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PubMedDate not supplied

A case of rhinoscleroma cured with ciprofloxacin.

The diagnosis of rhinoscleroma was confirmed in a 17-year-old female patient from Tehran, Iran, suffering from a roundish tumour of the nose. Prior treatment with streptomycin and tetracycline had been unsuccessful. A three-month course of high-dose oral ciprofloxacin (750 mg b.i.d.) led to prompt cessation of the growth of the granuloma which was removed later by plastic surgery. Although serology alone appeared to have little value for the specific diagnosis of rhinoscleroma, a significant increase of IgG antibodies during treatment with ciprofloxacin confirmed infection by Klebsiella rhinoscleromatis in this case.

Adolescent↗
PubMed1979

Transmission and scanning electron microscopic studies of rhinoscleroma.

Using both types of electron microscope, combined transmission and scanning electron microscopic studies were done on 6 patients with rhinoscleroma. The present work suggests the possibility of two types of organisms causing the disease: one type--being in the majority--was a rod-shaped bacillus measuring about 3 micrometers; the other type was a short, stout bacillus with terminal spiral cilia. The ultrastructure of these bacilli has been described. The advantages and limitations of each type of electron microscopy in the investigation of rhinoscleroma have been discussed.

Humans↗
PubMed1981

Local acriflavine: a new therapy for rhinoscleroma.

Fifty patients with rhinoscleroma have been studied clinically, histopathologically and bacteriologically before, during and after the local application of acriflavin solution, in different concentrations, over an eight-week period. The results have been encouraging. Local acriflavine solution, in a concentration of 2 per cent, has been shown to be an effective and safe remedy for rhinoscleroma.

Acridines↗
PubMed1988

Local rifampicin in treatment of rhinoscleroma.

Many antibiotics, chemotherapeutic agents and other chemicals have been tried in the treatment of scleroma without much success (Toppozada et al., 1967). The most popular of these drugs are streptomycin and aureomycin (Botros et al., 1954; Zwiefach, 1955; El-Mofty, 1962), terramycin and chloromycetin (Hoover and King, 1953) and ampicillin, septrin and vibramycin (Ssali, 1975). El-Mofty and Attia (1957) attributed considerable value to the use of 20 per cent aureomycin ointment locally in treating the disease. Nigonol in the form of a local injection was tried by Toppozada et al. (1967) and they claimed good results. Shaer et al. (1981) reported that local application of 2 per cent acriflavine solution over an eight-week period was an effective and safe remedy for rhinoscleroma. Rifampicin has been used systemically with success as a new antibiotic for the treatment of scleroma (Riad, 1982). The aim of the present study was to evaluate the response of rhinoscleroma to local medication with rifampicin.

Administration, Intranasal↗
PubMed1990

The effect of rifampicin on rhinoscleroma: an electron microscopic study.

Twenty-five cases suffering from rhinoscleroma were divided into two groups. The first group consisted of 15 patients treated with rifampicin systemically. The other group consisted of 10 patients treated locally with rifampicin in the form of ointment. Electron microscopic study of the pathological changes in the lesions showed that rifampicin is highly effective both systemically and locally in the treatment of rhinoscleroma.

Administration, Oral↗
PubMed2001

An interpretation of the structural changes responsible for the chronicity of rhinoscleroma.

OBJECTIVE: To identify the structural changes of the proliferative phase of rhinoscleroma which could be responsible for the chronicity of the disease. STUDY DESIGN: Observational research. METHODS: Samples of friable tissue taken from the nasal mucosa of nine untreated patients were processed for light and ultrastructural microscopy. RESULTS: The majority of changes contributing to the chronicity of the disease occurred in the subepithelium and followed three closely related but distinct events. In the first (infiltrative), subepithelial invasion by the Klebsiella was followed by its active multiplication and proliferation of capillaries. In the second (neutrophilic), large numbers of neutrophils were delivered into this space. Neutrophils actively phagocytized the Klebsiella but appeared to die at an accelerated rate without completing digestion of the microorganisms. In the third event (histiocytic), histiocytes entered the subepithelium and engaged in unrestrained phagocytosis of decaying neutrophils, Klebsiella, and debris. During this process, the histiocytes' phagosomes underwent massive dilation, thus becoming Mikulicz cells. Mikulicz cells were unable to consistently destroy the Klebsiella and eventually ruptured, releasing them into the interstitium. Evidence was found that an autophagic process might contribute to phagosome distention and to the rupture of the vacuolar membranes and cell wall. CONCLUSIONS: Several critical changes responsible for the chronicity of rhinoscleroma occur during the proliferative phase of the disease. The majority of these take place in the subepithelium and include: 1) factors leading to the transformation of histiocytes into Mikulicz cells, 2) the inability of these cells to consistently destroy the Klebsiella, 3) their rupture releasing viable Klebsiella, and 4) the intrinsic resistance of the pathogen.

