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Bejel
Last reviewed: 23.04.2024
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Bejel is a kind of tropical treponematosis, observed mainly in children in Arab countries and manifested by the defeat at its different stages of the skin, and in later - the bone system.
At present, the disaster occurs mainly in Arab countries (Syria, Yemen, Iraq, Jordan, United Arab Emirates), India, Afghanistan. Independence of the disaster as a special nosology is based on the following points: there is mainly a domestic character of infection, the defeat of the majority of children, a frequent absence of primary affect, a clear cyclicity of the course, lack of congenital transmission and lesions of internal organs and nervous system, and high treatment efficiency.
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Epidemiology of the disaster
The source of infection is a sick person. Infection, as a rule, occurs by a household way. Contribute to the spread of infection low sanitary and cultural standard of living of the population, the habit of drinking and eating from common utensils, frequent ablutions in mosques and houses. Most often, children in poor rural families are ill. Especially predisposed to infection by the poor are children aged 2-10 years. At the age of 15 years, 30-70% of patients are found, and from 20 to 30 years - only 1%. Adults, as a rule, get infected from their children.
Bejel has a clearly expressed endemic character and in one locality can cover up to 40-60% of the inhabitants.
What causes the disaster?
Pathogen causative agent - Treponema bejel, by morphological and biological properties is indistinguishable from the causative agents of syphilis and yaws. Significant differences are not revealed in electron microscopic studies. In the experiment, vaccinations are successful in rabbits.
Symptoms of a disaster
There are no reliable data on the duration of the incubation period, it is believed that it is often 2-5 weeks. This uncertainty is due to the fact that, in contrast to syphilis and yaws, the affect usually remains unnoticed, and the earliest symptoms of the disaster are a disseminated rash on the skin and mucous membranes. Probably, the causative agent is capable of rapid generalization from the entrance gates.
Eruptions are usually localized on the trunk and face, less often on the limbs. Typical location of the rash - in the areas of skin transition in the mucous membrane (corners of the mouth, folds of the anus and genitals). Symptoms of the thaw and its rash are similar to syphilides of the secondary period (roseola, papules, pustules in all their varieties). In comparison with secondary syphilis, the eruption lasts longer on the poorer - on average up to 12 months, its evolution is rather torpid. Serious violations of the general condition is not observed. Subcutaneous lymph nodes increase insignificantly, are painless, not soldered to each other and to surrounding tissues, the skin over them is not changed.
About a year later the rash partially or completely regresses, usually without leaving a trace. Sometimes in its place there is a transient hyperpigmentation.
After a prolonged latent period (from 1 to 5 years) on the skin and mucous membranes appear rashes, reminiscent of syphilis of the Tertiary period, which marks the transition of the disease to the late stage. They have the character gumm, developing not only on the skin and in the subcutaneous tissue, but also in long tubular bones, as well as in the bones of the nose. Hummous ostites and periostitis with necrosis and spontaneous fractures are noted. In the event of decay, the gummy nodes give extensive ulceration followed by the formation of disfiguring scars. Diffuse and focal dyschromia of palms and soles, various forms of alopecia are also described. In the late stages of the disease, patients are not infectious.
After the transferred disease, stable immunity is not formed, and therefore reinfection is possible.
Troubleshooting
Diagnosis of the poor is based on an epidural setting, a characteristic clinical picture, detection in the dark field of the pathogen in the material from fresh rashes, often positive serological reactions to syphilis (in low titres).
What do need to examine?
How to examine?
Treatment of a disaster
Treatment of the poor is carried out with antisyphilitic drugs (both soluble and durant forms of penicillin), as well as with antibiotic reserve. The disease is very quickly amenable to treatment.
How is the disaster prevented?
Prevention of the disaster consists in the timely detection and simultaneous treatment of all the diseased in a given endemic zone, as well as individuals who were with them in close contact. An important role is played by the improvement of living conditions, the improvement of sanitary culture, and the observance of personal hygiene standards.