goundou

8/8/2019 Goundou

http://slidepdf.com/reader/full/goundou 1/22

A historical form of yawsBy Abhinay Sharma Bhugoo

8/8/2019 Goundou


y Y aws (also known as framboesia tropica and pian) is aform of non-venereal treponematoses.

y Treponema pallidum subsp pertenue ismorphologically and serologically identical to T pallidum ssp pallidum (syphilis)

8/8/2019 Goundou


Yaws has three stages.

8/8/2019 Goundou


Primary stage (early) yaws

y usually begins in childhood as a spontaneously healinggranulomatous or macular lesion (mother yaws) on a

leg.

8/8/2019 Goundou


Secondary stage (recent) yawsy is characterised by various diff use skin lesions, and

some patients develop osteoperiostitis.

8/8/2019 Goundou


Third stage (late) yawsy features severe skin ulcers and sometimes bone

destruction causing

y severe disabling deformities and disfiguration. Latelesions

y include mutilating facial ulcer (gangosa) andgummatous skin lesions

8/8/2019 Goundou


y Goundou is a manifestation of recent yaws, withproliferative exostoses.

y The first case was described in 1882y This disease was rare even when yaws was

hyperendemic in the early 1900s, and has nowdisappeared.

y Because of its highly stigmatising effect on thepatients appearance, goundou posed a nosologicaland clinical problem for doctors at the beginning of the 20th century

8/8/2019 Goundou


Clinical presentationy In most cases, goundou presented as paranasal

swelling,

y characterised by two large hard tumours that did notadhere to the superficial skin layer.

y Tumours were round or oval, with an oblique long axisrunning from the base outward (figures 1 and 2)

8/8/2019 Goundou


Figure 1: Typical bilateral goundou in a young boy Ivory Coast,

1916 (reproduced by permission of Institut de MédecineTropicaledu Service de Santé des Armées, Le Pharo, Marseille, France)

8/8/2019 Goundou


Figure 2: Unilateral goundou in a young woman Ivory Coast, 1917

(reproduced by permission of Institut de MédecineTropicale du

Service de Santé des Armées, Le Pharo, Marseille, France).

8/8/2019 Goundou


Clinical picture (ctd)y Pus formation and associated adenopathies were never

seen.

yThe tumours could be painf ul to touch and coulddevelop over several years, beginning with theappearance of diff use thickening or deposits on theascending branches of the maxilla.

y

Large lesions could cause blindness by reducing the visual field, sometimes in association with severeinfection of the eyeball, and with nasal obstruction.

8/8/2019 Goundou


y Involvement of other bones of the face was generally associated with goundou and, in rare cases, was

exclu

sive.y In these forms of the disease, hypertrophy pushed the

palate into the buccal cavity and enlargement of thealveolar ridge caused wide spacing between teeth.

y

Sometimes tumour growth was so extensive that the whole rhinomaxillary region was pushed forward,resulting in impairment of both breathing andswallowing (figure 3).

8/8/2019 Goundou


Figure 3: Diffuse maxillofacial goundou with protrusion of all the

maxillae and palate Ivory Coast, 1917 (reproduced by permission

of Institut de MédecineTropicale du

Service de

Santé des Armées,Le Pharo, Marseille, France).

8/8/2019 Goundou


Epidemiologyy Goundou was reported in populations of black people

not only in regions of sub-Saharan Africasuch as theG

old Coast,I vory Coast, Angola, Zanzibar, and Central Africa but also in New World countries, such as

Jamaica, Brazil, Trinidad, and the southern USA. A fewcases were even reported in Asia.

8/8/2019 Goundou


y Anàkhré and Henpuye (dog-nose).

y More limited use of the names Toupakié in the Baoule

language and Noukrou in the Bambara language wasalso reported.

y The term goundou comes from the dialect used by the Agni people in I vory Coast,

8/8/2019 Goundou


y The geographic zones of goundou and yaws coincided.

y Goundou consistently occurred as a concurrent (44%),

short-term (49%), or long-term (7%) complication of yaws.

y In most cases, lesions were associated with diff useosteoperiostitis, mainly on the tibia, which resulted ina swordblade-like appearance. The bones of the

forearms, fingers, hands, and feet were also affected.y Postcranial lesions, which were often painf ul, could be

associated with skin lesions at the recent and latestages.

8/8/2019 Goundou


Figure 4: Bilateral goundou on a skeleton of an adolescent

Left, the upper jaw and mandible are deformed by an osteoperiostitis but the

rest of the skull is intact. Right, the round excrescences caused a majorreduction of the visual field and nasal aperture.

8/8/2019 Goundou


y Surgical resection was the mainstay of treatment forgoundou.

y In patients with limited forms of the disease with two

paranasal excrescences the operation was simple, becausethere was an easily identifiable subperiosteal cleavageplane.

y Such operations were done by H Strachan in Jamaica in1894,6 A J Chalmers in Africa in 1900,7 and P Mendes inBrazil in 1901.13 In the I vory Coast in 1912, Botreau-Rousseloperated successf ully on a patient with goundou, with theassistance of a Canadian surgeon named J N Roy who was visiting Abidjan from Montreal.

8/8/2019 Goundou


y Surgery was not the only weapon against suspected yaws.

y At the beginning of the 20th century, early forms of the

disease cou

ld be treated with treponemicidal dru

gscontaining arsenic derivatives, and later antibiotics wereused.

y However, even without treponemicidal treatment,goundou did not recur after surgical excision. In patients

who presented with inoperable late forms, treatment withdrugs caused the disease to stabilise, mucosalinflammation to disappear, and facial deformity to regress,but new bone growth persisted

8/8/2019 Goundou


Eradicationy Mass treatment campaigns in endemic areas have now

eradicated goundou.

y

Only three minor, nosologically debatable cases havebeen reported in the past 30 years

8/8/2019 Goundou


Several questions remain unanswered.y Why does yaws seem to be the only treponematoses

associated with inflammatory hypertrophy?

y

What are the underlying physiopathologicalmechanisms?

y Why did these tumours develop on the internalbranches of one or both maxillary bones in some

patients, and over the whole face in others?y Why was the incidence higher in western Africa than

in other tropical areas?

8/8/2019 Goundou


Source :THE LANCET Vol 360 October 12, 2002

www.thelancet.com

goundou

Documents