Bejel

Bejel is an infectious disease caused by the same organism in syphilis called Treponemapallidumbut in bejel, the bacteria are not transmitted sexually. [1] The disease has many alternate names based on locality such as siti in Gambia, therlijevo in Croatia, frenjak in Balkans and njovera in southern Rhodeisa. The disease is related to yaws and pinta and collectively these three are called treponematoses. Most cases of bejel resolve completely and death is uncommon. [2]

Epidemiology

Bejel usually occurs in dry and hot regions particularly in eastern Mediterranean and in SaharanWest Africa. [3] It is rare in United States. The disease primarily affects children 2 to 15 years of age. 25%of cases occur in children below 6 years old and 55% of patients are under 16 years of age. Adults who are in close contact with patients may get the disease. There is no sex predilection. [2]

Causes

Treponemapallidum, the causative agent of bejel, is transmitted by direct or indirect contact with infected person. Direct contact transmission is possible with broken skin or contaminated hands. Sharing drinks and eating utensils are ways of indirectly transmitting the bacteria. The disease is often noted onpatients living in unsanitary environment and those with poor hygienic habits. [2]

Symptoms

Bejel is characterized by skin and bone lesions often starting at the mouth and progressing in a gradual fashion. [4] The lesions are small ulcers called mucosal patches which are often found in mouth, on the back of the lips and on the cheeks. These can also be found at the genitals. [5]

The typical history is slimy patches that began inside the mouth followed by blisters occurring on the trunk, arms and legs. Pain is noted when the bone gets affected and usually at the later stage of the disease, the bones may become deformed. Lesions may be noted at the nasal passages which can destroy nasal structures that may even break through the mouth palate.

Due to the lesions, people affected with bejel usually have disfiguring scars. [2]

Diagnosis

History and physical exam are important in diagnosis. Treponemapallidumis detected by microscopic studies. [2]

Treatment

Intravenous benzathine penicillin G given intramuscularly is usually given. Alternative drugs are chloramphenicol and tetracycline. Usually, tetracycline is not prescribed to children because ofpermanent teeth discoloration. [2]

References:

1. http://www.rightdiagnosis.com/b/bejel/intro.htm

2. http://www.healthofchildren.com/B/Bejel.html

3. http://www.webmd.com/sexual-conditions/bejel

4. http://www.cigna.com/individualandfamilies/health-and-well-being/hw/medical-topics/bejelnord124.html

5. http://www.asnom.org/en/422_treponematoses.html