bejel

Bejel, also known as endemic syphilis, is a chronic infection caused by Treponema pallidum endemicum, a bacterium related to the one that causes sporadic syphilis 1. It affects mainly children in the Middle East and Africa, and causes mouth and skin lesions, bone involvement, and skin pigment loss 1.

The symptoms of bejel include:

• Mouth sores: Bejel begins with mouth sores, which are a distinctive feature of this disease 13.
• Skin lesions: Bejel also causes skin lesions, which can appear on the face, neck, and other areas of the body 1, 3, 5, 8.
• Bone involvement: In some cases, bejel can cause bone involvement, particularly in the long bones such as the forearm, tibia, or fibula 5.

It's worth noting that bejel is a nonvenereal disease, meaning it is not spread through sexual contact. It can be spread by close contact with an infected person, including mouth-to-mouth contact or sharing eating utensils 2.

Early Signs and Symptoms of Bejel

Bejel, also known as endemic syphilis, typically begins in childhood with the appearance of small, painless lesions on the mucous membranes of the mouth, particularly in or near the mouth. These initial lesions are often patchy and slimy, and may go unnoticed by parents or caregivers.

Progression of Symptoms

As the disease progresses, blisters may appear on the back, arms, and legs. In some cases, infections of the bones, especially those of the legs, can occur. It's essential to recognize these early signs and symptoms to ensure timely diagnosis and treatment.

Common Manifestations

Some common manifestations of bejel include:

• Painless ulcers or sores (gummas) on the skin or mucous membranes
• Lesions on the face, mouth, or genital areas
• Papulosquamous and erosive papular lesions on the trunk and extremities

Importance of Early Detection

Recognizing the early signs and symptoms of bejel is crucial for prompt medical attention. If left untreated, bejel can lead to more severe complications.

References:

[1] Signs & Symptoms. At the outset, children with bejel have patchy, slimy, ulcerations (lesions) on the mucous membranes, particularly in or near the mouth. Later, blisters appear on the back, arms, and legs. Further disease progression is indicated by infections of the bones, especially those of the legs. [3] bejel, chronic infection characterized by eruptions initially in the mouth and on the skin and typically later involving the bones.Bejel is a nonvenereal form of syphilis.It is caused by the bacterium Treponema pallidum endemicum, which is closely related to T. pallidum pallidum, the cause of sporadic (venereal) syphilis. [4] Bejel, or endemic syphilis, is a chronic bacterial infection that primarily affects the skin and mucous membranes. [12] Recognizing the early signs and symptoms of Bejel is crucial for timely diagnosis and treatment. One of the initial manifestations of Bejel is the development of painless ulcers or sores, known as gummas, on the skin or mucous membranes. [14] The symptoms of bejel appear in gradual stages, with the late stages being the most severe. Early symptoms include lesions (patchy, slimy ulcerations) that begin in the mucous membranes of the mouth, followed by blisters on the arms, back, and legs as the disease progresses.

Diagnostic Tests for Bejel

Bejel, also known as endemic syphilis, can be diagnosed through a combination of clinical evaluation and laboratory testing.

• Clinical Evaluation: The diagnosis of bejel is based on the geographic history of the patient, as well as physical examination. Healthcare providers look for characteristic symptoms such as painless ulcers, skin lesions, and lymph node enlargement [11].
• Darkfield Examination: A sample of fluid from the lesions can be examined under a microscope to identify the presence of treponemes, which are spiral-shaped bacteria that cause bejel [2].
• VDRL (Venereal Disease Research Laboratory) Test: This is a nontreponemal test that detects antibodies against syphilis in the blood. A positive result can indicate bejel or other treponematoses [3, 4].
• Treponemal Tests: These tests specifically detect antibodies against treponemes and are more sensitive than nontreponemal tests. They can confirm a diagnosis of bejel or other treponematoses [5, 6].
• Polymerase Chain Reaction (PCR): This molecular technique can identify the genetic material of treponemes in samples from lesions or blood [9].

