Pinta

Pinta

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Pinta is an endemic treponematosis caused by Treponema carateum. [1] It is an ancient disease that was first described in the 16th century in Aztec and Carib Amerindians. In 1938, treponemes indistinguishable from those that cause yaws and syphilis were demonstrated in lesions of a Cuban patient. [2] Pinta is characterized by chronic skin lesions that occur primarily in young adults. [3, 4, 5, 6, 7]

Like other treponematoses, pinta is classified into an early and late stage. The early stage comprises the initial lesion and the secondary lesions, while the late stage comprises the latent phase and tertiary stage.

After an incubation period of approximately 2-3 weeks, the initial lesion appears on the skin. The primary lesion is a papule or erythematosquamous plaque usually found on exposed surfaces of the legs, dorsum of the foot, forearm, or hands. The lesion slowly enlarges and becomes pigmented and hyperkeratotic. It is often accompanied by regional lymphadenopathy.

Disseminated lesions, referred to as pintids, are similar to the primary lesion and may appear 3-9 months after infection. These secondary lesions vary in size and location and become pigmented with age.

Late or tertiary pinta is characterized by disfiguring pigmentary changes, hypochromia, achromic lesions, and hyperpigmented and atrophic lesions. The pigmentary changes often produce a mottled appearance of the skin. Lesions may appear red, white, blue, violet, and brown.

United States

Pinta does not occur in the United States.

International

Pinta occurs in scattered foci in rural areas of Central and South America. [8] In the 1950s, about 1 million cases of pinta were reported in Central and South America. In the 1980s, 20% seropositivity was found in remote rural areas of Panama. The current prevalence of pinta is unknown, but only a few hundred cases have been reported per year. [9, 10]

Pinta is the most benign of the endemic treponematoses. The skin is the only organ involved.

No neurologic, bone, or cardiac manifestations occur. No congenital form exists.

Both sexes are affected with equal frequency.

Pinta affects children and adults of all ages. [11]

The peak age of incidence is 15-30 years.

Chulay JD. Treponema Species (Yaws, Pinta, Bejel). Mandell, Douglas, Bennett eds. Principles and Practice of Infectious Diseases. 5th ed. Philadelphia, Pa: Churchill Livingstone; 2000. (2)2490-4.

Giuliani M, Latini A, Palamara G, Maini A, Di Carlo A. The clinical appearance of pinta mimics secondary syphilis: another trap of treponematosis?. Clin Infect Dis. 2005 May 15. 40(10):1548; author reply 1548-9. [Medline].

Antal GM, Lukehart SA, Meheus AZ. The endemic treponematoses. Microbes Infect. 2002 Jan. 4(1):83-94. [Medline].

Engelkens HJ, Niemel PL, van der Sluis JJ, Meheus A, Stolz E. Endemic treponematoses. Part II. Pinta and endemic syphilis. Int J Dermatol. 1991 Apr. 30(4):231-8. [Medline].

Hook III EW. Treponemal infections. Guerrant RL, Walker DH, Weller PF, eds. Tropical Infectious Diseases: Principles, Pathogens, and Practice. Philadelphia, Pa: Churchill Livingstone; 1999. 527-34.

Morand JJ, Simon F, Garnotel E, Mahé A, Clity E, Morlain B. [Overview of endemic treponematoses]. Med Trop (Mars). 2006 Feb. 66(1):15-20. [Medline].

Farnsworth N, Rosen T. Endemic treponematosis: review and update. Clin Dermatol. 2006 May-Jun. 24(3):181-90. [Medline].

Woltsche-Kahr I, Schmidt B, Aberer W, Aberer E. Pinta in Austria (or Cuba?): import of an extinct disease?. Arch Dermatol. 1999 Jun. 135(6):685-8. [Medline].

Engelkens HJ, Vuzevski VD, Stolz E. Nonvenereal treponematoses in tropical countries. Clin Dermatol. 1999 Mar-Apr. 17(2):143-52; discussion 105-6. [Medline].

Lupi O, Madkan V, Tyring SK. Tropical dermatology: bacterial tropical diseases. J Am Acad Dermatol. 2006 Apr. 54(4):559-78; quiz 578-80. [Medline].

Parish JL. Treponemal infections in the pediatric population. Clin Dermatol. 2000 Nov-Dec. 18(6):687-700. [Medline].

Rothschild B. Pinta: specific disease or anomalous skin reaction?. Clin Infect Dis. 2005 Sep 15. 41(6):914. [Medline].

Centurion-Lara A, Giacani L, Godornes C, Molini BJ, Brinck Reid T, Lukehart SA. Fine Analysis of Genetic Diversity of the tpr Gene Family among Treponemal Species, Subspecies and Strains. PLoS Negl Trop Dis. 2013 May. 7(5):e2222. [Medline]. [Full Text].

de Caprariis PJ, Della-Latta P. Serologic cross-reactivity of syphilis, yaws, and pinta. Am Fam Physician. 2013 Jan 15. 87(2):80. [Medline].

Harper KN, Ocampo PS, Steiner BM, George RW, Silverman MS, Bolotin S. On the origin of the treponematoses: a phylogenetic approach. PLoS Negl Trop Dis. 2008. 2(1):e148. [Medline].

Marks M, Solomon AW, Mabey DC. Endemic treponemal diseases. Trans R Soc Trop Med Hyg. 2014 Oct. 108 (10):601-7. [Medline].

Giacani L, Lukehart SA. The endemic treponematoses. Clin Microbiol Rev. 2014 Jan. 27 (1):89-115. [Medline].

Mitjà O, Šmajs D, Bassat Q. Advances in the diagnosis of endemic treponematoses: yaws, bejel, and pinta. PLoS Negl Trop Dis. 2013. 7 (10):e2283. [Medline].

de Caprariis PJ, Della-Latta P. Serologic cross-reactivity of syphilis, yaws, and pinta. Am Fam Physician. 2013 Jan 15. 87 (2):80. [Medline].

Stamm LV. Pinta: Latin America’s Forgotten Disease?. Am J Trop Med Hyg. Nov 2015. 93:901-3. [Medline].

Natalie C Klein, MD, PhD Associate Director, Infectious Disease Division, Associate Professor of Medicine, The School of Medicine at Stony Brook University Medical Center

Natalie C Klein, MD, PhD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, New York County Medical Society, American Medical Association, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Richard B Brown, MD, FACP Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine

Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Florida Infectious Diseases Society

Disclosure: Nothing to disclose.

Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Consultant, Public Health, Dayton and Montgomery County (Ohio) Tuberculosis Clinic

Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of America, Infectious Diseases Society of Ohio

Disclosure: Nothing to disclose.

Pinta

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