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Bejel Definition

Bejel, which was previously called endemic syphilis, is a nonsexually transmitted infection caused by treponemal spirochetes closely related to Treponema pallidum, the bacterium that causes the sexually transmitted disease syphilis. Bejel, yaws, and pinta are diseases closely related to syphilis. They mainly occur in the tropics and subtropics. Unlike syphilis, they are transmitted through skin contact, mostly between children living in poor hygienic conditions. Like syphilis, these diseases start with skin sores and have a latent period that is followed by more a destructive disease. Bejel occurs mainly in the warm arid countries like the eastern Mediterranean region and West Africa. Yaws occurs in equatorial countries. Pinta is most common among the Indians of Mexico, Central America, and South America. Although the bacteria that causes bejel, Treponema pallidum endemicum, is morphologically and serologically indistinguishable from Treponema pallidum pallidum, transmission of bejel is not venereal in nature, generally resulting from mouth-to-mouth contact, skin-to-skin contact, or sharing of domestic utensils, and the courses of the two diseases are vary somewhat.

Bejel Diagnosis

A medical expert makes the diagnosis when typical symptoms appear in a person who lives in or has been to an area where the disease is common. Because the bacteria causing the treponematoses and syphilis are morphologically and serologically similar, a person with one of these infections can test positive for syphilis. Standard tests cannot distinguish between any of the treponematoses and syphilis.

Bejel Symptoms and Signs

Bejel affects the skin, bones, and mucous membranes of the mouth. It usually starts in childhood as a small patch of mucus, often on the inside of the mouth, followed by the appearance of raised, eroding lesions on the arms, legs, and torso. Bone infection, or periostitis (inflammation) of develops later, mainly seen in the legs. Soft gummy lumps, or gummas, may appear on the nose and soft palate (roof of the mouth) in later stages of the disease.

Bejel Treatment

Active diseases are treated with 1 dose of penicillin benzathine in 1.2 million units IM. Children less than 45kg should receive 600,000 units IM. Because these diseases are very contagious, public health measures seek out and treat infected people and their close contacts. Public health control includes finding of active cases and the treatment of family and close contacts with penicillin benzathine. The lesions are destructive and may leave obvious scars. A single injection of penicillin, however, kills the bacteria, so the skin can heal. Tetracycline and chloramphenicol are also found to be effective against the bacteria.

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