Klebsiella rhinoscleromatis of the membranous nasal septum

Abstract

Rhinoscleroma is a chronic, infectious, granulomatous disease that may present with mass lesions in the respiratory tract anywhere from the nose to the trachea. The nose is involved in 95-100 per cent of cases. There are three stages of the disease: catarrhal-atrophic, granulomatous (also known as hypertrophic) and sclerotic. The diagnosis is made either by positive Klebsiella rhinoscleromatis culture or from the classic histological findings of Mikulicz cells and transformed plasma cells with Russell bodies. Rhinoscleroma is endemic to areas of Africa, South-East Asia, Mexico, Central and South America, and Central and Eastern Europe, and it has been associated with low socioeconomic status. In the past, rhinoscleroma was infrequent in the US population but, with current trends in migration, the incidence of rhinoscleroma may be on the rise. There is often a delay in diagnosis in non-endemic areas such as the US due to unfamiliarity with the disease, the stage-dependent clinical and histological manifestations of disease, and the fact that only 50-60 per cent of cultures are positive for K rhinoscleromatis. Such late diagnosis leads to increased morbidity in the form of nasal and airway obstruction and nasal deformity from erosive processes. Rhinoscleroma is difficult to cure and prone to recur. Currently, the recommended treatment consists of a combination of surgical debridement and long-term antibiotic therapy. We present a case report of a culture-positive diagnosis of rhinoscleroma, and we review the existing literature.

Rhinoscleroma in a 5-year-old Portuguese Child

“…3 Treatment includes surgery in patients with obstructive symptoms and long-term antimicrobial therapy in an attempt to eradicate K. rhinoscleromatis, because the relapse rate is high. 1,3 In vitro, these bacteria are inhibited by clinically achievable concentrations of amoxicillin-clavulanate, chloramphenicol, trimethoprim-sulfamethoxazole, cephalosporins, streptomycin, tetracyclines and ciprofloxacin. 3 However, in vivo, effective antibiotics are streptomycin, doxycycline, tetracycline, rifampicin, sulfonamides, clofazimine, ciprofloxacin and ofloxacin.. 2,3 Because of our patient's age, antibiotic choice was challenging, as most of the recommended drugs present risk of serious side effects in this age group.…”

“…1 Rotavirus is one of the most important causative agents of acute gastroenteritis in children between 4 and 24 months of life. Rotavirus gastroenteritis has an annual incidence of 130 million cases and 440,000 deaths and is responsible for approximately 20% of diarrhea-associated deaths in children <5 years of age.…”

“…1,2 Despite being broadly distributed in nature, it has not been found in a nonhuman host. 2 It is endemic in some regions of Africa (Egypt, tropical areas), Southeast Asia, Mexico, Central and South America and Central and Eastern Europe.…”

“…Although first reported in Europe, nowadays only a few sporadic cases have been described in Western Europe, probably the result of emigration of people from endemic areas. 1 Rhinoscleroma can affect most parts of the respiratory tract and is classified in 3 overlapping stages: catarrhal or atrophic (sometimes called ozaena), granulomatous (proliferative or nodular) and sclerotic (cicatricial or fibrotic). 3 Most patients are diagnosed in the granulomatous stage, in which the typical histologic characteristics can be observed.…”

Difficulties in diagnosing and treating nasal rhinoscleroma: A case study

“…Because of civilizational and medical development, its occurrence in Europe is very rare today. 1 The WHO sources estimate its occurrence at about 6 cases between 2000 and 2004. Other reports rarely explain its occurrence in Europe.…”