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[Comment] Macrolide resistance in yaws

The study by Oriol Mitjà and colleagues in The Lancet1 shows that a single round of mass administration of azithromycin is insufficient to achieve yaws eradication. It also represents the first report of a mutation in both 23S rRNA genes of the yaws-causing spirochaete, Treponema pallidum subspecies pertenue (T p pertenue), causing macrolide resistance in five epidemiologically linked patients. The mutation, A2059G, was previously reported in a patient with syphilis (caused by T p pallidum) with spiramycin treatment failure;2 it is one of two macrolide-resistant mutations previously detected in T p pallidum (the other is A2058G).

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