I found this disease state to be intriguing, therefore I
wanted to discuss it in this post, and learn a new topic for this week.
Rhinoscleroma (or Scelroma) is a chronic granulomatous
bacterial disease of the nose that infects the upper respiratory tract. In rare
cases, it can also affect the nasopharynx, larynx, trachea, and bronchi.
Scleroma is a tropical disease and is mostly endemic to Africa and Central
America, and it slightly affects more females than males.
Scelroma is caused by Klebsiella
rhinoscleromatis, which is a subspecie of Klebsiella pneumoniae. Rhinoscleroma
is a member of the Enterobacteriaceae family; it is an encapsulated gram-negative,
nonmotile, diplobacillus that is sometimes referred to as the "Frisch
bacillus," named for Anton von Frisch who has identified the organism. It
is contracted directly by droplets or by contamination of food/objects that are
subsequently inhaled.
The
presentation is often nonspecific and is often unrecognized due to its
resemblence for cold symptoms. It should be taken into consideration in cases
of chronic rhinitis, even in developed countries. Nasal obstruction is the main
complain, and the disease can be divided into 3 stages: catarrhal/atrophic,
granulomatous, and sclerotic stages; only the granulomatous stage has
diagnostic changes. Cellular immunity is impaired in patients infected with
rhinoscleroma but the humoral immunity is preserved. CD4–CD8 ratio within the
lesion is altered, showing decreased CD4 lymphocytes and increased CD8
lymphocytes, with a diminished T-cell response. A positive culture in MacConkey
agar is diagnostic of rhinoscleroma, but cultures are positive in only 50% to
60% of cases. Treatment should include long-term antimicrobial for 2 to 3 months with tetracycline being the drug of choice, and surgical intervention in patients with symptoms of obstruction.
Very interesting discussion. This is a good topic to find out more about especially since there is nothing in your textbook. The effect on the nose looks terrible and causes a lot of problems, so even though it is rare the morbidity is great.
ReplyDeleteIt is a very interesting disease in terms of what it does to the human body, and how its often mistaken for cold symptoms. I wonder what can be done to reduce the misdiagnosis of patients who come in with cold like symptoms.
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