Rhinoscleroma: Causes, Symptoms, Daignosis, Prevention and Treatment

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Rhinoscleroma
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Rhinoscleroma

• Rhinoscleroma is a very rare kind of chronic
  inflammatory condition that is caused by bacteria
  called Klebsiella rhinoscleromatis.Rhinoscleroma
  is characterized by granulomatous swellings
  (lumpy firm masses composed of immune cells) in
  the nose and other parts of the respiratory
  tract, such as the paranasal sinuses, mouth,
  lips, larynx, trachea, and bronchi.The disease
  is further contracted by taking droplets or
  contaminated material and typically appears in
  patients aged 10-30 years of age.Risk factors
  for the disease include immunodeficiency
  (particularly HIV infection), poverty, poor
  hygiene, and prolonged contact with infected
  patients.

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Clinical Features of Rhinoscleroma

• Three clinical stages have been described
• Catarrhal stage Initially patients have
  non-specific symptoms, such as a running nose or
  blocked nose. As the disease progresses, the
  nasal discharge may contain pus and develop a
  foul smell. Dry crusting of the mucous membranes
  of the nose can occur. This stage can last for
  weeks to months.
• Granulomatous (also called hypertrophic or
  proliferative) stage the mucosal tissue inside
  the nose becomes bluish-red, and rubbery nodules
  (lumps) form. As these granulomatous swellings
  grow, they can cause nasal enlargement and
  deformity. Symptoms include bleeding noses, nasal
  obstruction (or obstruction elsewhere in the
  respiratory tract), loss of the sense of smell, a
  hoarse voice, and thickening or numbing of the
  soft palate.
• Sclerotic or fibrotic phase the granulation
  tissue is replaced by hardened scars, which can
  occasionally result in blocked airways.

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Diagnosis of Rhinoscleroma

• K rhinoscleromatis can be grown in the laboratory
  in around 50-60 of cases, using blood agar or
  MacConkey agar.
• The organisms may also be seen under the
  microscope using Gram, Giemsa, and silver
  staining.
• Microscopic examination of biopsy samples can
  reveal characteristic findings, including
  Mikulicz cells (large immune cells that contain
  the bacteria).

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Treatment of Rhinoscleroma

• Rhinoscleroma can be easily treated with the use
  of long-term antibiotics and surgery in patients
  who are having symptoms of respiratory tract
  obstruction.
• Antibiotics that have been used include
  streptomycin, tetracycline, rifampicin,
  trimethoprim-sulfamethoxazole, and ciprofloxacin.
  Antibiotic treatment alone may be sufficient in
  early stage disease. Antibiotics are generally
  needed for months to years to prevent recurrent
  infection.
• Surgery is often required, when granulomatous
  lesions or scarring are present.

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