What Is Bejel

Overview

Bejel is a chronic skin and tissue disease caused by infection by the endemicum subspecies of the spirochete Treponema pallidum. It is also known as endemic syphilis.¹ Bejel usually begins in childhood as a small patch on the mucosa, often on the interior of the mouth, followed by the appearance of raised, eroding lesions on the limbs and trunk. Periostitis (inflammation) of the leg bones is commonly seen, and gummas of the nose and soft palate develop in later stages.²

Causes

Bejel is caused by the bacterium Treponema pallidum endemicum, which is closely related to T. pallidum, the cause of sporadic (venereal) syphilis.¹ It is transmitted through non-sexual contact and is most common in children living in arid, unhealthy conditions.

Symptoms

Bejel usually begins in childhood as a small patch on the mucosa, often on the interior of the mouth, followed by the appearance of raised, eroding lesions on the limbs and trunk. Periostitis (inflammation) of the leg bones is commonly seen, and gummas of the nose and soft palate develop in later stages.² Other symptoms may include swollen glands or lymph nodes (lymph-adenopathy), and/or skin ulcerations under the arms or around the rectum and groin.³

Diagnosis

The diagnosis of bejel is based on the following factors:

The geographic history of the person

Bejel is more common in certain areas of the world, such as the eastern Mediterranean and Saharan West Africa.¹ If the person has lived in or visited these areas, they may have a higher risk of exposure to the bacteria.

The clinical examination of the lesions

Bejel causes various types of sores and lumps on the mouth, skin, and bones. These lesions may resemble those of syphilis, yaws, or pinta, which are other infections caused by similar bacteria. However, bejel does not affect the genitals or spread through sexual contact or blood transfusion. A doctor may examine the lesions for their appearance, location, and duration.

The laboratory testing of the material from the lesions

The most definitive way to diagnose bejel is to identify the bacteria under a microscope. A sample from the lesion is taken and examined using a special technique called dark-field microscopy.¹ This technique allows the bacteria to be seen as spiral-shaped organisms that move rapidly. Alternatively, a blood test may be done to detect antibodies against the bacteria. However, this test may not be very specific or sensitive, as it may cross-react with other treponemal infections.

Treatment

The treatment of bejel is similar to that of venereal syphilis, which is caused by a closely related bacteria. The most effective and recommended treatment is a single dose of the antibiotic azithromycin by mouth. This medication can kill the bacteria and prevent further complications. However, it may not reverse the damage that has already been done to the tissues and organs.

Alternatively, penicillin G can be given by injection into a muscle.¹ This medication is also effective against the bacteria, but it may cause allergic reactions in some people. Therefore, it is important to check for penicillin allergy before administering this treatment.

Tetracycline is another antibiotic that can be used to treat bejel, especially if azithromycin or penicillin is not available or contraindicated.⁴ However, tetracycline should not be given to pregnant women or children under 8 years old, as it may affect the development of teeth and bones.

The treatment of bejel should be accompanied by good hygiene practices, such as washing hands, avoiding sharing utensils, and cleaning wounds. This can help prevent the spread of the infection to others and reduce the risk of reinfection.

Bejel is a chronic infection caused by a type of bacteria called Treponema pallidum subspecies endemicum. It is also known as endemic syphilis or nonvenereal syphilis. Bejel mainly affects the mouth, skin, and bones of children living in poor hygiene conditions in some regions of Africa, Asia, and the Mediterranean.¹²

Prevention

The prevention of bejel is based on the following measures:

Improving hygiene and sanitation

Bejel is transmitted by close skin contact, especially through mouth-to-mouth contact or sharing eating and drinking utensils. Therefore, it is important to maintain good hygiene practices, such as washing hands, avoiding sharing utensils, and cleaning wounds. This can help prevent the spread of the infection to others and reduce the risk of reinfection.¹

Treating infected people and contacts

Bejel can be effectively treated with antibiotics, such as azithromycin or penicillin. Treatment can kill the bacteria and prevent further complications. However, it may not reverse the damage that has already been done to the tissues and organs. Therefore, it is advisable to seek medical attention as soon as possible if symptoms of bejel are noticed. Moreover, people who have been in close contact with infected people should also be screened and treated if necessary.²

Educating and raising awareness

Bejel is often neglected and underreported because of its low mortality rate and lack of awareness among the affected populations. However, bejel can cause serious morbidity and disability if left untreated. Therefore, it is essential to educate and raise awareness about the causes, symptoms, diagnosis, treatment, and prevention of bejel among the communities at risk. This can help reduce the stigma and discrimination associated with the infection and encourage people to seek timely medical care.²

Summary

• Bejel is a chronic infection caused by a type of bacteria called Treponema pallidum subspecies endemicum. It is also known as endemic syphilis or nonvenereal syphilis. Bejel mainly affects the mouth, skin, and bones of children living in poor hygiene conditions in some regions of Africa, Asia, and the Mediterranean
• Bejel is transmitted by close skin contact, especially through mouth-to-mouth contact or sharing eating and drinking utensils. Bejel does not affect the genitals or spread through sexual contact or blood transfusion
• Bejel causes various types of sores and lumps on the mouth, skin, and bones. These lesions may resemble those of syphilis, yaws, or pinta, which are other infections caused by similar bacteria
• Bejel can be diagnosed by geographic history, clinical examination, and laboratory testing. The most definitive way to diagnose bejel is to identify the bacteria under a microscope using a special technique called dark-field microscopy. Alternatively, a blood test may be done to detect antibodies against the bacteria
• Bejel can be treated with antibiotics, such as azithromycin or penicillin. Treatment can kill the bacteria and prevent further complications. However, it may not reverse the damage that has already been done to the tissues and organs
• Bejel can be prevented by improving hygiene and sanitation, treating infected people and contacts, and educating and raising awareness. This can help prevent the spread of the infection to others and reduce the risk of reinfection