RHINOSCLEROMA (KLEBSIELLA RHINOSCLEROMATIS A.K.A. VON FRISCH BACILLUS)
A GRAM – BACILLUS INFXN WHICH INSTITUTES A CHRONIC GRANULOMATOUS DISEASE OF THE AIRWAY
APPEARS VERY MUCH LIKE WEGENERS–AFFECTS SUBGLOTTIC LARYNX
RARE
SOUTH CENTRAL AMERICA OR EASTERN EUROPE
MALE = FEMALE
PRIMARILY YOUNG ADULTS—LOWER SOCIOECONOMIC CLASS
USUALLY BEGINS IN THE NOSE–PROGRESSES DOWN TO THE SUBGLOTTIS
SLOW GROWING, PAINLESS, NON-ULCERATING NODULES
FOUR STAGES:
I–RHINITIC/CATARRHAL STAGE = PROLONGED PURULENT HONEYCOMED RHINORHEA
II–ATROPHIC STAGE—CRUST FORMATION/ NODULAR MUCOSAL CHANGES
III–FLORID/GRANULOMATOUS STAGE–NODULAR MUCOSAL CHANGES COALESCE
IV–FIBROTIC/SCLEROTIC STAGE–CICATRICIAL-DENSE FIBROSIS
DYSPHONIA, DYSPNEA, STRIDOR, FOUL SMELLING RHINORHEA
Bx: MIKULICZ CELLS = FOAMY(VACUOLIZED) HISTIOCYTES CONTAININGTHE ORGANISM—-BEST SEEN WITH WARTHIN STARRY SILVER STAIN, RUSSEL BODIES, PLASMA CELLS, LYMPHOCYTES
PSEUDOEPITHELIOMATOUS HYPERPLASIA, CHRONIC GRANULOMATOS CHANGES, AND SQUAMOUS METAPLASIA
Rx: STREPTOMYCIN AND TETRACYCLINE FOR UP TO 6 MONTHS (AT LEAST 2 MONTHS)
STEROIDS, AND HYPERBARIC OXYGEN
SURGERY—TRACH AND LTR