is a fastidious organism requiring specific nutritional atmo
is a fastidious organism requiring specific nutritional, atmospheric, and temperature requirements for growth. For this reason culture capability might only be available in limited PICT microbiology laboratories. The use of multiplex PCR targeting common pathogens associated with genital ulceration— and herpes simplex virus—has increased the diagnostic yield. PCR for DNA has better sensitivity than culture because it is not affected by the loss of viability of organisms associated with collection at sites distant from the processing laboratory. The study by Mitjà and colleagues used PCR for these very reasons. However, although PCR alone allows for the detection of the organism, it does not allow for susceptibility testing and molecular characterisation. Future studies will need to attempt culture of in addition to detection by PCR.
Yaws is a contagious non-venereal endemic treponemal infection caused by subsp It affects mostly children in rural communities in developing countries and infection occurs after direct person-to-person contact. Ulcerative skin lesions occur early in the disease. The lesions differ from those caused by ; most importantly they are usually painless, as shown in this recent study. In endemic regions, such as Papua New Guinea, the presence of characteristic lesions is adequate for diagnosis. The yaws eradication programmes of the 1950s have not succeeded in eliminating this infection; newer strategies to eradicate yaws have recently been proposed.
Increasing antimicrobial resistance in strains has been reported, leading to a shift away from benzylpenicillin as the treatment of choice. Strains containing TEM-1 β-lactamase plasmid were recognised in the 1970s and resistance to multiple other mth1 inhibitor is also widely reported. Of note, the isolates from New Zealand were all penicillin susceptible, with penicillin minimum inhibitory concentrations of 0·25 mg/L, and were negative for TEM β-lactamase by PCR. Newer yaws eradication strategies propose the use of a single oral dose of azithromycin. This strategy would also be effective against lesions caused by ; however, active surveillance would need to be undertaken to monitor for the development of resistance to macrolides.
There remains a number of unanswered questions. First, have these two clinical entities always existed in parallel or has there been a more recent shift to non-genital-site infections? Human infection studies have shown infection of abraded upper arm skin with low infecting doses, supporting infection occurring at non-genital sites. Second, infection confers only partial immunity, allowing for reinfection; presumably these might present at different sites. Additional work is needed to better understand the role of in chronic skin ulceration.
Whether it is mobile phone service or vacation travel, good businesses know that success depends on providing a complete and customer-centric solution. Should patients with tuberculosis not be offered a complete solution that is patient-centred? After all, millions are affected and a large market at the base-of-the-pyramid remains unserved. A complete and patient-centric solution will not only include care that meets the International Standards for Tuberculosis Care, but also be delivered with dignity and compassion, grounded in the reality of patients\' lives as they navigate the long pathway from symptoms to cure. Such solution-based innovation requires a systems-thinking approach that must place patients at the centre of design strategies, recognise their clinical and psychosocial needs, and be cost-effective. Are tuberculosis patients in high-burden countries currently getting such a patient-centric solution? Let us consider India, which accounts for quarter of all tuberculosis cases in the world. Whether patients in India seek care in the public or the private sector, they struggle to get a complete solution. Although the Revised National Tuberculosis Control Programme (RNTCP) has done well to reach scale and provide free diagnosis and treatment for patients with drug-sensitive disease in the public sector, the programme falls short in making sure that all patients get screened for drug resistance and in ensuring adequate therapy for all patients with multidrug-resistant (MDR-TB) and extensively drug-resistant tuberculosis. Of the estimated 64 000 cases of MDR-TB in 2012, only 17 373 cases were diagnosed under the RNTCP.