Definition

Bejel, also known as endemic syphilis, is a chronic but curable disease, seen mostly in children in arid regions. Unlike the better-known venereal syphilis, endemic syphilis is not a sexually transmitted disease.

  Description

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 and symptoms

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. 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.

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.

  Diagnosis

T. pallidum can be detected by microscopic study of samples taken from the sores or lymph fluid. However, since antibody tests don't distinguish between the types of syphilis, specific diagnosis of the type of syphilis depends on the patient's history, symptoms, and environment.

  Treatment

Large doses of benzathine penicillin G given by injection into the muscle can cure this disease in any stage, although it may take longer and require additional doses in later stages. If penicillin cannot be given, the alternative is tetracycline. Since tetracycline can permanently discolor new teeth still forming, it is usually not prescribed for children unless no viable alternative is available.

  Prognosis

Bejel is completely curable with antibiotic treatment.

  Prevention

The World Health Organization(WHO)has worked with many countries to prevent this and other diseases, and the number of cases has been reduced somewhat. Widespread use of penicillin has been responsible for reducing the number of existing cases, but the only way to eliminate bejel is by improving living and sanitation conditions.

   Key Terms:

Endemic disease An infectious disease that occurs frequently in a specific geographical locale. The disease often occurs in cycles. Influenza is an example of an endemic disease. Lymph This is a clear, colorless fluid found in lymph vessels and nodes. The lymph nodes contain organisms that destroy bacteria and other disease causing organisms (also called pathogens). Syphilis This disease occurs in two forms. One is a sexually transmitted disease caused by a bacteria. The second form is not sexually transmitted, but passed on by direct contact with the patient or through use of shared food dishes and utensils.

   Resources:

Books

• Harrison's Principles of Internal Medicine. Ed. Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.