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Within 90 days (but usually less than a month) of infection a painless but distinctive "mother yaw" nodule appears, which enlarges and becomes warty in appearance. Nearby "daughter yaws" may also appear simultaneously.
This primary stage resolves completely within six months. The secondary stage occurs months to years later, with typically widespread skin lesions that vary in appearance, including "crab yaws" on the palms of the hands and soles of the feet with desquamation. These secondary lesions frequently ulcerate and are then highly infectious, but heal after six months or more. About 10% of people then go on to develop tertiary disease within five to ten years (during which further secondary lesions may come and go), with widespread bone, joint and soft tissue destruction, which may include extensive destruction of the bone and cartilage of the nose (Rhinopharyngitis mutilans or "gangosa").
Yaws is a tropical infection of the skin, bones and joints caused by the spirochete bacterium "Treponema pallidum pertenue". The disease begins with a round, hard swelling of the skin, 2 to 5 centimeters in diameter. The center may break open and form an ulcer. This initial skin lesion typically heals after three to six months. After weeks to years, joints and bones may become painful, fatigue may develop, and new skin lesions may appear. The skin of the palms of the hands and the soles of the feet may become thick and break open. The bones (especially those of the nose) may become misshapen. After five years or more large areas of skin may die, leaving a scar.
Yaws is spread by direct contact with the fluid from a lesion of an infected person. The contact is usually of a non-sexual nature. The disease is most common among children, who spread it by playing together. Other related treponemal diseases are bejel ("Treponema pallidum endemicum"), pinta ("Treponema pallidum carateum"), and syphilis ("Treponema pallidum pallidum"). Yaws is often diagnosed by the appearance of the lesions. Blood antibody tests may be useful but cannot separate previous from current infections. Polymerase chain reaction (PCR) is the most accurate method of diagnosis.
Prevention is, in part, by curing those who have the disease thereby decreasing the risk of transmission. Where the disease is common, treating the entire community is effective. Improving cleanliness and sanitation will also decrease spread. Treatment is typically with antibiotics including: azithromycin by mouth or benzathine penicillin by injection. Without treatment, physical deformities occur in 10% of cases.
Yaws is common in at least 14 tropical countries as of 2012. The disease only infects humans. In the 1950s and 1960s the World Health Organization (WHO) nearly eradicated yaws. Since then the number of cases has increased and there are renewed efforts to globally eradicate the disease by 2020. The last estimate of the number of people infected was more than 500,000 in 1995. Although one of the first descriptions of the disease was made in 1679 by Willem Piso, archaeological evidence suggests that yaws may have been present among humans as far back as 1.6 million years ago.
Aerotoxic syndrome is a phrase coined by Chris Winder and Jean-Christophe Balouet in 2000, to describe their claims of short- and long-term ill-health effects caused by breathing airliner cabin air which was alleged to have been contaminated to toxic levels (exceeding known, parts per million, safe levels) with atomized engine oils or other chemicals. Repeated investigations of such claims have failed to document cabin air has ever contained contaminants which exceeded known safe levels. An assessment by the UK's House of Lords Science and Technology Committee found that claims of health effects were unsubstantiated.
An update in 2008 found no significant new evidence. this syndrome is not recognized in medicine.
Modern jetliners have an environmental control system (ECS) that manages the flow of cabin air. Outside air enters the engines and is compressed in the forward section, prior to the combustion section, ensuring no combustion products can enter the cabin. A portion of that compressed bleed air is used to pressurize the cabin. The ECS then recirculates some of that cabin air through HEPA filters, while the rest is directed to outflow valves, ensuring there is a constant supply of fresh, clean air coming into the cabin pressurization system at all times.
It is possible for contaminants to enter the cabin through the air-supply system and through other means. Substances used in the maintenance and treatment of aircraft, including aviation engine oil, hydraulic fluid, cleaning compounds and de-icing fluids, can contaminate the ECS. Ground and flight crews, as well as passengers themselves can be sources of contaminants such as pesticides, bioeffluents, viruses, bacteria, allergens, and fungal spores.
Possible sources of poor-quality cabin air include exposures related to normal operations of the aircraft:
- Ozone (O)
- Carbon dioxide (passengers exhaling CO)
- Carbon monoxide (CO - Jet exhaust fumes, Ambient airport air)
- Temperature
- Relative humidity
- Off-gassing from interior material and cleaning agents
- Bioeffluents
- Personal-care products
- Allergens
- Infectious or inflammatory agents
- Cabin pressure/partial pressure of oxygen
- Alcohol
- Formaldehyde
- Deicing fluid
- Particulate matter (including dust which contains microbes)
- Dry ice used to keep food cold
- Toilet fluid, leaked or spilled
- Rain repellent fluid
- Pyrethroid pesticides
- Pre-existing illness—such as anemia, asthma, COPD, and coronary arterial disease—the stresses of flight could exacerbate symptoms.
- Nocebo effects can lead to serious health problems too.
Jet engines require synthetic oils for lubrication. These oils contain ingredients such as tricresyl phosphate (TCP or TOCP), an organophosphate, which can be toxic to humans in quantities much larger than are found in aviation engine oil.
Engine bearing seals are installed to ensure that critical engine bearings are continuously lubricated, and to prevent engine oil from leaking into the compressed air stream. If a bearing seal fails and begins to leak, depending on the location of the seal, some amount of engine oil may be released into the compressed air stream. Oil leaks may be detected by an odour akin to hot frying-pan fume, or, in more serious cases, by smoke in the cabin. This is known in the industry as a fume event.