Bejel disease, also known as endemic syphilis, is a chronic infection caused by the bacterium *Treponema endemicum*, closely related to the agent of venereal syphilis. It primarily affects children in arid regions such as parts of the Middle East and the Sahel area of Africa. The disease is transmitted through nonsexual direct contact, often via shared utensils or close personal contact in childhood.
The complications of bejel arise mainly from its progression if left untreated, which can lead to significant deformities and chronic health issues. Initially, bejel presents with skin and mucous membrane lesions that resemble those of venereal syphilis, but its complications differ somewhat due to its endemic nature and typical patient population.
One of the primary complications is the development of destructive lesions in the bones and cartilage. These lesions can cause chronic inflammation and deformities, particularly in the facial bones. For example, the nasal cartilage and maxillary bones may become eroded, leading to a characteristic “saddle nose” deformity, where the bridge of the nose collapses. This can severely affect facial appearance and function.
In addition to facial deformities, bejel can cause lesions on the skin and mucous membranes that may ulcerate and scar, leading to disfigurement. These gummatous lesions, although not infectious themselves, can cause tissue destruction over time. The involvement of the oral mucosa can lead to painful ulcers and difficulty eating or speaking.
Unlike venereal syphilis, bejel rarely affects the nervous system or cardiovascular system seriously. This means complications such as neurosyphilis or cardiovascular syphilis, which are severe in venereal syphilis, are uncommon in bejel. Fatalities are also very rare, making the disease more of a chronic disabling condition than a life-threatening one.
Bone complications can include periostitis, an inflammation of the periosteum (the tissue surrounding bones), which can cause swelling and pain in the affected areas. This can lead to deformities in the long bones of the limbs, sometimes resulting in impaired mobility or function.
Because bejel primarily affects children, these complications can interfere with normal growth and development. Chronic inflammation and bone deformities may cause lifelong disability if not treated early.
Treatment with penicillin is highly effective and can prevent these complications if administered promptly. However, in endemic areas where access to healthcare is limited, delayed treatment often results in the chronic complications described.
In summary, the complications of bejel disease mainly involve chronic skin and mucous membrane lesions, destructive bone and cartilage deformities (especially in the face), and associated functional impairments. Serious involvement of the nervous or cardiovascular systems is rare, and fatalities are uncommon. Early diagnosis and treatment are crucial to prevent these disabling outcomes.