Biopsy↗
PubMedDate not supplied

Rhinoscleroma in three siblings.

Rhinoscleroma is a chronic, granulomatous infectious disease that responds poorly to treatment. In recent years an increasing number of cases have been reported in nonendemic areas, explained largely by major migratory movements. We describe rhinoscleroma in three siblings. They had ulcerated but painless lesions, which bled spontaneously, and hemorrhagic scabs or crusts in their noses. In one child, the lesions had destroyed the entire left nasal ala and alar cartilage and most of the right. Dermatopathologic study identified the Mikulicz macrophages that contained organisms. It is possible that disposing factors could have been the neutropenia common to the three children and their poor living conditions. They were treated with a combination of trimethoprim-sulfamethoxazole and cefalexin, for a period of 3 months. We present this unusual case history of three siblings affected by a process that is relatively infrequent in our area of practice and is not considered very contagious. It is important to recognize the clinical signs characteristic of this disease, the diagnosis of which is not easy. Improvements in living conditions, hygiene, and health standards are essential prerequisites for its control and prevention.

Child↗
PubMed1992

Rhinoscleroma and rhinosporidiosis.

For North American otolaryngologists, rhinoscleroma and rhinosporidiosis are moving more into the differential diagnosis of chronic inflammatory diseases of the upper airway, particularly the nasal cavity. This change is occasioned by the influx of immigrants from parts of the world to which the diseases are endemic. Diagnosis is established by identification of the causal organisms, the readily seen Rhinosporidium seeberi for rhinosporidiosis and the more elusive Klebsiella rhinoscleromatis for rhinoscleroma.

Humans↗
PubMed2003

Nasal rhinoscleroma in a nonendemic area: a case report.

Rhinoscleroma is a chronic, granulomatous infectious lesion most frequently affecting the respiratory tract mucosa. This disease is endemic to Africa, Central and South America, South Central and Eastern Europe, the Middle East, and China. We report an extremely rare disease of nasal rhinoscleroma in Korea. The patient was a 63-yr-old man, who suffered from chronic nasal obstruction and septal deviation. Characteristic histology from a nasal biopsy was proven and special stains for bacteria were employed: periodic acid-Schiff, Warthin-Starry silver, Giemsa, and Gram stains. Isolation of Klebsiella rhinoscleromatis from a culture of nasal discharge was failed, but ultrastructural examination of numerous phagocyzed bacilli in the Mikulicz cells confirmed the diagnosis. The histiocytic nature of the Mikulicz cells was confirmed, using CD 68 and alpha-1 antitrypsin, and by the ultrastructural features of Mikulicz cells. Here, we emphasize the recognition of this rare entity in nonendemic regions, frequently leading to delayed diagnosis.

Endemic Diseases↗
PubMed2001

[Clinicopathologic analysis of rhinoscleroma].

OBJECTIVE: To investigate the clinicopathologic characteristics and reason of tissue injury caused by klebsiella rhinoscleromatis(KR) infection. METHODS: Twenty-four cases of rhinoscleromas in the nasal and pharyngeal region in this hospital from March 1983 to March 1998 were studied retrospectively. Warthin-Starry (W-S) stain was used in all cases and CD43, CD20, CD68, Lysozyme mark were observed in eleven specimens by ABC immunochemical method. Two cases were studied further with transmission electron microscopy. RESULTS: A great number of KR were found in Mikulicz cells and were confirmed further in the phagosomes in cytoplasm of Mikulicz cells, where a small number of endoplasmic reticulums and lysozymes was squeezed to the side of cells. A few of T-lymphocytes was found within the granuloma. CONCLUSION: Cellular immunity function of the patient with rhinoscleroma was depressed and the response to immunization of host which regards to KR was the major cause of tissue injury.

Adolescent↗
PubMed2004

[A new case of rhinoscleroma with skin extension].

Scleroma is a chronic and specific granulomatous disease of bacterial origin. Klebsialla rhinoscleromatis, a gram-negative bacillus. The majority of cases affect the upper airways, particularly the nose, thus justifying the term of rhinoscleroma. Extension to the palate, the upper lip and the skin is possible. A new case of rhinoscleroma with skin extension is reported. To us, this is the second case in Senegal (Casamance). Epidemiological, clinical, bacteriological and histological aspects of the disease are reviewed. Under suitable antibiotic, evolution is currently favorable.

Adult↗
PubMed1983

In situ demonstration of T lymphocyte subsets in granulomatous inflammation: leprosy, rhinoscleroma and sarcoidosis.

