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Terramycin in the treatment of yaws and tropical ulcer
261 TRANSACTIONS OF THE ROYAL SOCIETY OF TROPICAL MEDICINE AND HYGIENE.
Vol. 45.
No. 2. October, 1951.
TERRAMYCIN
IN
THE TREATMENT TROPICAL ULCER.*
OF
YAWS AND
BY
O. AMPOFO AND
G. M. FINDLAY, Mampong Ahwapim, Gold Coast, and the Pharmacological Laboratories, School of Pharmacy, London, W.C.1.
In previous communications it has been shown that aureomycin by m o u t h is highly effective in healing the lesions of primary and secondary yaws (AMPOFO and FINDLAY, 1950a, b). These results have been confirmed from Brazil b y LINS et al. (1950) ; from Haiti (LoucHLIN et al., 1951, and SCtIAEFFER et al., 1951a, b) as well as from Indonesia (HILL, 1950). In addition to aureomycin, chloramphenicol is highly effective by m o u t h in treating yaws (AMI'OFO and FINDLA¥, 1950@ In the present communication t h e effect of terramycin on yaws is described when the antibiotic is given by mouth. LOUGHLIN and JosEPH (1951) state that terramycin is active on Treponema pertenue, especially in primary and secondary yaws. GUIMARYkE8and TRAYASSOS (1950) used terramycin in four cases with total doses of gramme 5 to 15 over a period of 10 days : active lesions cleared in from 6 to 16 days. T e r r a m y c i n is now known e Our thanks are due to Messrs. CtlARLES PFIZER & Co., INC., for the supply of terramycin and to Dr. T. C. R. BUCHANAN,e.M.O., for his assistance in facilitating transport to Africa. One of us (G.M.F.) is in receipt of an expenses grant from the Medical Research Council. Our thanks are due also to Professor G. A. H. BUTTLE,in whose laboratories the pathological studies were carried out.
262
T E R R A M Y C I N IN Y A W S AND T R O P I C A L U L C E R
to be active in early syphilis (ScHocH and ALEXANDER,1950) and, in addition, it has some action on Spironema duttoni infections in mice (BERKS and GOODWIN, 1951). TERRAMYCIN
AND
YAWS.
Six patients with secondary yaws, three boys and three girls, aged from 4 to 12 years of age, were treated with capsules of terramycin by mouth. Three received four capsules twice daily, a daily total of gramme 2 ; the three others were given three capsules twice daily, a daily total of gramme 1.5. Medication was continued for 7 days. Thus the first group of patients had a total of gramme 14, the second group a total of gramme 10.5. There was no difference in the rate of healing of the lesions in the two series. All patients reported that pain had disappeared within 24 hours of commencing therapy. Spirochaetes disappeared in four cases within 24 hours and in the remaining two cases within 36 hours of beginning of therapy. Healing of all the secondary lesions was complete in from 24 hours to 4 days. All six patients have been kept under observation for 3 months after completing treatment. There has been no recurrence. All the patients had positive Kahn reactions before beginning treatment; none has yet become completely negative, but in all the Kahn reaction has shown a decrease. One case, a boy, Kwaku Gyan, is of some interest for, in addition to secondary yaws lesions most pronounced on the chin, there was a large ulcer on the lower third of the left leg. This ulcer, unlike the typical yaws ulcer, was covered by yellowish pus which microscopically showed masses of fusiform bacilli and spirochaetes. The yaws lesions were healed in from 36 to 48 hours and the tropical ulcer showed no further organisms in smears, after from 48 hours' treatment. The ulcer was healed completely on the 14th day after beginning treatment. TERRAMYCIN AND TROPICAL ULCERS. In addition to Kwaku Gyan, five other children, two boys and three girls with tropical ulcers, were treated with terramycin ; six capsules each of 250 rag., were given daily for 7 days to a total of gramme 10.5. Smears from the ulcers were made daily; fusiform bacilli, spirochaetes and in three cases cocci, were seen in smears. The effect of terramycin on the bacterial flora was noticeable within 48 t:ours of treatment as by then there were no spirochaetes and only a few fusifcrm bacilli. In 72 hours the ulcers were sterile. No relapse occurred in a period of 3 months' observation. DISCUSSION. Patients were questioned daily for any evidence of toxicity. In no case were there any toxic signs or symptoms. Terramycinthus takes its place with aureomycin and chloramphenico] as one of the antibiotics which are
O. A~IPOFO A N D
G.
