Latent bejel, also known as endemic syphilis, is a chronic, non-venereal treponemal infection caused by Treponema pallidum subspecies endemicum. This disease predominantly affects impoverished communities in arid regions, particularly among children, and is transmitted through direct contact with lesions or indirectly via shared utensils.
Epidemiology and Transmission
Bejel is endemic in the Sahel region of Africa and the Arabian Peninsula, thriving in hot, dry climates. Transmission occurs primarily through non-sexual direct contact with infectious lesions or indirectly through sharing contaminated objects, such as drinking vessels and eating utensils. Children living in unsanitary conditions with poor hygiene practices are most susceptible.
Clinical Manifestations
The disease progresses through stages:WebMD+1CheckOrphan+1
- Primary Stage: Characterized by small, painless ulcers in the mouth or on the mucous membranes.
- Secondary Stage: Features mucous membrane ulcers, skin rashes, and lymphadenopathy.
- Tertiary Stage: If untreated, late-stage bejel can lead to destructive lesions affecting the skin, bones, and nasopharynx, resulting in significant disfigurement and disability.
Diagnosis
Diagnosing bejel involves clinical evaluation and laboratory testing. Dark-field microscopy can detect T. pallidum in samples from lesions. Serological tests, such as the rapid plasma reagin (RPR) and T. pallidum latex agglutination (TPLA), are used; however, these tests cannot distinguish between different treponemal infections. Therefore, diagnosis relies on patient history, clinical presentation, and epidemiological context.
Treatment
Bejel is effectively treated with antibiotics. The standard regimen includes intramuscular injections of benzathine penicillin G. In cases of penicillin allergy, alternative antibiotics may be considered. Treatment is effective at any stage of the disease, though later stages may require prolonged therapy.
Prevention and Control
Preventing bejel necessitates improving living conditions, promoting good hygiene practices, and reducing overcrowding. Public health initiatives should focus on education about transmission routes and the importance of personal hygiene. Mass treatment campaigns with antibiotics have been successful in reducing prevalence in endemic areas. Continuous surveillance and prompt treatment of new cases are essential to prevent resurgence.
Global Perspective
While bejel was historically confined to specific regions, globalization has led to cases emerging in non-endemic areas. Healthcare providers worldwide should consider bejel in the differential diagnosis when patients present with compatible symptoms and relevant epidemiological history. This awareness is crucial for timely diagnosis and treatment, preventing complications and further transmission.
Latent bejel remains a public health concern in certain regions, particularly among children in impoverished communities. Understanding its transmission, clinical features, and effective treatment options is vital for healthcare providers. Continued efforts in public health education, improved living conditions, and accessible medical care are essential to control and eventually eradicate this neglected tropical disease.
