What is a Pint?
Pinta (syn. Pinto, mal del Pinto, carate, azul, boussarole, etc.) is an exceptionally dermal, non-venereal trepanomatosis endemic to Latin American countries, with lesions of the mucous membranes, but without involving the internal organs, bones and joints in the process. Pinta in Spanish means spot – spotty elements are the main morphological manifestation.
The causative agent of Treponema Carateum Herrejin was discovered in 1927 by A.V. Herrejon. In its morphological and antigenic properties, it is similar to Pale Treponema and Treponema pertenue Castellani, therefore there is a cross-immunity between pint and syphilis. The causative agent of pint lives in the soil, on plants, fruits. Infection occurs through direct and indirect contact with a sick person. The pathogen penetrates the damaged skin or mucous membranes. Proved transmission of the pathogen by insects (mosquitoes, bugs, midges). Children are especially susceptible to the disease. Among endogenous factors, low immune reactivity, excessive sweating of the skin and the alkaline reaction of its water-lipid mantle should be highlighted. Among the exogenous factors, the crowding of the population, microtraumas and maceration under high temperature and humidity in a tropical climate are especially notable. The role of insects is especially great in transmitting treponematosis in Colombia, Venezuela, Ecuador, Peru, Brazil, Bolivia, Honduras, El Salvador and Nicaragua.
Infection during sexual intercourse is not dominant, since the majority of patients become infected in childhood. Therefore, a pint as well as frambesia refers to non-venereal trepanomatosis.
The incubation period lasts 6-8 weeks, then a small papule (pinto chancre) appears at the entrance gate, which transforms into a pink spot for a few weeks, with a slight compaction and pronounced peeling resembling psoriatic peeling. The incubation period is characterized by the absence of prodromal symptoms, and pintotic chancre is accompanied by a feeling of burning and soreness. Due to auto-inoculation, small, daughter, spotty-knotty primary affects grow around the pinto-chancre, growing along the periphery and prone to fusion. The bed forms a large, slightly compacted erythemato-squamous lesion. The most common location for pinto-chancre is the open skin of the upper and lower extremities or the face. Regional lymph nodes react weakly and irregularly, lymphangitis is absent. After a few months, the primary period is resolved spontaneously, and atrophic dyschromia of the skin remains in place of pintotic chancre.
The secondary period, occurring after a few months, manifests as a result of spirochetemia by dissemination of secondary lesions – pintids.
Pintids are manifested by polymorphic efflorescences in the form of lichenoid, papular, and erythemato-squamous elements, accompanied by itching. Against the background of infiltrative erythemato-squamous discs, the emergence of exudative elements is often observed: papulovesicles, microvesicles, which open and form moist nidus like eczematids. Pintids and eczematids are often multiple, merging. In the process of their existence, the function of pigmentation is disrupted, there are areas of dyschromia with the formation of achromatic and hyperpigmented pintids, accompanied by severe itching.
Dyschromia stains, preserving lichenization, are often located in the folds, especially in the genital and anal areas, where they are subjected to myceration, erosion, and secondary infection. In these cases, regional and distant lymph nodes increase, itching increases, and a pebble condition occurs. At the same time there are various types of onychodystrophy, hyperkeratotic lesion of the palms and soles with infiltrated areas, painful bleeding cracks. Dischromia extends to hair that atrophy and partially fall out. The mucous membranes of the mouth and urogenital area at the beginning of the disease are focal hyperemic, edematous with eroding phenomena, and in the future partial consolidation is possible with the formation of leukoplaky and hyperigmentation sites.
After 3-5 years of the latent period, the secondary stage of the pint is replaced by the late phase – the tertiary period. The main manifestations of a pint in the final stage are pronounced dyschromia, up to atrophy and vitiliginization. At the same time, pronounced peeling and severe itching are observed.
Due to intense itching, abundant excoriations are often formed, complicated by superficial and deep pyoderma, with multiple lymphadenopathy and the appearance of lymphangitis. At the same time, asthenia and malignancy are possible.
The diagnosis is based on epidemiological and clinical data, the results of bacterioscopic examination of both pintotic chancre discharge and eruptions characteristic of the 2nd and 3rd period, as well as negative seological reactions to syphilis. Differential diagnosis is carried out with psoriasis, eczematids, trichophytosis, syphilis.
The treatment is carried out with durant and penicillin preparations, such as bitillin, or with new drugs — extentsillnn, retarpen, etc. In early forms, a single injection of 2,400,000 IU of bicillin, retarpen, extentsillin is sufficient. Late forms undergo regression after 2-3 injections of these drugs at a dose of 2,400,000 U. You can use tetracycline, erythromycin, azit-romycin and others. 1 g per day, 10-14 days.
Children and adults in contact with patients are given prophylactic treatment with bicillin at a dose of 3,000,000 and 600,000 U, respectively, or extensillin is prescribed, and retarpene, 1,200,000 U, once.
The prognosis is favorable.
Prevention consists in improving the living and working conditions, providing medical care and conducting prophylactic vaccination in endemic areas.