, the bacterium does not survive, but uses people as the main and intermediate host.
The distribution area of the pathogen is the poor in Latin America, Africa and Southeast Asia. A few years ago, the governments of India and Ecuador stated that they were able to completely eradicate the disease in their countries, but WHO should check this information. Therefore, Russians need to be careful when visiting these regions and know how to get infected with phramesia.
Most often, you can get infected by contact, for example, with a handshake. Other transmission routes have been established:
- sexual - extremely rare
- household (through personal hygiene items),
- through the bites of blood-sucking insects.
Approximately 80% of patients with signs of the disease are children. The risk of infection increases with violations of personal hygiene and crowding in the room.
Signs of frambesia in indigenous people
As for susceptibility, the picture is as follows:
- at the age of one and a half years, the disease practically does not occur,
- under the age of five, the probability of infection is 50%,
- at the age of 15 years - 90%.
It turns out that the most susceptible to infection are adolescents aged 12-15 years. Adults and older people get sick much less often. Perhaps this is due to a high culture, personal hygiene and more careful contacts with the local population (it was found that most often infection occurs during games with the indigenous inhabitants of the country).
For bacteria to enter the body, an infection gate is required. In the case of frambesia, they are scratches, abrasions, insect bites and other violations of the integrity of the skin.
During the diagnostic activities, clinical manifestations are evaluated, information is collected, and the patient is examined. In some cases, it is advisable to conduct rapid tests. To make sure that the diagnosis is 100% complete, you can use the genomic analysis, which is based on the polymerase chain reaction.
If a person has found on his body the symptoms that are characteristic of this disease (especially after a visit to areas with an outbreak of frambesia), then he is obliged to visit the attending physician as soon as possible. This will prevent the occurrence of complications and the further spread of infection.
The treatment of this pathology is not very difficult, but the main thing is to take drugs regularly. Doctors use the following drugs in the treatment regimen for phrambesia:
- azithromycin orally,
- penicillin antibiotics, benzathine / muscle.
Also, in case of urgent need, the patient may be given symptomatic therapy.
Features of the incubation period
The causative agent may not show its presence in the body for several weeks. During this period, a person may experience the following symptoms:
- joint pain
- feeling of chills in the morning.
The younger the infected, the more pronounced the symptoms. However, most people are unaware of the infection and attribute the discomfort to colds.
To date, the vaccine for frambesia has not been developed. There is an opinion that this disease can be completely eradicated, since the only carrier of the virus is a person.
Prophylaxis is possible only if patients arrive at the doctor on time for a diagnosis and undergo full treatment. Also, an important part of prevention is educating citizens about the need for personal hygiene.
The first stage of frambesia
Frambesia begins with a change in the structure of the skin in a certain area of the body, more often - on the hands, lips, ears. At first, a small swelling appears, tight to the touch, 2-5 cm in size. At this stage, the symptoms can be confused with an insect bite, but if treatment is not started, the disease progresses.
- The swelling takes on a pale pink color.
- Itching begins.
- In the center of the swelling appears a bubble with purulent yellow liquid.
The resulting lesion gradually grows, absorbs healthy areas of the skin and becomes covered with grayish blotches. The defeat takes the form of raspberries, for which the disease got its name: framboise (raspberries).
Subsequently, an ulcer forms at the site of the swelling, the middle of which is filled with purulent fluid, which has a sharp and unpleasant odor. Drying, purulent ulcerative exudate is transformed into a crust covering the entire surface of the lesion.
Early phrambesia photo
In addition to the formation of ulcers, frambesia is characterized by damage to nearby lymph nodes. They become inflamed, increase in size, and become sore with pressure.
The first stage of the disease lasts several months, then the ulcers go away. In their place there are formations that look like scars after operations and have a white color.
The second stage of frambesia
A few weeks after the healing of the primary ulcers, the second stage of frambesia begins. The causative agent, which was in the body this time, grows stronger and manifests itself in multiple rashes on the body, accompanied by severe itching. The nature of the lesion is different:
On the body, the formations are located in groups or singly, in the places of skin folds (in the armpits, abdomen, perineum) form a continuous lesion due to the merger of smaller lesions.
The second stage lasts up to six months, then the ulcers pass, in their place there are areas of white connective tissue (as in the first stage). One gets the impression of recovery and a person can live for a long time without suspecting that he is a vector of infection.
Causes of occurrence
Frambesia is caused by a corkscrew-shaped mobile microorganism discovered in 1905, belonging to the species Treponema pertenue. Infection occurs through direct contact with the patient. In addition, there is an assumption that phrambesia can be transmitted through flies of the genus Hippealates. The causative agents of the disease, located on the skin of a sick person, can penetrate only through damaged skin or mucous membrane.
Frambesia is usually treated with penicillin. If the patient is allergic to this antibiotic, other drugs are prescribed, for example, tetracycline or erythromycin.
How to help yourself? First of all, it is necessary to avoid any contact with patients. If one or more papules resembling raspberries appear on the skin, you should immediately consult a dermatologist. The doctor will examine the affected skin, take a tissue sample and examine it under a microscope, perform a special blood test.
If untreated, this infectious pathology is constantly progressing.