M.
FINDLAY
263
active, when given by mouth, in the treatment both of yaws and tropical ulcer, two of the most widespread and disabling diseases of the tropics. It is as yet too early to deternfine which of these antibiotics is the most suitable for mass treatment but from its complete absence of toxicity, terramycin is obviously a highly satisfactory chemotherapeutic agent for the treatment of early yaws and tropical ulcer. CONCLUSION.
Terramycin by mouth causes rapid healing of the lesions of secondary yaws; it is also very satisfactory in the treatment of tropical ulcer and has little or no toxicity. REFERENCES. AMPOFO, O. & FINDLAY, G . M . (1950a). Nature, Lond., 165, 398. & (1950b). Trans. R. Soc. trop. ]Fled. Hyg., 44, 311.
& (1950c). Ibid., 44, 315. GUIMAR~ES, F. IW. & T~VASSOS, J. (1950). Hospital, Rio de Janeiro, 38, 295. BERKS, G. & GOODWlN, L. G. (1951). Nature, Lond., 167, 447. HILL, K. R. (1950). Personal communication. LINS, S. A., GUIMaP~ES, F. N., VASCONCELLOS,P. & LISBOAMIRANDA, J. (1950). Rev. brazil. ]Vie&, 7, 439. LOUGHLIN, E. H. • JOSEPH, A . A . (1951). Antibiot. Chemotherap., 1, 87. ,- & SCHAEFER, K. (1951). Amer. J. trop. Med., 31, 20. SCHAEFFER, K., LOUGHLIN, E. H. & JOSEPH, A. A. (1951a). Ibid., 31, 24. , & - - . (1951b). Ibid., 31, 26. SCHOCH, A. G. 8,~ ALEXANDER, L . J . (1950). Ann. N . Y . Acad. Sci., 53, 459.
Vol. 45.
No. 2. October, 1951.
TERRAMYCIN
IN
THE TREATMENT TROPICAL ULCER.*
OF
YAWS AND
BY
O. AMPOFO AND
G. M. FINDLAY, Mampong Ahwapim, Gold Coast, and the Pharmacological Laboratories, School of Pharmacy, London, W.C.1.
In previous communications it has been shown that aureomycin by m o u t h is highly effective in healing the lesions of primary and secondary yaws (AMPOFO and FINDLAY, 1950a, b). These results have been confirmed from Brazil b y LINS et al. (1950) ; from Haiti (LoucHLIN et al., 1951, and SCtIAEFFER et al., 1951a, b) as well as from Indonesia (HILL, 1950). In addition to aureomycin, chloramphenicol is highly effective by m o u t h in treating yaws (AMI'OFO and FINDLA¥, 1950@ In the present communication t h e effect of terramycin on yaws is described when the antibiotic is given by mouth. LOUGHLIN and JosEPH (1951) state that terramycin is active on Treponema pertenue, especially in primary and secondary yaws. GUIMARYkE8and TRAYASSOS (1950) used terramycin in four cases with total doses of gramme 5 to 15 over a period of 10 days : active lesions cleared in from 6 to 16 days. T e r r a m y c i n is now known e Our thanks are due to Messrs. CtlARLES PFIZER & Co., INC., for the supply of terramycin and to Dr. T. C. R. BUCHANAN,e.M.O., for his assistance in facilitating transport to Africa. One of us (G.M.F.) is in receipt of an expenses grant from the Medical Research Council. Our thanks are due also to Professor G. A. H. BUTTLE,in whose laboratories the pathological studies were carried out.
262
T E R R A M Y C I N IN Y A W S AND T R O P I C A L U L C E R
to be active in early syphilis (ScHocH and ALEXANDER,1950) and, in addition, it has some action on Spironema duttoni infections in mice (BERKS and GOODWIN, 1951). TERRAMYCIN
AND
YAWS.
