Pinta disease8/18/2023 ![]() ![]() 1 – 3 Small disseminated lesions known as “pintids” may coalesce into plaques. The secondary stage usually appears several months after the initial manifestations of the primary stage. The lesions may heal spontaneously or they may persist and become indistinguishable from the lesions of secondary pinta. Plaques may last for months to years and pigmentary changes may be observed in the plaques. During early infection, serological tests for syphilis (STS) may be negative for antibodies to nontreponemal (cardiolipin) and treponemal antigens. The papule or plaque, which is teeming with infectious treponemes, does not ulcerate, but expands to a diameter of 10 cm or greater. The body area most commonly affected is the exposed skin of the extremities. The primary stage is characterized by the presence of one or several papules or erythematous scaly plaques that develop about 3 weeks after infection. Like syphilis, pinta is classified into stages (see references 1 – 3 for pictures of the clinical stages of pinta). 9 On the basis of these data, it is plausible that pinta has remained endemic in some remote areas of Latin America where access to health services is limited and living standards have not yet risen. 7, 8 Although the last reported case of pinta in Cuba was in 1975, an active, early pinta lesion was identified in a Cuban female who was visiting Austria in 1999. 6 In 19, pinta cases were reported in native Indians (Ticuna) living in the Amazon border region of Brazil, Columbia, and Peru. For example, in 19, clinical evidence of pinta was discovered in 20% of the examined inhabitants of a remote village in Panama. However, some findings suggest that pinta has not disappeared. ![]() Because of the lack of surveillance data, the current prevalence of pinta is unknown. 4, 5 The World Health Organization (WHO) lists 15 countries in Latin America where pinta was previously endemic. Although pinta was most highly endemic in Mexico and Columbia, cases declined in these countries due to treatment campaigns and possibly due to improvements in living standards, access to health services, and hygiene. 4 In the 1950s, there were an estimated 1 million cases of pinta in Mexico, Central America, and northern South America. 1 – 3 Pinta was first described in the sixteenth century in the Aztec and Carib Amerindians by Spanish conquistadors and missionaries. Pinta, also known as mal del pinto or carate, is the most benign of the endemic treponematoses since it affects only the skin. Whereas venereal syphilis has a global distribution and is transmitted primarily by sexual activity, the endemic treponematoses are transmitted by nonsexual, direct skin-to-skin contact with infectious lesions. Unlike venereal syphilis, the endemic treponematoses are usually acquired by children or adolescents living in poor rural communities in tropical climates (see references 1 and 2 for maps showing the geographical distribution of endemic treponematoses). Moreover, serological tests cannot differentiate the endemic treponematoses from each other or from venereal syphilis, which is caused by the closely related spirochete, Treponema pallidum subspecies pallidum. 1 – 3 These neglected infectious diseases (NIDs), for which there are no vaccines, present a diagnostic dilemma to physicians because their clinical manifestations must be differentiated from those of other diseases that affect the skin. The endemic treponematoses, pinta, yaws, and bejel, are caused by spiral-shaped, not-yet-cultivable bacteria of the genus Treponema. All stages of pinta are treatable with a single intramuscular injection of penicillin. physicians should consider pinta in the differential diagnosis of skin diseases in children and adolescents who come from areas where pinta was previously endemic and have a positive reaction in serological tests for syphilis. Because of the influx of migrants and refugees from Latin America, U.S. pallidum subspecies, comparable information is not available for T. Although genomic sequencing has enabled the development of molecular techniques to differentiate the T. The etiological agent of pinta, Treponema carateum, cannot be distinguished morphologically or serologically from the not-yet-cultivable Treponema pallidum subspecies that cause venereal syphilis, yaws, and bejel. However, the current prevalence of pinta is unknown due to the lack of surveillance data. The World Health Organization lists 15 countries in Latin America where pinta was previously endemic. Pinta is a neglected, chronic skin disease that was first described in the sixteenth century in Mexico. ![]()
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