Biomedical subjects
Publications and source records attributed to H J Engelkens.
A 15-year-old girl presented with the typical clinical, serological, and pathological lesions of yaws. The patient was a native of Sumatra. The important diagnostic criteria and the relationship to venereal syphilis were discussed.
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OBJECTIVES: Investigation of sera, especially rabbit serum, in preventing in vitro immobilisation of Percoll purified T. pallidum. MATERIALS AND METHODS: The immobilisation of Percoll purified T. pallidum (Nichols) was studied after pre-incubations with basal reduced medium (BRM), heat-inactivated serum of seven different species of animals, heat-inactivated normal human serum (NHS) and rabbit sera containing a different level of antitreponemal antibodies. Also increasing percentages of heat-inactivated normal rabbit serum (NRS) were studied. RESULTS: The rapid immobilisation of purified treponemes by NHS is delayed by pre-incubation with NRS in a dose-dependent manner. The treponemes from 5-day infections were immobilised significantly more slowly than treponemes from 7- and 8-day infections. Compared with NRS, pre-incubations with a high-titred, low-titred and "autologous" serum resulted in significantly more rapid immobilisation of the treponemes. With most other animal sera resistance to immobilisation was slight compared with that produced by NRS. Immunofluorescent studies revealed that the treponemes were covered with a layer of the human third complement factor (C3b), within an hour of incubation. With two sequential pre-incubations, a delay of the immobilisation was only noted in those test mixtures in which NRS had been present in both preincubations. CONCLUSION: Rabbit serum delays the rapid in vitro immobilisation of Percoll purified treponemes by normal human serum. There was no evidence that this was caused by preventing access of antibodies (in vivo as well as in vitro) to, or preventing the activation of complement on, the treponemal surface. The evidence points to a mechanism in the fluid phase, suggesting participation of a third factor in the immobilisation process, for instance an enzyme, which can be partially inhibited by rabbit serum component(s).
Yaws (framboesia tropica), caused by Treponema pallidum subspecies pertenue, is a chronic infectious disease, found in tropical rural regions. As a result of mass treatment campaigns conducted in the 1950s and 1960s the prevalence of yaws and the other endemic treponematoses (pinta and endemic syphilis) has decreased greatly. However, in several tropical regions in the world resurgence of yaws was reported in the 1980s. In this article we present the results of a small survey on yaws in six health centres in the Pariaman region in West Sumatra, Indonesia. A general conclusion from this small survey is that yaws is far from being eradicated and that in this region the disease is on the increase again. Some major findings of T. pertenue research are presented here.
The results of a yaws survey on the island of Sumatra in Indonesia are presented. The prevalence of yaws in the investigated region was found to be very high, a minimum of 300 cases per 100,000 individuals, which indicates that yaws is far from being eradicated and that campaigns for treatment are necessary. Patients suffering from early infectious yaws showed florid skin lesions. Of 101 serum samples from such patients, 100 had a positive reaction in one or more treponemal tests. The Treponema pallidum haemagglutination assay was found to be the most sensitive test (97% positive) in detecting antibodies against Treponema pallidum subsp. pertenue, followed by the fluorescent treponemal antibody absorption test (94%), the Venereal Disease Research Laboratory test and the TmpA enzyme immunoassay (91%), and analysis by Western blot using Treponema pallidum antigens (88%). Of 42 asymptomatic contacts of yaws patients 32 showed positive reactions in one or more tests, indicating that many people in the investigated region have been infected with treponemes. Eight new Treponema pallidum subsp. pertenue strains were isolated from yaws skin lesions. In vitro amplification of treponemal DNA and hybridisation with specific DNA probes showed that all eight strains were identical with Treponema pallidum subsp. pertenue CDC 2575, with regard to the subsp. pertenue specific tyfl gene.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
OBJECTIVE: To study ultrastructural aspects of infection with Treponema pertenue (Pariaman strain), originating from West Sumatra, Indonesia. MATERIALS AND METHODS: Biopsy material originating from skin lesions in ten young children suffering from early infectious yaws in Indonesia, and rabbit testicular tissue inoculated with T pertenue. Human skin as well as rabbit testicular tissue was examined by means of conventional electron microscopy. RESULTS: In human skin, treponemes were found in interepidermal spaces in 5 out of 10 specimens. In two of five positive specimens, treponemes were also seen in the dermis. In one out of five specimens from rabbit testicular tissue a profusion of treponemes was found lying in the interstitial myxomatous tissue. Microorganisms showed no adhesion to fibroblasts. CONCLUSION: This ultrastructural study of T pertenue demonstrated the scarcity and focal distribution of treponemes in tissue and did not reveal any morphological differences from the Gauthier strain of T pertenue. No differences from the ultrastructure of T pallidum were observed either.
