Bedzhel
Description:
Bedzhel (Xing.: the dichuchva, local syphilis, a freng, баляш, not venereal syphilis, the Arab syphilis, трепонематоз, a zukhriya) is an infectious disease which seldom meets in Russia, but is widespread in certain parts of the world.
Bedzhel meets generally in droughty rural areas of the Middle East and the Equatorial Africa. In certain settlements the prevalence of the population can reach 40-60%. Incidence carries the family character expressed focal, most often. Infection is promoted by the low sanitary and cultural standard of living of the population, narrowness of dwellings, a habit to eat and drink from the general ware, ritual ablution in mosques, etc. More often children aged from 2 up to 10 years in low-prosperous families are ill.
Reasons беджеля:
Organisms which cause беджель belong to the same group of bacteria which cause syphilis, karate and a frambeziya, and are called treponemas.
The activator - the spirochete of Treponema bejel (pallidium) from the Spirochaetaceae family of the sort Treponema, morphologically and serological is indistinguishable from a pale spirochete - the causative agent of syphilis.
Tank and sources of the activator: the infected person.
The period of infectivity of a source - weeks and months during existence on skin of specific defeats.
The mechanism of transfer of the activator - direct contact with a source of a contagium or the mediated transfer of the activator in the household way through kontaminirovanny towels, bed linen, use objects.
Symptoms беджеля:
Bedzhel is very similar to syphilis, but is not given sexually. Most often transfer happens through skin contact, or by means of sharing of ware.
Often called by local syphilis, беджель it is characterized by emergence of skin and bone damages, it begins in a mouth and gradually progresses. The last stage is the most serious.
Incubation interval of 2 weeks up to 3 months.
Early and late stages беджеля as are observed at a frambeziya and pint. Carry an incubation interval, primary and secondary rashes to an early stage. Completes disease the tertiary stage similar to gummous manifestations of a frambeziya and syphilis. The incubation interval беджеля varies over a wide range and, according to most of authors, fluctuates from 1-2 to 5-6 weeks – 3 months.
Primary affect, or bedzheloidny chancre, is shown on site implementations of the activator by the insignificant inflammatory phenomena in the form of quickly disappearing papulovesicule or an ephemeral vesicle on hardly hyperemic edematous basis. Limfangita and lymphadenites are absent. As a result of weak local fabric reaction and an anergichny condition of regional lymph nodes there is more active spirokhetemiya, and secondary efflorestsention – bedzhelida – form in shorter terms, than at a frambeziya and syphilis. They disseminated, multiple, symmetric and polymorphic: rozeolezno-papular, pustular and condylomatous. In the beginning rozeolezny and pustular elements appear on mucous membranes of a mouth, generative organs and in large folds of skin. Their formation is provoked by an injury, irritation of an acute mucous membrane of pi-necks of an oral cavity, allocations and maceration of an epithelium in the field of an anus and generative organs. Characteristic of the papular rashes which are located pleated and on mucous membranes is their tendency to maceration, a moknutiya and hypertrophies as it happens at patients to secondary syphilis. Therefore such bedzhelida are called condylomas. Further bedzhelida extend to a trunk and extremities. Here they are more infiltrirovana, brown-red color, are often plentifully shelled, like psoriasis papules. Unlike syphilitic secondary rashes of a bedzhelida are followed by an itch, with firmness keep within 6-8 months, and sometimes till 1 year and more.
In the course of their existence owing to the proceeding spirokhetemiya and insufficient activity of an immunogenesis appearance of additional groups of efflorestsention is observed. Partial disappearance of evolutionarily outdated elements you occur formation of the pigmental or depigmented, slightly shelled spots. Pustules, superficial and deep, arise as manifestation of a substandard course of process. However formation of secondary piokokkovy rashes as a complication of bedzhelid a staphylococcal infection is possible. In these cases furuncles, ecthymas, hydradenites, piogenic ulcers are formed. In response to accession of an additional infection, but as well as at specific purulent bedzhelida, the feverish state, an indisposition, a polyadenitis are observed. A part of patients has painful periostites and osteoperiostites, especially in long tubular bones, with reddening and a cutaneous dropsy. In the course of evolution of a bedzhelida are partially spontaneously resolved with a hyperpegmentation or a depigmentation.
The remained their part through uncertain term, from 1 year to 3-5 years, can be transformed to tertiary gummous and knotty or gummous and ulcer rashes which exist along with secondary elements. Tendency to a necrosis, destruction of gummous bedzhelid pulls together them with gummous defeats of syphilitic character; however they are distinguished by a pasty consistence not inherent to syphilis, morbidity and a local situation. Germination of gummous infiltrates in deep layers of a hypodermic basis with damage of bones, sinews and joints leads to formation of extensive ulcers with plentiful purulent separated, sequestration and the fistular courses. At localization in extremities there are bedzheloidny osteomyelites which are allowed disabling hems. Often in connection with provocative travmatiziruyushchy effect of substandard food the gummous and ulcer centers are localized in a mouth, a throat, getting into fabrics of the sky, a nose. Process with formation of a palatopharyngeal anchylosis comes to an end with vicious hands. Diffusion gummous infiltration forms around a mouth, on a pilar part of the head, palms and soles more often. On a pilar part of the head the peeling, a poredeniye of hair like the mixed diffusion and focal baldness are observed; on palms and soles the hyperkeratosis with a dyschromia, painful cracks develops. Gummous bedzhelioidny defeats unlike secondary bedzhelid there is not enough kontagiozna as Treponema bejel is in insignificant quantity in the depth of inflammatory infiltrate, and the destructive phenomena develop owing to the infectious and allergic state forming as Sanarelli's phenomenon – Shvarttsmanna.
Pull together беджель with syphilis and features of immunity. If after pint and a frambeziya there is a durable postinfectious immunity, then the persons who had bedzhely, no durable immunity is had and therefore the phenomena of superinfection and reinfection are possible.
Diagnosis:
The diagnosis is established on the basis of results of the epidemiological analysis in the center, age of sick, clinical manifestations, detection of treponemas in microdrugs, positive takes of serological researches. It is necessary to distinguish a late stage беджеля from a frambeziya and venereal syphilis.
Laboratory diagnosis is based on serological tests of RPR, TPHA, IFA, Wasserman, Kan, cytocholic, and also RIBT.
Treatment беджеля:
Use penicillin of the prolonged action, erythromycin or tetracycline. Treatment carry out by dyurantny drugs of penicillin – экстенциллин, ретарпен 1,2 mln units intramusculary 1 time a day (2 injections at early forms at an interval of 1 week). At late forms the called drugs are administered on 2,4 mln units of 1 times a day in a week (2-3 injections). Azithromycin (сумамед) – 1 g a day (in 2 receptions on 0,5 g) and 4 days on 0,5 in one step, on a course of 3 g at early forms, and at late – 8 days on 0,5 g in one step and on a course – 5 g. It is possible to appoint tetracyclines, erythromycin, левомицепин on 1 g a day, within 14 days.
The forecast when performing specific therapy in an early stage favorable, a disease recovers completely. In a late stage at heavy destructions of bones, soft tissues, development of a gangosa after an antibioticotherapia carrying out the recovering surgeries can be required.
