PLoS neglected tropical diseases · 2026
Assessment of the role of Haemophilus ducreyi coinfection on outcomes of Yaws treatment in the southwestern part of Ghana.
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Agbanyo Abigail, Oppong Michael Ntiamoah, Ahiatrogah Dzifa Kofi, Tuwor Ruth Dede, Tettey Clement, Azabire Joseph, Boakye Yiadom Owusu, Laryea Dennis Odai, Owusu-Ofori Alex, Phillips Richard Odame, Amoako Yaw Ampem
Аннотация
BACKGROUND: Yaws, caused by Treponema pallidum subsp. pertenue (TP) is targeted for eradication by 2030 under the World Health Organization's (WHO) initiative, which relies on mass drug administration (MDA) of azithromycin. Evidence of persistent lesions after treatment has been reported. While the occurrences of Haemophilus ducreyi (HD) in yaws-like lesions has been widely documented, there is limited evidence regarding its influence on treatment outcomes assessed at the WHO-recommended 4-week follow-up. In this study, we sought to detect the occurrence of H. ducreyi in yaws-confirmed cases and assess its influence on treatment outcomes.
METHODOLOGY: We conducted a prospective cohort study of school children from Wassa Amenfi East and Aowin Districts in Ghana. A total of 46 Dual Path Platform (DPP) positive yaws cases were subjected to PCR analysis to determine the aetiological agents, including T. pallidum and/or H. ducreyi. Treatment was with a single dose of oral azithromycin and outcomes were evaluated 4 weeks post-treatment, assessing clinical resolution and time to healing, with results stratified by the identified aetiological agents.
FINDINGS: Of the 46 participants tested, 18/46 (39%) were positive for HD, 6 (13%) were TP positive, 3 (7%) were positive for TP/HD, and 19 (41%) were negative for both pathogens tested. Healing rate was 80.4% (95% Confidence Interval [CI], 73.9-95.5) for all cases; 72.2% (95% CI: 57.0-93.4) for HD only, 83.3% (95% CI: 43.6-97.0) for TP only, 100% (95% CI: 43.9-100) for TP/HD, and 84.2% (95% CI: 62.4-94.5) for negative cases. Complete healing was generally observed by day 15-20.
CONCLUSION: These results support the ongoing use of a single dose azithromycin in yaws elimination programmes, as evidenced by the healing rates observed. Nonetheless, greater focus should be directed toward improving diagnostic and treatment approaches for individual patients. Further research is necessary to better understand the aetiology of cutaneous ulcers in yaws-endemic regions.
METHODOLOGY: We conducted a prospective cohort study of school children from Wassa Amenfi East and Aowin Districts in Ghana. A total of 46 Dual Path Platform (DPP) positive yaws cases were subjected to PCR analysis to determine the aetiological agents, including T. pallidum and/or H. ducreyi. Treatment was with a single dose of oral azithromycin and outcomes were evaluated 4 weeks post-treatment, assessing clinical resolution and time to healing, with results stratified by the identified aetiological agents.
FINDINGS: Of the 46 participants tested, 18/46 (39%) were positive for HD, 6 (13%) were TP positive, 3 (7%) were positive for TP/HD, and 19 (41%) were negative for both pathogens tested. Healing rate was 80.4% (95% Confidence Interval [CI], 73.9-95.5) for all cases; 72.2% (95% CI: 57.0-93.4) for HD only, 83.3% (95% CI: 43.6-97.0) for TP only, 100% (95% CI: 43.9-100) for TP/HD, and 84.2% (95% CI: 62.4-94.5) for negative cases. Complete healing was generally observed by day 15-20.
CONCLUSION: These results support the ongoing use of a single dose azithromycin in yaws elimination programmes, as evidenced by the healing rates observed. Nonetheless, greater focus should be directed toward improving diagnostic and treatment approaches for individual patients. Further research is necessary to better understand the aetiology of cutaneous ulcers in yaws-endemic regions.