Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Infectious Diseases, Kyoto City Hospital, Kyoto, Japan.
Sonezaki Furubayashi Clinic, Osaka, Japan.
J Infect Chemother. 2022 Mar;28(3):444-450. doi: 10.1016/j.jiac.2021.11.012. Epub 2021 Nov 23.
Bejel, caused by Treponema pallidum subsp. Endemicum (TEN), is a locally transmitted disease among children and juveniles in hot and dry regions. The number of adult cases of TEN infection outside of endemic areas has recently increased. We clinically examined five cases of TEN infection among adult cases previously reported in Japan. TEN infection mainly developed among young to middle-aged men who have sex with men (MSM). The clinical features of cases of TEN infection were similar to those of primary- and secondary-stage T. pallidum subsp. pallidum (TPA) infection. Genital lesions were common as the primary lesion. The clinical features and laboratory parameters of cases of TEN infection were similar to those of TPA infection. Most of the isolated strains had the A2058G mutation in 23S rDNA, which is responsible for resistance to macrolides. We also performed the systemic literature review of the TEN cases outside the endemic countries. The recent reported cases diagnosed with molecular methods shared the clinical features, occurred in young-to middle-aged sexually active persons in urban areas of developed countries and often accompanied with genital lesions, which were distinct from the classic description of bejel. This case series and the literature review provides important clinical insights and will contribute to the clinical detection of this rarely identified disease in developed countries. The surveillance of treponematoses, including TEN infection, using molecular diagnostic techniques is also warranted in developed countries, for the purpose of grasping the epidemic situation and control the local transmission.
贝杰尔病由梅毒密螺旋体亚种地方性（TEN）引起，是流行地区儿童和青少年的地方性疾病。近年来，非流行地区 TEN 感染的成人病例数量有所增加。我们对日本先前报道的五例 TEN 成人感染病例进行了临床检查。TEN 感染主要发生在年轻到中年的男男性行为者（MSM）中。TEN 感染病例的临床特征与一期和二期梅毒密螺旋体亚种苍白密螺旋体（TPA）感染相似。生殖器病变是常见的原发性病变。TEN 感染病例的临床特征和实验室参数与 TPA 感染相似。大多数分离株在 23S rDNA 中具有 A2058G 突变，这是对大环内酯类药物耐药的原因。我们还对流行国家以外的 TEN 病例进行了系统的文献复习。最近通过分子方法诊断的病例具有相似的临床特征，发生在发达国家城市地区年轻到中年的性活跃人群中，常伴有生殖器病变，与经典的贝杰尔病描述不同。本病例系列和文献复习提供了重要的临床见解，将有助于在发达国家对这种罕见疾病进行临床检测。为了掌握疫情并控制本地传播，也有必要在发达国家使用分子诊断技术对包括 TEN 感染在内的密螺旋体病进行监测。
