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The results are presented of the electron-microscopic examination of the main element of scleroma granulomatous tissue - the Mikulicz cells. New data on the shape and structure of their nuclei as well as on the presence of electron-dense bodies in their cytoplasma are given.
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Scleroma is a chronic granulomatous disease reported from many parts of the world. 5% of the cases are located in Africa. Ten cases of scleroma histologically diagnosed at the Department of Human Pathology, Kenyatta National Hospital, Nairobi are reported. Four of the 10 cases were males and six were females. They were aged between 18 and 53 years. The patients came from highland areas in Central and Western Kenya where an endemic focus may well exist.
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An unusual case of nasal and laryngeal scleroma is presented. Laryngeal scleroma should be included in the differential diagnosis of obstructing lesions of the supraglottic airway. The immunoperoxidase staining method is useful in establishing the diagnosis in cases of equivocal culture and histopathologic appearance. It can further be used as an objective test to determine the effectiveness and duration of antibiotic therapy.
Antibiotic sensitivity of 292 strains of Proteus, 60 strains of Ps, aeruginosa, 309 strains of S. aureus and 88 strains of S. epidermidis isolated from the upper respiratory tract of patients with scleroma and ozena was studied. The cultures of Pr. mirabilis were sensitive to aminoglucosides (54.9-96.2 per cent) and Pr. morganii were sensitive to levomycetin (81.5 per cent) and neomycin (92.6 per cnet). Sensitivity of Pr. vulgaris and Pr. morganii was reliably higher (p less than 0.001) than that of Pr. mirabilis. The strains of Pr. morganii were less sensitive to monomycin (P less than 0.001) and streptomycin (p less than 0.01) as compared to the cultures of other Proteus species tested. The strains of Ps. aeruginosa were sensitive only to gentamicin (90 per cent) and neomycin (81.1 per cent). Most of the strains of S. aureus (85.4-100 per cent) were sensitive to oleadomycin, erythromycin, olemorphocycline, tetraolean, oxacillin, methicillin ceporin, lincomycin, ristomycin, kanamycin, monomycin and gentamicin. Benzylpenicillin (90.8 per cent of the sensitive strains), ampicillin (67.1 per cent), tetracycline (66.7 per cent), levomycetin (68.6 per cent) and streptomycin (38.1 per cent) were less effective. Antibacterial therapy in cases with scleroma and ozena should be directed not only against causative agents of the diseases but also against the microbes developing due to disbacteriosis. Combination of parenteral and local use of the antibiotics in the treatment of chronic clebsiellesis decreased the isolation rate of Proteus and Ps. aeruginosa in the patients.
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