bejel

bejel
Name	Bejel
Synonyms	Endemic syphilis, Nonvenereal endemic syphilis
Field	Infectious disease (medical specialty), Tropical medicine
Symptoms	Mucous patches, gummatous lesions, bone pain
Complications	Gumma (pathology), Periostitis, Saber shin
Onset	Childhood
Duration	Chronic
Causes	Treponema pallidum subspecies endemicum
Risks	Poor hygiene, crowded living conditions
Diagnosis	Clinical, Serology, Dark-field microscopy
Differential	Syphilis, Yaws, Pinta (disease)
Prevention	Improved sanitation, Mass drug administration
Treatment	Penicillin, Benzathine benzylpenicillin
Prognosis	Good with treatment
Frequency	Rare, focal in arid regions

bejel. Bejel, also known as endemic syphilis, is a chronic, non-venereal Treponematosis caused by the bacterium Treponema pallidum subspecies endemicum. It is one of the endemic treponematoses, a group that also includes Yaws and Pinta (disease), and is primarily transmitted through non-sexual contact, often among children in communities with poor Hygiene. The disease is characterized by lesions of the skin, bones, and mucous membranes, and while it can cause significant morbidity, it is effectively treated with Penicillin.

Overview

Bejel is classified among the human treponematoses, a set of chronic bacterial infections caused by closely related spirochetes of the genus Treponema. Historically, it was widespread in arid regions of the Eastern Mediterranean, the Sahel region of Africa, and parts of the Arabian Peninsula. The disease shares clinical and serological features with venereal Syphilis but is distinguished by its mode of transmission and epidemiology. Major control efforts in the mid-20th century, led by organizations like the World Health Organization and supported by UNICEF, dramatically reduced its prevalence through Mass drug administration campaigns using Benzathine benzylpenicillin.

Causes and transmission

The causative agent is Treponema pallidum subspecies endemicum, a spiral-shaped bacterium closely related to the agents of Syphilis and Yaws. Transmission occurs through direct non-sexual contact, typically among children living in conditions of poverty and overcrowding. The bacteria are spread via shared eating or drinking utensils, skin-to-skin contact with infectious lesions, or possibly by certain flies acting as mechanical vectors. Key risk factors include a lack of access to clean water, inadequate Sanitation, and low socioeconomic status, which facilitate the person-to-person spread of the organism within isolated communities.

Signs and symptoms

The initial stage often presents with a painless mucous patch, frequently in the oral cavity, which may go unnoticed. The secondary stage involves widespread manifestations, including Mucocutaneous lesions, Condylomata lata, and painful Periostitis of the long bones, such as the tibia, which can lead to the characteristic deformity known as Saber shin. Late-stage bejel, developing after years of untreated infection, is marked by destructive gummata affecting the skin, bones, and Nasal cartilage, potentially causing severe Disfigurement and septal perforation. Unlike venereal syphilis, bejel rarely involves the Cardiovascular system or the Central nervous system.

Diagnosis

Diagnosis is primarily based on clinical findings in a patient from an endemic region, supported by serological tests. Standard nontreponemal tests, such as the Rapid plasma reagin (RPR) or Venereal Disease Research Laboratory (VDRL) test, are reactive, as are treponemal-specific tests like the Treponema pallidum particle agglutination (TPPA) assay. Direct visualization of the bacterium from lesion exudate using Dark-field microscopy can provide definitive identification, though this technique requires specialized equipment. The disease must be differentiated from other treponematoses like Yaws and Pinta (disease), as well as conditions such as Cutaneous leishmaniasis and Tuberculosis.

Treatment and prevention

A single intramuscular injection of long-acting Benzathine benzylpenicillin is the standard treatment for all stages of bejel and is highly effective. For patients allergic to penicillin, alternatives like Doxycycline or Tetracycline may be used. Prevention relies on improving living standards, particularly through better Sanitation, access to clean water, and health education to reduce direct contact with infectious lesions. Historically, successful eradication campaigns, such as those conducted in Bosnia and Herzegovina and Iraq, have been based on Mass drug administration programs that treat entire at-risk communities, a strategy also employed against Yaws.

Epidemiology

Bejel is currently a rare disease, persisting only in focal, isolated pockets within arid regions. Historically endemic areas included countries like Syria, Iraq, Saudi Arabia, Mali, and Burkina Faso. The global incidence plummeted following the World Health Organization's intensive control programs during the 1950s and 1960s, which were part of a broader effort to eliminate the endemic treponematoses. Today, sporadic cases or small outbreaks may still occur in remote, underserved populations in the Sahel or the Eastern Mediterranean, often signaling broader systemic failures in Public health infrastructure and Primary healthcare.

Category:Bacterial diseases Category:Tropical diseases Category:Neglected tropical diseases