It's worth noting that a combination of clinical evaluation and laboratory testing is usually required to confirm a diagnosis of bejel. A healthcare provider will consider the patient's symptoms, medical history, and geographic location when making a diagnosis.

References: [2] Diagnosis of Bejel, Pinta, and Yaws​​ [3] Diagnosis of Bejel, Pinta, and Yaws​​ [4] Diagnosis of Bejel, Pinta, and Yaws​​ [5] by O Mitjà · Cited by 5 — Serologic tests [6] Positive serologic tests, the presence of treponemes in dark-field examination of exudates of skin lesions, and examination of skin biopsies usually confirm ... [9] Jun 24, 2022 — With the development of molecular techniques, all treponeme pathogens may now be identified using PCR.

Treatment Options for Bejel

Bejel, also known as endemic syphilis, can be effectively treated with antibiotics. The primary treatment for Bejel involves the use of antibiotics to eliminate the bacteria.

• Penicillin: Penicillin is the drug of choice for treating Bejel and is usually administered intramuscularly or intravenously [11]. It is effective in eliminating the bacteria and relieving symptoms.
• Alternative Antibiotics: For patients allergic to penicillin, alternative antibiotics such as tetracycline or erythromycin may be used [11].
• Benzathine Penicillin G: Benzathine penicillin G is a common treatment for early Bejel infection and usually provides a cure and relieves bone infection and pain [14]. However, it may not work for late-stage infections.
• Doxycycline or Tetracycline: Patients who are allergic to penicillin may receive doxycycline or tetracycline as an alternative treatment [14].

Important Considerations

It is essential to note that scarring may be permanent after treatment, even if the lesions heal [14]. Additionally, patients should be checked 2-4 weeks after receiving antibiotic treatment to ensure the infection has been cleared [7].

References

[11] The primary treatment for Bejel involves the use of antibiotics to eliminate the bacteria. Penicillin is the drug of choice and is usually administered intramuscularly or intravenously. [14] Benzathine penicillin G is a common treatment for early Bejel infection and usually provides a cure and relieves bone infection and pain, but may not work for late-stage infections. [7] Patients should be checked 2-4 weeks after receiving antibiotic treatment.

Differential Diagnosis of Bejel

Bejel, also known as endemic syphilis, is a bacterial infection caused by the bacterium Treponema pallidum endemicum. The differential diagnosis of bejel involves distinguishing it from other diseases that may present with similar symptoms.

Similarities to Other Diseases

• Syphilis: Bejel and syphilis can present with mucosal lesions, papules at the oral commissures, and intertriginous condyloma lata. Syphilis should always be considered in the differential diagnosis of bejel [11][10].
• Yaws: The early lesions of yaws may be confused with bacterial skin infections, including tropical ulcer, and parasitic infections, including leishmaniasis.
• Pinta: Bejel and pinta can present with similar symptoms, but pinta is characterized by extensive depigmentation and acral dyschromia.

Other Conditions to Consider

• Psoriasis: Early bejel may be mistaken for psoriasis [3].
• Eczema: Bejel can present with a generalized rash, which may be confused with eczema.
• Leprosy: The lesions of bejel may be similar to those found in leprosy.

Key Points

• Bejel is a bacterial infection caused by Treponema pallidum endemicum.
• The differential diagnosis of bejel involves distinguishing it from other diseases that may present with similar symptoms, including syphilis, yaws, pinta, psoriasis, eczema, and leprosy.
• A careful analysis of the patient's symptoms and signs, in combination with knowledge of the epidemiological context, is necessary for an accurate diagnosis.

References

[1] Differential Diagnosis of Endemic Treponematoses from Other Diseases. [2] Syphilis Syphilis Syphilis is a bacterial infection caused by the spirochete Treponema pallidum pallidum (T. p. pallidum), which is usually spread through sexual contact. Syphilis has 4 clinical stages: primary, secondary, latent, and tertiary. [3] Yaws, bejel, and pinta are endemic, non-venereal treponematoses. Medical. ... Differential Diagnosis. [4] by O Mitjà · Cited by 5 — They may be differentiated by clinical manifestations, geographic distribution, and molecular diagnostic testing [14].