品他病 (Pinta)
臨床特徵 (Clinical Features)
- 品他病 (pinta) 是一種非性接觸傳播的密螺旋體病 (treponematosis)，以皮膚的脫色素病灶 (depigmented skin lesions) 為特徵。其致病原為 Treponema carateum (T. pallidum subsp. carateum)，此微生物與 T. pallidum subsp. pallidum 極為相似。
- 本病一般侷限於熱帶中、南美洲的偏遠地區，當地居民生活於衛生條件不良且彼此緊密接觸的環境中。然而，在非地方流行 (nonendemic) 國家，亦可能於來自地方流行地區的移民與難民中遇見此病。
- 主要影響兒童、青少年及年輕成人，傳播被認為是經由直接的皮膚或黏膜接觸，可能是透過細微的擦傷 (minute abrasions)。
- 病灶表現為暴露部位皮膚（通常在手與足）上的小而具鱗屑、紅斑且硬結的丘疹與斑塊 (small scaly erythematous indurated papules and plaques)。這些病灶會消退，但會以更播散的型態復發 (pintids)。可能發生區域性淋巴結腫大 (regional lymphadenopathy)。
- 品他病的晚期 (late stages) 以毀容性的色素沉著過度 (disfiguring hyperpigmentation)、色素脫失 (achromia)、角化過度 (hyperkeratosis) 及萎縮 (atrophy) 為特徵 (Fig. 18.145)。
- B
- 與梅毒 (syphilis) 及雅司病 (yaws) 不同，本感染的所有表現皆侷限於皮膚，並無系統性疾病 (systemic disease) 的證據。
組織病理特徵 (Histopathology)
- 組織學上，早期的原發性與次發性品他病病灶 (early primary and secondary pinta lesions) 顯示角化過度 (hyperkeratosis) 與棘層肥厚 (acanthosis)，而較晚期的病灶則顯示表皮萎縮 (epidermal atrophy) 與基底層黑色素含量減少 (diminished basal melanin pigment concentration)。
- 可見淋巴球外滲 (lymphocytic exocytosis)、輕度海綿水腫 (mild spongiosis)、基底細胞水樣變性 (basal cell hydropic degeneration) 與色素
880 Infectious diseases of the skin
圖 18-140：(A, B) 早期雅司病 (early yaws)：多發、較小的「子代雅司」(daughter yaws) 可能廣泛分布，通常在「母雅司」(mother yaw) 出現後 2–4 個月出現。By courtesy of H.J.H. Engelkens, MD, and E. Stolz, MD, University Hospital, Rotterdam-Dijkzigt and Erasmus University, Rotterdam, The Netherlands.
Fig. 18.140 (A, B) Early yaws: multiple smaller ‘daughter yaws’ may be widely distributed and usually present 2–4 months after the ‘mother yaw’. By courtesy of H.J.H. Engelkens, MD, and E. Stolz, MD, University Hospital, Rotterdam-Dijkzigt and Erasmus University, Rotterdam, The Netherlands.
圖 18-141：晚期雅司病 (late yaws)：注意此晚期階段下肢的彎曲 (bowing) 伴有皮膚潰瘍與結痂病灶。By courtesy of R.A. Marsden, MD, St George’s Hospital, London, UK.
Fig. 18.141 Late yaws: note the bowing of the lower leg with cutaneous ulcerated and crusted lesions in this late stage. By courtesy of R.A. Marsden, MD, St George’s Hospital, London, UK.
圖 18-143：早期雅司病 (early yaws)：穿過一發育中乳頭瘤 (evolving papilloma) 的切片。可見非常顯著的角化不全 (parakeratosis) 伴有大量嗜中性球碎屑 (neutrophil debris)。表皮顯示強烈的急性發炎。By courtesy of H.J.H. Engelkens, MD, and E. Stolz, MD, University Hospital, Rotterdam-Dijkzigt and Erasmus University, Rotterdam, The Netherlands.
Fig. 18.143 Early yaws: biopsy through an evolving papilloma. There is very marked parakeratosis associated with abundant neutrophil debris. The epidermis shows intense acute inflammation. By courtesy of H.J.H. Engelkens, MD, and E. Stolz, MD, University Hospital, Rotterdam-Dijkzigt and Erasmus University, Rotterdam, The Netherlands.
圖 18-145：品他病 (pinta)：此為一晚期病灶，顯示特徵性的完全色素脫失 (complete loss of pigmentation)，周圍環繞著色素沉著過度的邊緣 (hyperpigmented border)。By courtesy of R. Arenas, MD, and J. Salas, MD, Azteca, Monterrey, Mexico.
Fig. 18.145 Pinta: this is a late lesion showing characteristic complete loss of pigmentation surrounded by a hyperpigmented border. By courtesy of R. Arenas, MD, and J. Salas, MD, Azteca, Monterrey, Mexico.