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Scleroma (Rhinoscleroma). A histologic immunohistochemical study with bacteriologic correlates.
Scleroma was diagnosed in nine of 30 Spanish-surnamed patients who had inflammatory lesions of the nose, pharynx, and larynx during the two-year period from Jan 1, 1978, through Dec 31, 1979. A total of 19 biopsy specimens were taken from these nine patients. In six of the 19 specimens, a histologic diagnosis of scleroma was not possible. Seventeen of the specimens with characteristic histologic findings stained with the peroxidase-antiperoxidase method for detection of Klebsiella capsular antigen III, although in 11 of these specimens, simultaneous cultures failed to reveal the characteristic Klebsiella rhinoscleromatis. These specimens showed the features of one of the three histopathologic forms of scleroma: ozena, granuloma, or scleroma. A range of tissue reactions was identified: histiocyte and plasma cell nodules, vasculitis, acute inflammation, pseudoepitheliomatous hyperplasia, ulceration, and submucosal keratin cyst. Comparison with histochemical bacterial stains revealed that the PAS and Hotchkiss-McManus stains gave unequivocal positive results less frequently than the immunoperoxidase method, and were less specific. Methenamine silver, Giemsa, Deiterle, Brown and Brenn, and Brown and Hopps were unreliable for the detection of the organism. The immunoperoxidase method can be appropriately used when the spectrum of histopathologic findings suggests a differential diagnosis of scleroma.
The assessment of recruitment in rhinoscleroma patients with hearing loss after streptomycin therapy.
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[Case of rhinoscleroma with skin involvement].
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[Ultrastructural studies of specific granulation in patients with rhinoscleroma. II].
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[Ultrastructural studies of specific granulation in patients with rhinoscleroma. III].
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[Nasal mucosa ultrastructure in rhinoscleroma].
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[Serum immunoglobulin content in rhinoscleroma].
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Rhinoscleroma as a cause of airway obstruction.
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[Cytodiagnosis of rhinoscleroma].
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In-vivo and in-vitro studies of rhinoscleroma.
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Treatment of scleroma with ceforanide.
Three patients with rhinoscleroma who presented with nasal and pharyngeal symptoms are described. Treatment with ceforanide, a new second-generation cephalosporin with high intrinsic activity against Klebsiella, and possessing a long half-life, was used as outpatient treatment. A total of 120 g of ceforanide was administered over a period of two months. All three patients showed signs of clinical improvement, but only two of three became bacteriologically sterile at the end of two months; one patient relapsed bacteriologically but not clinically, once the drug was discontinued. Second- and third-generation cephalosporins appear to have excellent activity against the causative pathogens of rhinoscleroma. Because of the impracticality of administering these agents parenterally over prolonged periods of time, there is a need for the development of an oral cephalosporin with similar intrinsic activity and beta-lactamase stability. Perhaps the novel beta-lactam antibiotics such as the penems and monobactams, some of which can be administered orally, will answer that need.
Antroscleroma.
Oedema, hypertrophy, polyposis, atrophy or empyema of the maxillary sinus are common features of rhinoscleroma. However, actual involvement of the antrum by the nasal granuloma is rare and primary scleroma of the antrum is of extreme rarity. Three cases of antroscleroma are presented, one secondary to an extensive rhinoscleroma and two primary. The difference in the physical, biological and microbiological environment in the antrum from that in the nose might explain the rarity of antroscleroma.
Scleroma of the eustachian tube: salpingoscleroma.
Rhinoscleroma is a chronic specific granulomatous inflammatory condition that has an affinity with the mucosa of the upper respiratory tract. Involvement of the eustachian tube is uncommon. In the present study nasopharyngoscopy was performed in 20 patients with rhinoscleroma to find out the type, nature and site of the lesion at the orifices of the eustachian tube. A lesion involving the eustachian tube was found in six cases (30 per cent). Lesions occurred in the form of atrophic changes with crusting, granuloma and fibrotic thick areas. Involvement of the eustachian tube was found to be associated with intranasal scleroma and was more common at the granulomatous stage. Eustachian tube scleroma had a possible association with subsequent changes in the tympanogram pattern. Nasopharyngoscopy was found to be of therapeutic value in removing the crust, discharge and granulations at the eustachian tube orifices.
Respiratory scleroma: a clinicopathologic and ultrastructural study.
Respiratory scleroma (rhinoscleroma) is a chronic granulomatous infection produced by Klebsiella rhinoscleromatis, a gram-negative aerobic coccobacillus. This disease is endemic to Africa, Central and South America, South Central and Eastern Europe, the Middle East, and China. Sporadic cases have been reported in the United States, especially in persons who migrated from the aforementioned areas. The majority of cases affect the nose, but extension to the soft and hard palate, upper lip, and maxillary sinuses also is frequent. This study comprises 11 patients (6 females and 5 males) with respiratory scleroma identified over a 6-year period in Guatemala. Their ages ranged from 16 to 60 years. Light microscopy showed a dense plasmacytic infiltrate, Mikulicz histiocytes, and Russell bodies within the plasma cells. Ultrastructural study revealed Mikulicz histiocytes, cytoplasmic vacuoles containing bacilli, and so-called A and B granules. We favor the term respiratory scleroma for this lesion because it affects not only the nose but also the upper and lower respiratory tracts as well as the mouth.
The epithelium and chronic inflammatory cells in scleroma. (An electron microscopic study).
The ultrastructure of 15 cases or rhinoscleroma have been studied. The epithelium showed intercellular edema, a reaction to the polysaccharide coat of intact bacilli, passing through defects in the basal lamina and subsequently inviting polymorph migration. The transitional stages between normal and 'reactive' plasma cells to the formation of the Russell body and the Unna cell were demonstrated, thus supporting the theory of an intracellular formation of the Russell bodies.
Role of endoscopy in diagnosing scleroma in its uncommon sites.
Eighty cases suffering from rhinoscleroma were studied. Suspected cases were examined by sinoscopy, nasopharyngoscopy and bronchoscopy for detection of secondary involvement in these sites. Antroscleroma, salpingoscleroma and tracheo-bronchoscleroma have been found in a relatively high percentage of cases. The role of endoscopy in early diagnosis, initial symptomatic treatment and follow-up cases is discussed.