zithromax and Leg-Ulcer

Topics: Adult; Azithromycin; Biopsy, Needle; Diagnosis, Differential; Diphtheria; Female; Humans; Immunohistochemistry; Leg Ulcer; Pyoderma Gangrenosum; Risk Assessment; Severity of Illness Index; Skin Diseases, Bacterial; Treatment Outcome

Haemophilus ducreyi and Treponema pallidum subsp. pertenue are major causes of leg ulcers in children in Africa and the Pacific Region. We investigated the presence of DNA (PCR positivity) from these bacteria on asymptomatic people, flies, and household linens in an endemic setting.. We performed a cross-sectional study in rural villages of Lihir Island, Papua New Guinea during a yaws elimination campaign. Participants were asymptomatic subjects recruited from households with cases of leg ulcers, and from households without cases of leg ulcers. We rubbed swabs on the intact skin of the leg of asymptomatic individuals, and collected flies and swabs of environmental surfaces. All specimens were tested by PCR for H. ducreyi and T. p. pertenue DNA. Of 78 asymptomatic participants that had an adequate specimen for DNA detection, H. ducreyi-PCR positivity was identified in 16 (21%) and T. p. pertenue-PCR positivity in 1 (1%). In subgroup analyses, H. ducreyi-PCR positivity did not differ in participants exposed or not exposed to a case of H. ducreyi ulcer in the household (24% vs 18%; p = 0.76). Of 17 cultures obtained from asymptomatic participants, 2 (12%) yielded a definitive diagnosis of H. ducreyi, proving skin colonization. Of 10 flies tested, 9 (90%) had H. ducreyi DNA and 5 (50%) had T. p. pertenue DNA. Of 6 bed sheets sampled, 2 (33%) had H. ducreyi DNA and 1 (17%) had T. p. pertenue DNA.. This is the first time that H. ducreyi DNA and colonization has been demonstrated on the skin of asymptomatic children and that H. ducreyi DNA and T. p. pertenue DNA has been identified in flies and on fomites. The ubiquity of H. ducreyi in the environment is a contributing factor to the spread of the organism.

Topics: Adolescent; Animals; Anti-Bacterial Agents; Asymptomatic Diseases; Azithromycin; Chancroid; Child; Child, Preschool; Cross-Sectional Studies; Diptera; DNA, Bacterial; Female; Fomites; Haemophilus ducreyi; Humans; Leg Ulcer; Logistic Models; Male; Papua New Guinea; Polymerase Chain Reaction; Skin; Treponema pallidum; Yaws

The management of yaws has changed in recent years. Mass treatment with oral azithromycin has replaced intramuscular benzathine benzylpenicillin. Treponemal and non-treponemal serology (equivalent to TPHA and RPR) point-of-care blood testing is now available. In addition, recent studies in yaws endemic regions have shown that a significant number of leg ulcers in children which are clinically suggestive of yaws are caused by Haemophilus ducreyi. It is noteworthy that the World Health Organization has also set the ambitious goal to eliminate yaws by 2020.

Topics: Anti-Bacterial Agents; Azithromycin; Child; Disease Eradication; Humans; Leg Ulcer; Penicillin G Benzathine; Point-of-Care Systems; Treponema pallidum; Vanuatu; Yaws