A 3 1/2-year-old boy, born and living in Indonesia, experienced disseminated skin lesions and an ulcerated, crusted, papillomatous lesion on the prepuce of his penis. This location suggested venereal syphilis, but on clinical, serologic, and epidemiologic grounds a diagnosis of early yaws was made. This treponemal disease should be considered in children who have traveled to or migrated from remote tropical regions, and who have unusual skin lesions in combination with a positive treponemal serology. Although yaws is considered a rare and exotic disease in the United States and Europe, it is still widespread in some parts of the world.
Two children suffering from early yaws in Indonesia are presented. Apart from skin lesions and a positive treponemal serology in both patients, involvement of tubular bones, particularly of the hands, was revealed by radiological examination. In one patient involvement of a distal phalanx was remarkable. Early diagnosis and treatment of yaws is important since a delay in treatment may result in severe and irreversible bone deformities of the late stage of the disease. This report illustrates that radiological changes, although rare, can still be detected in the early stage of yaws in areas where yaws is resurgent nowadays.
This paper presents the light microscopic findings in biopsies of skin lesions from 45 patients, in whom a diagnosis of early yaws was suspected. In 27 cases typical light-microscopic features of yaws were observed, consisting of parakeratosis or crust containing exudate, marked acanthosis with widening and elongation of the rete ridges or pseudo-carcinomatous hyperplasia and spongiosis. Intraepidermal microabscesses consisting of polymorphonuclear leucocytes were frequently encountered. In a large majority a moderate to dense infiltrate was present, composed mainly of lymphocytes and plasma cells. Vascular changes consisted of only slight endothelial cell proliferation and thickening of vessel walls. Steiner staining revealed the presence of treponemes in the epidermis in 23 of 27 cases. Remarkably, clusters of treponemes were also seen in the papillary dermis in three out of 23 cases. Seven other cases were strongly suggestive of yaws. Other histopathological diagnoses were made in 6 patients, due to the simultaneous occurrence of other skin diseases. The remaining five specimens did not contain enough tissue to allow conclusions to be made.
The use of Percoll-purified treponemes in an assay similar to the Treponema pallidum Immobilisation test demonstrated that immobilisation of purified treponemes by seronegative normal human serum proceeded at a much higher rate than that of unpurified treponemes. This suggests that the removal of the testicular extract makes the treponemes more vulnerable to this action. A preincubation of the purified treponemes with the testicular extract from infected or uninfected testes delayed their rate of immobilisation to that demonstrated by the unpurified treponemes. This showed that substances produced during the infection are probably not responsible for the delay in immobilisation. Discrimination between the classical and the alternative pathway of complement activation, studied by the ethylene glycol-bis (beta-aminoethyl ether) N,N,N',N'-tetraacetic acid (EGTA) method, showed that the classical pathway was responsible for the rapid immobilisation of the purified treponemes. However, the slow immobilisation in the EGTA-serum samples suggested a minor role of the alternative pathway in the immobilisation of the purified treponemes. Since the testicular extracts exerted an anti-complement activity, it needs to be investigated whether the protection offered to the purified treponemes by the testicular extracts is based on their deteriorating effect on the classical complement pathway or is due to a re-establishment of the protective cover around the treponemes.
Early yaws in a 9 year old girl from Ghana, diagnosed as imported disease in The Netherlands is reported. She had lived in The Netherlands for six months. Tropical non-venereal treponematoses are rarely seen in Europe, and only a few case reports have been published. Migration and travelling may confront the medical profession with cases of tropical diseases such as yaws. Positive serological reactions in non-venereal tropical or venereal treponematoses cannot be distinguished at present.
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We present a study of biopsies taken from skin lesions of 44 patients presenting with primary or secondary syphilis. In most primary lesions erosion or, more often, ulceration was present, with a dense inflammatory infiltrate. In secondary syphilis a wide variety of histological changes was present. Blood vessels were frequently involved, with marked endothelial swelling and often proliferation. Treponemes were demonstrated with the Steiner staining method in all investigated cases of primary syphilis and in 71% of secondary syphilis cases. Treponemes were present throughout the dermis, particularly perivascularly, and in the dermal-epidermal junction zone. In two specimens of secondary syphilis treponemes were located predominantly in the epidermis, but there were always some microorganisms demonstrable in the dermis. The inflammatory infiltrate was often located in a perivascular coat-sleeve-like arrangement. In this study plasma cells and lymphocytes were present in all specimens of primary and secondary syphilis. Syphilitic lesions differed from yaws lesions mostly in the location of treponemes and the affection of blood vessels. In this histopathological study of early syphilis, treponemes did not show the epidermiotropic character of yaws, and blood vessel changes were more pronounced than in yaws. Unfortunately, due to the protean histopathological manifestations described in venereal syphilis and in yaws, these two treponemal diseases cannot always be differentiated on histological grounds alone.