Six patients with secondary yaws, three boys and three girls, aged from 4 to 12 years of age, were treated with capsules of terramycin by mouth. Three received four capsules twice daily, a daily total of gramme 2 ; the three others were given three capsules twice daily, a daily total of gramme 1.5. Medication was continued for 7 days. Thus the first group of patients had a total of gramme 14, the second group a total of gramme 10.5. There was no difference in the rate of healing of the lesions in the two series. All patients reported that pain had disappeared within 24 hours of commencing therapy. Spirochaetes disappeared in four cases within 24 hours and in the remaining two cases within 36 hours of beginning of therapy. Healing of all the secondary lesions was complete in from 24 hours to 4 days. All six patients have been kept under observation for 3 months after completing treatment. There has been no recurrence. All the patients had positive Kahn reactions before beginning treatment; none has yet become completely negative, but in all the Kahn reaction has shown a decrease. One case, a boy, Kwaku Gyan, is of some interest for, in addition to secondary yaws lesions most pronounced on the chin, there was a large ulcer on the lower third of the left leg. This ulcer, unlike the typical yaws ulcer, was covered by yellowish pus which microscopically showed masses of fusiform bacilli and spirochaetes. The yaws lesions were healed in from 36 to 48 hours and the tropical ulcer showed no further organisms in smears, after from 48 hours' treatment. The ulcer was healed completely on the 14th day after beginning treatment. TERRAMYCIN AND TROPICAL ULCERS. In addition to Kwaku Gyan, five other children, two boys and three girls with tropical ulcers, were treated with terramycin ; six capsules each of 250 rag., were given daily for 7 days to a total of gramme 10.5. Smears from the ulcers were made daily; fusiform bacilli, spirochaetes and in three cases cocci, were seen in smears. The effect of terramycin on the bacterial flora was noticeable within 48 t:ours of treatment as by then there were no spirochaetes and only a few fusifcrm bacilli. In 72 hours the ulcers were sterile. No relapse occurred in a period of 3 months' observation. DISCUSSION. Patients were questioned daily for any evidence of toxicity. In no case were there any toxic signs or symptoms. Terramycinthus takes its place with aureomycin and chloramphenico] as one of the antibiotics which are
O. A~IPOFO A N D
G.
M.
FINDLAY
263
active, when given by mouth, in the treatment both of yaws and tropical ulcer, two of the most widespread and disabling diseases of the tropics. It is as yet too early to deternfine which of these antibiotics is the most suitable for mass treatment but from its complete absence of toxicity, terramycin is obviously a highly satisfactory chemotherapeutic agent for the treatment of early yaws and tropical ulcer. CONCLUSION.
Terramycin by mouth causes rapid healing of the lesions of secondary yaws; it is also very satisfactory in the treatment of tropical ulcer and has little or no toxicity. REFERENCES. AMPOFO, O. & FINDLAY, G . M . (1950a). Nature, Lond., 165, 398. & (1950b). Trans. R. Soc. trop. ]Fled. Hyg., 44, 311.
& (1950c). Ibid., 44, 315. GUIMAR~ES, F. IW. & T~VASSOS, J. (1950). Hospital, Rio de Janeiro, 38, 295. BERKS, G. & GOODWlN, L. G. (1951). Nature, Lond., 167, 447. HILL, K. R. (1950). Personal communication. LINS, S. A., GUIMaP~ES, F. N., VASCONCELLOS,P. & LISBOAMIRANDA, J. (1950). Rev. brazil. ]Vie&, 7, 439. LOUGHLIN, E. H. • JOSEPH, A . A . (1951). Antibiot. Chemotherap., 1, 87. ,- & SCHAEFER, K. (1951). Amer. J. trop. Med., 31, 20. SCHAEFFER, K., LOUGHLIN, E. H. & JOSEPH, A. A. (1951a). Ibid., 31, 24. , & - - . (1951b). Ibid., 31, 26. SCHOCH, A. G. 8,~ ALEXANDER, L . J . (1950). Ann. N . Y . Acad. Sci., 53, 459.