Ozena in Immigrants of Differing Backgrounds

Abstract

Abstract. Ozena, or atrophic rhinitis, is a chronic nasal process seen in Africa, India, and the Middle East. It is marked by the triad of fetid nasal discharge, crusting, and atrophy, and is often associated with Klebsiella infection. We present cases of ozena with nasal Klebsiella in three unrelated patients, including two east African children and one Saudi adult. All three patients grew Klebsiella species in culture and required prolonged treatment with multiple methodologies, including antibiotics, saline rinses, and surgical debridement. They differed greatly in time from presentation to diagnosis, and demonstrated various stages of the disease process. Ozena is rarely seen in the United States, and when it is seen, it is often misdiagnosed. Lack of prompt, adequate treatment can lead to long-term sequelae such as obliteration of nasal architecture, anosmia, sinus and skull base destruction, and social disenfranchisement due to the extreme foul smell of the nasal discharge. Clinicians should maintain a high index of suspicion for primary atrophic rhinitis when presented with its classic symptoms. Culture-directed and prolonged therapy with appropriate follow-up is a necessary component of a successful treatment plan.

Olfaction in Primary Atrophic Rhinitis and Effect of Treatment

“…Long-term studies need to be undertaken to establish the same. As a nonuniform outcome of antibiotics on ATR is reported in immigrants with different backgrounds, 23 resistant infection may account for nonsatisfactory clinical improvement, as seen in 59.64%. Its incurable yet nonfatal status was well addressed by Fraenkel in 1876.…”

Ozena with Leprosy: United States, 1980

“…The three cases of fetid ozena from two Africans and a Saudi Arabian immigrant reported from Minnesota by Yelenich-Huss and others 1 reminded me of polymicrobial sinus infections among leprosy patients seen in Carville, LA, in the 1980s. Klebsiella pneumoniae ozaenae grew mostly as a commensal from the upper respiratory tract of lepromatous leprosy patients with rhinorrhea.…”