Rhinoscleroma – Causes, Symptoms and Treatment
Rhinoscleroma is described for first time by F. Herba in 1870 like a slowly progressive granulomatous process. Later A. Frisch isolated from this lesion microorganism called Klebsiella rhinoscleromatis. The disease is endemic for African countries. Preference localization for the development of the process is nasal mucosa, as an exception is detect in the paranasal sinuses, larynx, trachea, bronchi and middle ear.
Rhinoscleroma with “typical”and rare localization.
Presented are two biopsy cases with tipical morphological picture and rhinoscleroma with rare localization – maxillary sinus (1) and tooth bone socket (2).
|Clinical date||First case||Second case|
|Age||28 years||68 years|
|Symptoms||From 1 year||From one month|
|Localization||Left maxillary sinus||Bone socket in right|
|X-ray||Cystic formation||Cystic formation|
|Intraoperative find||Thick walled cyst||Thick walled cyst|
|Treatment||Surgery and antibiotics||Surgery and antibiotics|
|Clinical diagnosis||Cyst of the maxillary sinus||Radicular cyst|
In both cases, the histological pictures are identical. There is specifically granulomatosus inflammation. Around hyperemic capillary opened plenty of plasmocytes, some of which with demonstrative Russell body. The other predominant cell type are Mikulich cells – histiocytes with pale cytoplasm grid. There are singly neutrophils and lymphocytes. Studying macrophages with electron microscope demonstrated low elelctron density of their cytoplasm – result of heavily destruction of intracellular organelles of the cause of the disease, especially, in prolonged course.
- The Rhinoscleroma is rare to see outside from the epidemic areas. The free movement of people nowadays, and maybe the global climate changes are some of the factors, advantage his appearace in our region. The evolution of the agent himself and condition of the immune system of the macrooganisms have also significant role.
- Klebsiela strains, especially clinical isolates, have marked polyresistance to many antimicrobial substances, mainly due to the new R plasmid with exaggerated genetic capacity. Moreover – already have proven such encoding β – lactamases with extended spectrum, especially in hospital strains. The percentage of polyresistant variants in our country is very high (up to 50% compared to gentamicin), which in most cases doomed to fail antibiotic treatment.
- The fact that Klebsiela are conditionally pathogenic microorganisms and a significant proportion in hospital ecosystems and also recently discovered Vi-factors and toxic components could lead to increase the frequency of infections by biotypes of Klebsiela pneumonie – ozaenae et rhinoscleromatis.
- Last but not least is the issue of patients with undermined immune status, which lately are not rarity in relation to malnutrition, uncontrolled use of drugs, heavy distressing and chronic diseases, including AIDS treatment, which require them.
- Diagnosis of rhinoscleroma in the clinic could be difficult, especially when the topic is unusual. Important supporting criteria in these cases is primarily patohistology study in which dominated plasma – cells by Russel corpuscles and Mikulich cells. Importance has and organ localization - respiratory tract, often above or areas immediately located close to them. Another important point supporting the diagnostic thinking is to take into account the conditions which probable reduced immunity in specific patient.
- Modern morphological method to express in the course of the operation, confirmation of diagnosis among gefrir investigated imprint cytology, which visualizes macrophages, swallowed by phagocytosis germs of Frisch.
1. Pathomorphology study in Rhinoscleroma has unquestionable value to specify the diagnosis and definitive cure.
2. Despite long established morphology and causative the rhinoscleroma should be searched and expected even in atypical locations.
3. Essential for proper diagnosis in the clinic have a better medical history to upward migration nowadays, especially in endemic areas and increased attention to conditions associated with low immunity.