Nonvenereal endemic syphilis
{{Distinguish|syphilis}}
{{Infobox medical condition (new)
| name = Nonvenereal endemic syphilis
| synonyms = nonvenereal syphilis, endemic syphilis, bejel
| pronounce = {{IPAc-en|ˈ|b|ɛ|dʒ|əl}}
| image = Infiltration of skin due to endemic syphilis.jpg
| caption = Disfiguring infiltration of the nose, glabella, and forehead with clustered nodules in left interciliary region of boy with endemic syphilis, Iran, 2010.
| field = Infectious disease
|
| symptoms =
| complications =
| onset =
| duration =
| types =
| causes =
| risks =
| diagnosis =
| differential =
| prevention =
| treatment =
| medication =
| prognosis =
| frequency =
| deaths =
}}
Bejel, or endemic syphilis, is a chronic skin and tissue disease caused by infection by the endemicum subspecies of the spirochete Treponema pallidum. Bejel is one of the "endemic treponematoses" (endemic infections caused by spiral-shaped bacteria called treponemes), a group that also includes yaws and pinta. Typically, endemic trepanematoses begin with localized lesions on the skin or mucous membranes. Pinta is limited to affecting the skin, whereas bejel and yaws are considered to be invasive because they can also cause disease in bone and other internal tissues.{{cite journal | vauthors = Mitjà O, Šmajs D, Bassat Q | title = Advances in the diagnosis of endemic treponematoses: yaws, bejel, and pinta | journal = PLOS Neglected Tropical Diseases | volume = 7 | issue = 10 | pages = e2283 | date = 2013 | pmid = 24205410 | pmc = 3812090 | doi = 10.1371/journal.pntd.0002283 | doi-access = free }}
Signs and 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.
Causes
Although the organism that causes bejel, Treponema pallidum endemicum,{{cite journal | vauthors = Antal GM, Lukehart SA, Meheus AZ | title = The endemic treponematoses | journal = Microbes and Infection | volume = 4 | issue = 1 | pages = 83–94 | date = January 2002 | pmid = 11825779 | doi = 10.1016/S1286-4579(01)01513-1 }} is morphologically and serologically indistinguishable from Treponema pallidum pallidum, which causes venereal syphilis, transmission of bejel is not venereal.{{cite journal | vauthors = Pace JL, Csonka GW | title = Endemic non-venereal syphilis (bejel) in Saudi Arabia | journal = The British Journal of Venereal Diseases | volume = 60 | issue = 5 | pages = 293–7 | date = October 1984 | pmid = 6487985 | pmc = 1046341 | doi = 10.1136/sti.60.5.293 }} However, recent epidemiological evidence suggests that Treponema pallidum endemicum may also cause venereal syphilis.{{Cite journal |last=Deresinski |first=Stan |date=2022-03-09 |title=Bejel: Sometimes a Venereal Nonvenereal Treponematosis—and in Places You Might Not Expect |url=https://academic.oup.com/cid/article/74/5/i/6545897 |access-date=2024-06-10 |journal=Clinical Infectious Diseases|volume=74 |issue=5 |pages=i-ii |doi=10.1093/cid/ciac091 }}
Diagnosis
The diagnosis of bejel is based on the geographic history of the patient as well as laboratory testing of material from the lesions (dark-field microscopy). The responsible spirochaete is readily identifiable on sight in a microscope as a treponema.{{cite journal | vauthors = Marks M, Solomon AW, Mabey DC | title = Endemic treponemal diseases | journal = Transactions of the Royal Society of Tropical Medicine and Hygiene | volume = 108 | issue = 10 | pages = 601–7 | date = October 2014 | pmid = 25157125 | pmc = 4162659 | doi = 10.1093/trstmh/tru128 }}
Epidemiology
Bejel has been known to be endemic in the Sahel region spanning from Mauritania and Senegal to Sudan, the other African countries of Côte d'Ivoire, Benin, and Somalia, the Kalahari Desert spanning from Namibia to Zimbabwe, West Asia spanning from Syria to Pakistan, and the Arabian Peninsula countries of Kuwait, Saudi Arabia, the United Arab Emirates, and Oman.{{Cite web |title=Status of bejel endemicity |url=https://www.who.int/data/gho/data/indicators/indicator-details/GHO/status-of-bejel-endemicity |access-date=2024-06-10 |website=www.who.int |language=en}} It is unclear if it remains endemic in these countries, but a recent study suggested that the causative bacteria circulates outside of this range as venereal syphilis.
See also
References
{{reflist}}
External links
{{Medical resources
| ICD10 = {{ICD10|A|65||a|65}}
| ICD9 = {{ICD9|104}}
| ICDO =
| OMIM =
| DiseasesDB = 30090
| MedlinePlus =
| eMedicineSubj =
| eMedicineTopic =
| MeshID = D014211
}}
{{Gram-negative non-proteobacterial bacterial diseases}}
{{Bacterial cutaneous infections}}