Frambesia is a contagious and rather dangerous disease, but it can be successfully treated. With timely treatment, the patient can hope for a full recovery. In addition, with the help of modern orthopedic remedies, it is often possible to correct late complications, for example, lesions of bones and joints. At the initiative of the World Health Organization (WHO), frambesia has been consistently treated with penicillin worldwide. Today, this disease is almost completely eradicated.
Differences of frambesia from syphilis
- Distributed in almost all tropical regions.
- More often children are ill.
- Papules are very itchy.
- There is no alopecia (baldness).
- The internal organs and central nervous system are not affected.
- Distributed all over the world.
- Sometimes congenital.
- More often adults become infected.
- There is no itching.
- Often affected internal organs and central nervous system.
Causes of Frambesia
The disease is also known as framboesia (in German or Dutch) and under the name pian (in French) and affects skin, bone and cartilage. The disease is caused by the microorganism T. pallidum subspecies pertenue. This organism belongs to the same group of bacteria that cause sexually transmitted syphilis.
Transmission mechanism. Frambesia is transmitted directly through non-sexual contact (from person to person) with biological fluid from the lesion of the infected person. Most of the lesions are in the extremities. At the site of the initial lesion of phrambesia, there are a large number of bacteria. Contact with fluid from this lesion, especially if it occurs in children who play and receive minor abrasions, leads to the transmission of infection.
Incubation period is 9-90 days (an average of 21 days).
About 75% of those infected are children under 15 years of age (the peak number of cases is observed in children aged 6 to 10 years). Male and female persons are equally affected.
The spread of frambesia is facilitated by overcrowding and unsatisfactory socio-economic conditions. Without treatment, infection can lead to chronic disfigurement and disability.
Campaigns to eliminate the disease in 1952-1964 conducted in 46 countries. Since 1990, official reporting under the WHO framework for phrambesia has been discontinued due to the closure of eradication programs in many countries. Only in a few countries did phrambesia form part of the public health action program.
A study of documents left over from the 1950s suggests that at least 90 countries in the tropical belt, located 20 degrees north and 20 degrees south of the equator, were endemic for frambesia. However, only 12 are currently considered endemic for frambesia, while two countries - Ecuador and India, claiming to have stopped transmission of the disease in 2003, need verification. In addition, WHO also plans to check the status of yoke in 76 countries that were previously endemic.
Reporting on phrambesia is not mandatory, therefore, the available data published in the latest edition of the Weekly Epidemiological Record are only an indication of the global spread of this disease.
Symptoms of Frambesia
Two main stages of frambesia are known: the early stage (infectious) and the late stage (non-infectious).
In the early stage of frambesia, the initial papilloma develops at the site of bacterial penetration (a round, dense swelling of the skin without visible release of fluid). This papilloma is filled with bacteria and can persist for 3-6 months and end with a natural recovery. In addition, bone pain and bone damage may also occur early on. Further, polymorphic skin rashes, an increase and soreness of the lymph nodes may appear.
Late manifestations of frambesia occur 5 years after the initial infection and are characterized by disfigurement of the nose and bones, thickening of the palms and soles of the feet and the appearance of cracks on them (frambesia hyperkeratosis). These complications on the soles of the feet make it difficult for patients to walk. The disease lasts for many years without leading to death.
In the field, the diagnosis is mainly based on the results of clinical and epidemiological examinations.
Resumption of work to eliminate the disease
The WHO Roadmap against Neglected Tropical Diseases and resolution WHA 66.12 define 2020 as the year of eradication of frambesia in countries still endemic.
Frambesia can be eliminated, since its only reservoir is people. If all at-risk populations through large-scale treatment programs are provided with oral azithromycin, then the transmission of the disease will be interrupted and the disease will be eliminated in the area. An offensive effort to achieve this is gaining momentum and WHO, together with partners, is leading a more active effort to eradicate frambesia. To ensure the uninterrupted implementation of measures to achieve the 2020 goals, it is crucial that azithromycin is provided in sufficient quantities, the availability of rapid diagnostic tests and the necessary funding.
The third stage of frambesia
It appears years after infection. There are cases when the third stage began 10 years after the initial infection. At this stage, the clinical picture is more serious - there are signs of damage to the joints and bones.
Symptoms of phrambesia in the third stage.
- Severe joint pain.
- Hunk in the bones.
- Deformation of the bones of the nose.
- Cracks in the palms and soles of the feet.
- Constant weakness, fatigue.
Ulcers reappear on the body. The nature and depth of the cracks in the soles of the feet are such that muscle fibers are damaged. The patient can not step on the whole foot, a characteristic “overwhelming” gait develops. Similar changes appear on the mucous membranes of the oral cavity. In rare cases, the pathogen affects the nails, which become thicker, then change color and fall off.
Foot injury with phrambesia
The treatment of frambesia in the third stage is complicated, doctors cannot give guarantees for achieving a positive result. At the same time, mortality from the disease is low, sick people have been forced to live with such terrifying symptoms for years.
Methods for treating the disease
Despite the unpleasant and severe symptoms, frambesia is easily treatable with antibiotics. It has been established that the following medications are harmful to the pathogen:
Antiseptic ointments can be used to relieve itching and reduce ulcerative plaques. A good effect is given by Levomekol and Miramistin.
The treatment of frambesia in the third stage is complicated. In addition to the course of antibacterial drugs and the use of local antiseptics, surgery may be required. The treatment of bones and joints is selected based on the nature of the lesion, the overall clinical picture and the characteristics of the patient.