Summary about Disease
Rhinoscleroma is a chronic, progressive granulomatous infectious disease that primarily affects the nose, but can also involve the pharynx, larynx, trachea, and bronchi. It is caused by the bacterium Klebsiella rhinoscleromatis. The disease is characterized by slowly developing, destructive lesions that can lead to disfigurement and airway obstruction if left untreated.
Symptoms
Symptoms typically develop slowly over years and progress through three stages:
Catarrhal/Atrophic Stage: This initial stage presents with nonspecific symptoms such as chronic rhinitis (nasal congestion, discharge), nasal dryness, epistaxis (nosebleeds), and foul odor (ozena).
Granulomatous Stage: This is the most characteristic stage, marked by the development of painless, firm, reddish-purple nodules or masses in the nasal cavity. These granulomas can obstruct the nasal passages, leading to difficulty breathing through the nose (nasal obstruction), facial swelling, and altered voice.
Sclerotic/Fibrotic Stage: In this late stage, the granulomas heal with extensive scarring and fibrosis, leading to nasal deformities (e.g., broadening of the nose, saddle nose deformity), nasal stenosis (narrowing), and potential airway obstruction.
Causes
Rhinoscleroma is caused by infection with the bacterium Klebsiella rhinoscleromatis. The exact mode of transmission is not fully understood, but it's believed to occur through direct contact with infected nasal secretions or respiratory droplets. Poor hygiene, malnutrition, and crowded living conditions are thought to contribute to the spread of the disease.
Medicine Used
The primary treatment for rhinoscleroma is long-term antibiotic therapy. Effective antibiotics include:
Tetracycline: Often used as a first-line treatment.
Ciprofloxacin: A fluoroquinolone antibiotic commonly used, particularly when tetracycline is not effective or contraindicated.
Rifampin: Can be used in combination with other antibiotics.
Streptomycin: Used in some cases. Treatment duration is typically several weeks to months, depending on the severity of the infection and the patient's response. Surgical intervention may be necessary to remove large granulomas, correct nasal deformities, or relieve airway obstruction.
Is Communicable
Rhinoscleroma is considered mildly communicable. Transmission requires close and prolonged contact with an infected individual, likely through respiratory droplets or nasal secretions. The exact mode of transmission is not fully understood, and the contagiousness is generally considered low.
Precautions
Hygiene: Practice good hygiene, including frequent handwashing, especially after contact with respiratory secretions.
Avoid Sharing: Avoid sharing personal items such as handkerchiefs, towels, and utensils with individuals who have rhinoscleroma.
Isolation: Individuals with active rhinoscleroma should avoid close contact with others, especially those who are immunocompromised, until they have completed a course of antibiotic treatment.
Early Diagnosis and Treatment: Prompt diagnosis and treatment are crucial to prevent the spread of infection and reduce the risk of complications.
Environmental Sanitation: Maintain a clean living environment, especially in crowded or unsanitary conditions.
How long does an outbreak last?
Rhinoscleroma is not typically described in terms of outbreaks like some other infectious diseases. The disease itself is chronic and progresses slowly over months to years if left untreated. An individual case can last indefinitely if not treated effectively with antibiotics. The duration of antibiotic treatment can last from weeks to months, depending on the severity.
How is it diagnosed?
Diagnosis of rhinoscleroma typically involves:
Clinical Examination: A thorough physical examination, focusing on the nasal cavity, pharynx, and larynx, can reveal characteristic granulomas or masses.
Nasal Endoscopy: This procedure involves inserting a thin, flexible tube with a camera into the nasal passages to visualize the lesions more clearly.
Biopsy: A tissue sample from the affected area is taken and examined under a microscope. Histopathological examination reveals characteristic Mikulicz cells (large foamy histiocytes containing Klebsiella rhinoscleromatis) and Russell bodies (eosinophilic immunoglobulin inclusions).
Culture: Culturing the tissue sample can help identify Klebsiella rhinoscleromatis, although this is not always successful.
PCR: Polymerase chain reaction (PCR) testing can detect Klebsiella rhinoscleromatis DNA in tissue samples.
Serology: Antibody tests are not typically used for diagnosis.
Timeline of Symptoms
The timeline of symptoms can vary, but generally follows this pattern:
Initial Stage (Catarrhal/Atrophic): Weeks to months or even years. Symptoms include nasal congestion, discharge, dryness, and foul odor. This stage is often mistaken for other nasal conditions.
Granulomatous Stage: Months to years. Nodules or masses develop in the nasal cavity, leading to nasal obstruction, facial swelling, and voice changes. The masses slowly enlarge.
Sclerotic/Fibrotic Stage: Years. Scarring and fibrosis occur, leading to nasal deformities and potential airway obstruction. This stage represents the long-term consequences of untreated disease.
Important Considerations
Differential Diagnosis: Rhinoscleroma can mimic other nasal conditions, such as Wegener's granulomatosis, sarcoidosis, tuberculosis, and fungal infections. Therefore, accurate diagnosis is crucial to ensure appropriate treatment.
Treatment Compliance: Long-term antibiotic therapy is essential for eradicating the infection and preventing recurrence. Patient adherence to the prescribed medication regimen is critical for successful treatment.
Surgical Management: Surgical interventions may be required to remove large granulomas, correct nasal deformities, or relieve airway obstruction. However, surgery alone is not sufficient and must be combined with antibiotic therapy.
Long-Term Follow-Up: Patients who have been treated for rhinoscleroma require long-term follow-up to monitor for recurrence and manage any complications, such as nasal stenosis or deformities.
Geographic Distribution: While rare in many parts of the world, rhinoscleroma is more prevalent in certain regions, including parts of Eastern Europe, Africa, Asia, and Central and South America. Clinicians should be aware of this geographic distribution when evaluating patients with nasal symptoms.