Bejel is an infectious disease that is rare in the United States but common in certain parts of the world. The infection is very similar to syphilis but is not sexually transmitted. Most frequently, transmission is by means of non-sexual skin contact or by common use of eating and drinking utensils. The organism that causes bejel belongs to the same family as the bacterium that causes syphilis, pinta and yaws and is known as treponema. Treponemas are spiral-shaped bacteria (spirochetes). Also known as endemic syphilis, bejel is characterized by lesions of the skin and bones that begin in the mouth and progress in gradual stages. The late stages are the most severe.
Bejel usually begins in childhood as a small mucous patch, 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. Bejel has many other names depending on the locality: siti, dichuchwa, njovera, belesh, and skerljevo are some of the names. It is most commonly found in the Middle East (Syria, Saudi Arabia, Iraq), Africa, central Asia, and Australia. Bejel is related to yaws and pinta, but has different symptoms.
Causes of Bejel
Treponema pallidum, the bacteria that causes bejel, is very closely related to the one that causes the sexually transmitted form of syphilis, but transmission is very different.
Contamination is likely to have occurred in Mali where she had been living for several years, but secondary stage manifestations only appeared in France, where she was living for several months. DISCUSSION: Although rare in France, bejel should not be overlooked in children originating from countries where endemic syphilis has a high prevalence.
The bacteria that causes bejel, is very closely related to the one that causes the sexually transmitted form of syphilis, but transmission is very different. In bejel, transmission is by direct contact, with broken skin or contaminated hands, or indirectly by sharing drinking vessels and eating utensils. T. pallidum is passed on mostly between children living in poverty in very unsanitary environments and with poor hygiene.
Symptoms of Bejel
The skin, bones, and mucous membranes are affected by bejel. Patches and ulcerated sores are common in the mouth, throat, and nasal passages. Gummy lesions may form, even breaking through the palate. Other findings may include a region of swollen lymph nodes and deep bone pain in the legs. Eventually, bones may become deformed.
Granulomas heal slowly and may recur. Keratotic lesions may develop on the soles, causing painful ulcerations (crab yaws). Later, destructive lesions may develop, including periostitis (particularly of the tibia), proliferative exostoses of the nasal portion of the maxillary bone (goundou), juxta-articular nodules, gummatous skin lesions, and, ultimately, mutilating facial ulcers, particularly around the nose (gangosa).
Mild constitutional symptoms of syphilis appear in the second stage and may include headache, malaise, anorexia, weight loss, nausea, vomiting, sore throat and, possibly, slight fever. Alopecia may occur, with or without treatment, and is usually temporary. Nails become brittle and pitted.
Pinta involves only the skin. It begins as flat, reddened areas on the hands, feet, legs, arms, face, or neck. After several months, slate blue patches develop in the same areas on both sides of the body and over bony places, such as the elbow. Later, the patches lose their pigmentation. Thickened skin may develop in the patches on the palms and soles.
