From Big Medical Encyclopedia

FRAMBEZYYa (framboesia, irainbe-sia; fr. framboise raspberry; synonym: tropical syphilis, a tropical polypapilloma) — high-contagious treponematoz, widespread in the tropical countries.

The term «frambeziya» was for the first time applied in 1768 Mr. of Buassye de San-nazhem (Boissier de Sannages).

Etiology. Activator F. Treponema pertenue Castellani, open A. Castellani in 1905 is. It is a mobile shtoporopodobny spirochete from 7 to 20 long to a mkm having from 8 to 20 curls. For the first time its culture was received in 1911 by X. Noguchi. H. M. Ovchinnikov and V. V. Lecturing (1969) at electronic microscopic examination revealed distinctions between T. pallidum — the causative agent of syphilis (see) and T. pertenue Castellani consisting in the content of mucoid substance (it it is more at T. pallidum), structure of trailer educations, etc. On other morfol. to properties they practically do not differ from each other.

A question of genetic identity of activators of a framboziya, a badge of la (see. From a pirokhetoza) and pints (see) finally it is not solved; the question of degree of reliance of a cross immunity between them continues to remain open.

Epidemiology. T. it is widespread in tropical countries; the endemic

centers are Cameroon, Uganda, Zaire, Gabon, Kenya, Togo, the Malagasy Republic, Indonesia, Philippines, Thailand, Malaysia, etc. In the USSR the disease does not meet.

Infection usually results in the household way from direct contact with the patient, is more rare than indirect contact (through household goods). Sexual transmission is possible, but is observed very seldom. The possibility of mechanical transmission of infection of ire Crimea and insects, in particular flies, widespread in Africa, this is not excluded. Chloropidae, and also Musca sorbens, mites and cockroaches.

More often children are ill. Incidence of the children living in adverse a dignity is especially big. - a gigabyte. conditions. A susceptibility to F. at children in the local centers it is various depending on age: children to 1 — G/2 of years are ill extremely seldom, at more advanced age — a thicket. The disease occurs at adults much less often; at the same time infection, as a rule, occurs from sick children.

Patogistologiya. Gistol. picture of the main manifestations F. — fram-beziy (primary manifestations) and frambezid (secondary rashes) — has much in common and it is characterized by an acanthosis (see), to spongiosas (see), accumulations of segmentoyaderny leukocytes in epidermis; in a derma against the background of expansion and a plethora of vessels diffusion accumulations of plasmocytes come to light (see) with impurity of segmentoyaderny leukocytes. Gistol. the picture of gummous frambezid is characterized by existence of the granulematozny process similar to granulematozny process at syphilis.

Clinical picture. After an incubation interval, to-ry 3 — 4 weeks last, there comes primary period: on site implementations of the activator on skin there is primary affect — a frambezioma (a synonym: pianoma, pianichesky chancre) representing a small papule (see) on a surface a cut it is possible to find papillomatous growths. As a result of the central caseous necrosis it is transformed to an ulcer (see) with soft (unlike a hard ulcer at syphilis) the basis. At the same time there can be regional lymphadenitis (see). Gradually the frambezioma cicatrizes. There comes the secondary period F., characterized by generalization of an infection,<‘ () p ro in about d and that i of c and y with I and about the phenomenon of m of N and skin of a trunk (less often) than extremities of multiple slightly pruritic rashes — frambezid. Most often they represent juicy papules of pinkish color, a surface to-rykh becomes covered by the verrukozny growths reminding berries of raspberry. Sometimes in the secondary period are observed also erythematic, erythematic skvamoz-nye papules (isoriaziformny fram-bezida), lichenoid elements (flying lichenoid deprive), a hyperkeratosis of palms and soles with development of the painful cracks complicating walking (a symptom of «gait of a crab»). The secondary period lasts to 1V2 — 2 years; it is characterized by cycling change of active manifestations and the eclipse periods of a disease.

At a part of patients the disease as if comes to the end with the secondary period. However usually in 15 — 25 years there is a tertiary period F., to-ry it is characterized deep, sometimes by extensive damages of skin, hypodermic cellulose, and also bones and joints. Process begins with development usually single hypodermic (more rare bone) gummas — large, with a diameter up to 3 cm, at first plotnovaty, and then, in process of maturing, a pasty consistence of tumorous educations, to-rye can ulcerate.

In a crust, time depending on a wedge, diseases allocate early (primary and secondary periods) and late F. For late F., except gummous manifestations, also nodes in joints, a gangosa and Gounda are typical. Nodes develop preferential in areas of extensor surfaces of elbow and knee joints. They represent hypodermic fibrous educations from 3 to 10 cm, usually multiple (4 — 5 and more), symmetric, to-rye can exist decades, almost without changing; very seldom spontaneously resolve, do not ulcerate.

The gangosa (a synonym the disfiguring Leys's nasopharyngitis) begins with persistent rhinitis, then as a result of necrotic changes of a soft and hard palate there can be their perforation. Perhaps also formation of brain hernias at destruction of a frontal bone.

Gunda — slowly increasing (to several centimeters) painful bone tumorous (ginerostoz) the educations which are symmetrized usually on both sides of a nose. Process begins and followed by the accruing severe headaches and bloody purulent discharges from a nose (at first scanty, and then plentiful). The developing persistent hypostasis of fabrics leads to narrowing of the nasal courses and difficulty of nasal breath.

The diagnosis is based on a wedge, a picture, detection of the activator in the centers of defeat and positive Wassermann reactions. Differential diagnosis is carried out with syphilis (see).

Treatment is performed antibiotics. Outwardly apply bandages with antiseptic solutions.

The forecast for life at timely treatment favorable. In hard cases (a gangosa, Gounda) disability is possible.

Prevention. All members of the family of the patient and the person who were directly contacting to it are subject to the preventive treatment consisting in reception of antibiotics of the prolonged action. In the centers, where F. meets most often, all children or even all population can be subjected to preventive treatment. Holding social actions for the purpose of increase in the standard of living and a dignity is of great importance. cultures of the population.

Bibliography: Babayants R. S. Skin and venereal diseases of tropical countries, page 365, M., 1972; Venereal diseases, under the editorship of O. K. Shaposhnikov, page 470, M., 1980; Kassirsky I. A. and

Plotnikov H. H. Diseases of tropical countries, page 178, M., 1964; The multivolume guide to microbiology, clinic and epidemiology of infectious diseases, under the editorship of H. N. Zhukova-Verezhnikov, t. 7, page 477, M., 1966: Tropical diseases, under the editorship of E. P. Shuvalova, page 253, M., 1979; Adams A. R. a. Maeg-ú an i t h B. G. Clinical tropical diseases, p. 240, L., 1966; Andrews G. C. a. Domonkos A. N. Diseases of the skin, p. 314, Philadelphia — L., 1963.

P. S. Babayants.