Tuesday, December 15, 2015

Medical brain teaser from a colleague...

Okay. So I love to play Scrabble on my computer, early in the morning, with a cup of coffee. 

This morning I played the word "pint" and the computer added an "a" to the word on the next round.  

Pinta? As in Nina, Pinta and the Santa Maria???

I was lost for a definition. So I asked the program to define the word and it came back: skin disease.

Well you all know how I love Google. And guess what, pinta is a skin disease caused by a spirochete -Treponema pallidum (as many of the docs here might well know).

From the Merck Manual:

Bejel, pinta, and yaws (endemic treponematoses) are chronic, tropical, nonvenereal spirochetal infections spread by body contact. Symptoms of bejel are mucous-membrane and cutaneous lesions, followed by bone and skin gummas. Yaws causes periostitis and dermal lesions. Pinta lesions are confined to the dermis. Diagnosis is clinical and epidemiologic. Treatment is with penicillin.


Pinta is a bacterial infection of the skin that causes lesions, red to bluish-black colored spots and splotches, and discoloration of the skin.


Pinta is a skin infection caused by the bacterium Treponema carateum , a relative of the bacterium that causes syphilis. The word "pinta" comes from Spanish and means "painted." Pinta is also known as "azula" (blue), and "mal de pinto" (pinto sickness). It is one of several infections caused by different Treponema bacteria, which are called "endemic" or "non-venereal" treponematoses.


Pinta is spread from one person to another by direct skin-to-skin contact. The bacteria enter the skin through a small cut, scratch, or other skin damage. Once inside the body, warmth and moisture allow the bacteria to multiply. The bacterial infection causes red, scaly lesions on the skin.

The disease is also known as endemic syphilis. According to Medscape,

"Treponemes are highly sensitive to azithromycin and penicillin, which remain the drugs of choice. Yaws, pinta, and endemic syphilis are treated with azithromycin or penicillin G benzathine. Alternatives are appropriate only if penicillin cannot be used. Tetracyclines or chloramphenicol have been used. Treatment failures with penicillin have been reported, but reinfection could not be ruled out."

And look at this photo of rashes caused by the disease posted at a site run by BRIAN L. ALTONEN, MS MPH.  It resembles a bull's eye.

Here is Altonen's description of the disease:

Pintos Malady

Pinta is a skin condition that occurs in Mexico, Central America and South America.  It is caused by Treponema pallidum carateum, an organism quite similar in biology and genetics to the Treponema pallidum associated with syphilis.   The ability for a bacterium to evolve within a given region is obviously quite possible, and this version of Treponema is no exemption to this evolutionary concept.   The prevalence of  this version of Treponema is not unique to Mexico's epidemiological history.  As early as Chris Colon's arrival to the New World in 1492, it was possible for this form of sexually transmitted disease to make its way around the world in exchange for equally contagious forms of measles and small pox left behind by the same sailing crew.

The most noticeable feature of those infected by this bacterium is the mottled skin, with varying colors and sizes of the patches that are formed.  The resemblances of these patches to the mottled, marble-like patterns found on Pinto horses naturalizing to this region is the source of the name for this condition.  Pinta is transmitted through direct skin-to-skin contact rather than through mucosal membranes like the related Treponema pallidum when it is responsible for syphilis.  Two to three weeks following transmission the area in and around the point of contact erupts to form a papule, which ultimately becomes dry and scaley enabling the skin to flake off.  Three to nine months later, thick, flat patches are formed all over the body which can remain there permanently at times resulting in reductions and increases in the natural pigmentation process scattered about the body's surface irregularly.

What I haven't seen yet is how people come in contact with this bacteria in the first place.The disease common in childhood. Here's a 2014 article on the topic from Clinical Microbiology Reviews. 

I guess this rambling also speaks to six degrees of separation for bacteria too. And certainly provides food for thought about the rashes, sexual transmission and other issues we have discussed here.

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