T lymphocyte subpopulations in frozen tissue sections of four granulomatous conditions (five patients with tuberculoid leprosy, five with lepromatous leprosy, seven with sarcoidosis and four with rhinoscleroma) were studied using monoclonal antibodies and a modified immunoperoxidase technique. Two immunohistological patterns were observed. In tuberculoid leprosy and sarcoidosis, lymphocytes expressing the helper/inducer phenotype were present within the aggregates of mononuclear phagocytes (epithelioid cells); however, cells with the suppressor/cytotoxic phenotype were predominantly in the lymphocytic mantle surrounding each granuloma. In lepromatous leprosy and rhinoscleroma the helper/inducer T cells and suppressor/cytotoxic T cells were both diffusely distributed among the mononuclear phagocytes (histiocytes) without any discernible mantle. The segregation of the helper/inducer and suppressor/cytotoxic phenotypic subsets was associated with an epithelioid cell differentiation of mononuclear phagocytic cells, bacterial elimination and a delayed type hypersensitivity response. The intimate admixture of helper/inducer and suppressor/cytotoxic subsets was associated with undifferentiated mononuclear phagocytes, bacterial proliferation and the absence of a delayed type hypersensitivity response. Thus the different distributions of T cell subpopulations in granulomas may be associated with differences in the host's immune response in several forms of granulomatous reactions.

Granuloma↗
PubMed1980

Rhinoscleroma in Malawi and Eastern Zaire.

The first ten cases of rhinoscleroma from Malawi and six from Eastern Zaire are reported. Most of the patients were aged between 20 and 40 years (age range 3-60) and presented with either a nasal "tumour' or abnormalities of the nasal septum. Histological examination of biopsy material revealed features diagnostic of rhinoscleroma - a mixture of mature plasma cells and lareg foamy macrophages (Mikulicz cells) containing intra-cellular Gram negative bacilli. The organisms were best seen in sections stained by the Warthin-Starry technique. This study suggests that rhinosceleroma is perhaps more common in Malawi and Zaire than has been realised.

Adolescent↗
PubMed1976

[Rhinoscleroma in an immigrant].

A patient with rhinoscleroma was treated in our department. As far as we know it is the first importcase published in Belgium. Rhinoscleroma is an infectious disease caused by the Klebsiella Rhinoscleromatising. It is a chronic granulomatous process with subsequent stenosis and scarring. The nose and larynx are the most frequent localisations. The therapy consists of antibiotics in an early stage and is only palliative in the latter ones.

Diagnosis, Differential↗
PubMed1998

[Spheno-ethmoidal rhinoscleroma. Report of a case and review of the literature].

We report an unusual case of spheno-ethmoidal rhinoscleroma. This chronic granulomatous disease occurs sporadically in Western Europe. Culture is necessary for diagnosis showing the causative organism of rhinoscleroma, Klebsiella rhinoscleromatis. Immunocytochemistry is used in any suspicious case with a negative culture. Antibiotics are the mainstay of therapy for several weeks, using ciprofloxacine or rifampicin, until the nasal biopsies demonstrated no Klebsiella organism.

Adult↗
PubMed1975

[Electron microscopical investigation of rhinoscleroma (author's transl)].

A boy from Togo with a resistent Rhinoscleroma was observed. The specific granuloma was examinated by histological and electron microscopic methods. The plasma cells form fibrillary material or guttate Russel bodies in the rough endoplasmatic reticulum. The morphology of Mikulicz-cells and Klebsiella rhinoscleromatis is described. The cells are supposed to be (histiocytic) macrophages. The surface of the germs is coated with a fimbria-like radiate substance which in the vacuoles of the cells is crosslinked. This material could be the eliciting antigen for the formation of Russel bodies. These bodies then may represent immune substances bound within the cell.

Adolescent↗
PubMed1996

Rhinoscleroma with orbital extension: CT and MRI.

We describe the MRI features of a rhinoscleroma with orbital extension. This benign bacterial and granulomatous lesion of the paranasal sinuses gave homogeneous low intensity on T2-weighted images and enhanced with gadolinium. It could simulate a malignant sinonasal tumour or a fungal sinusitis; the diagnosis must be considered in patients from endemic areas.

Adult↗
PubMed1998

[Nasal scleroma (rhinoscleroma): pathological and clinical results].

Histologic, immunohistochemical and ultrastructural results of a rhinoscleroma diagnosed bioptically on a 38 aged man are demonstrated. The characteristic light microscopic sign is a plasmocytic inflammatory infiltrate with dense packed foamy transformed macrophages (Mikulicz cells) ultrastructurally containing diplobacilli (Klebsiella rhinoscleromatis, gram negative agent of the lesion). The lesion has to be differentiated as of other inflammatory diseases as of plasmocytoma. A local application of acriflavin solution 2% was of therapeutical benefit.

Acriflavine↗