Rhinoscleroma Research Articles

First report of rare persistence granulomatous extra respiratory Rhinoscleroma of oral pathology

Rhinoscleroma (RS) is a rare chronic specific progressive granulomatous disease of the upper airway and affect the nasal cavity, larynx, nasopharynx and may spread to the lower respiratory tract. Extra-respiratory involvement has rarely been described. A case report of extra-respiratory RS with oral manifestation in Egyptian female patient has been presented as a tumour extruded from mucosal lining of upper lip. She was living in crowded conditions with malnutrition and poor hygiene. On the first look, the lesion appeared to be carcinoma without any indication of infectious disease, and then patient was prepared for incisional biopsy. Upon clinicopathological evaluation, the diagnosis was made as RS in the granulomatous stage based on the presence of dense plasma cell infiltration with Mikulicz cells and Russell bodies. Long term oral ciprofloxacin 500 mg twice/day was started as a single treatment. By the end of six weeks antibiotic therapy, the large granulomatous mass reached the cicatricial stage, became very stiff fibrotic mass with sclerotic scar, markedly indurated & significantly decreased in size.This case shows the significant of through clinical examination and lab investigations to achieve correct diagnosis.

Rhinoscleroma: Our experiences at a tertiary care teaching hospital of Eastern India

Background: Rhinoscleroma (RS) is a chronic granulomatous disease due to infection of Klebsiella rhinoscleromatis. It often affects the respiratory mucosa, especially the nasal cavity and sometimes extends lower respiratory tract. RS is more common in certain geographical area than in others, but the pathogenesis and the risk factors of RS are still unclear. Materials and Methods: This was a retrospective study done between January 2014 and December 2019. The diagnosis of the RS was done on the basis of clinical presentations and histopathological findings. Details of clinical findings, investigations, and treatment were analyzed. Results: There were 13 cases of RS diagnosed after confirmation with histopathological examination. The female to male ratio was 1.6:1 with a mean age of 36 years. The most common clinical presentation was nasal obstruction. All were treated with ciprofloxacin. Relapse occurred in three cases which were confirmed by biopsy. Conclusion: RS is a rare clinical entity in Eastern India. Awareness of the clinical presentations of RS and early diagnosis will reduce the morbidity of this disease.

Non Indigenous Rhinoscleroma

Rhinoscleroma (RS) is a granulomatous illness of the upper respiratory tract caused by Klebsiella rhinoscleromatis. It is a rare, chronic, granulomatous disease. RS develops in the nasal mucosa subepithelium and can spread to the eustachian tube, maxillary antrum, oral cavity, larynx, orbit, trachea, and bronchi. The present case is of a 29-year-old female who came to the Ear Nose and Throat (ENT) outpatient department with chief complaints of bilateral nose block for six months. Examination by anterior rhinoscopy revealed pink nasal mucosa and a swelling arising from both sides of nasal septum, that was soft, non tender, did not bleed on touch. Diagnostic nasal endoscopy showed a midline septal mass which was present just posterior to mucocutaneous junction and a second septal mass was present posterior to first mass at level of posterior part of inferior turbinate. She underwent submucosal resection of septal mass and the same was sent for histopathological examination and it was diagnosed as features suggestive of RS. The patient was treated with a course of tablet ciprofloxacin, analgesics, antihistamines. There has been no recurrence during the one year follow-up period. Patient improved symptomatically and had no further complaints.

Rhinoscleroma-A Rare Granulomatous Disease in a Child

Rhinoscleroma (RS) is a chronic granulomatous disease caused by Klebsiella rhinoscleromatis. In all thepatients, the nose is affected but sometimes extends to any parts of the airways. Diagnosis of this disease isdone on the basis of the histopathological examination or direct evidence of the bacteria in nasal exudates.The differential diagnoses of the RS are syphilis, malignancy and midline granuloma. Streptomycin is drugof choice, although fluoroquinolones and cephalosporin also provide good results. Surgery is opted in caseof obstruction or deformity. Here, we reported a case of 11-year girl diagnosed as RS on the basis of thehistopathological examination. This case was treated by endoscopic removal of the mass in the nasal cavityfollowed by a course of ciprofloxacin. She was found asymptomatic at the last visit of 1 year after treatmentand there was no evidence of recurrence.

Correlation Between Nasal and Laryngeal Lesions of Rhinoscleroma in Patients of Upper Egypt

Rhinoscleroma (RS) is a chronic granulomatous disease of URT caused by Klebsiella Rinoescleromatis. RS is considered endemic in Egypt. The nasal mucosa represents the primary region of occurrence. The disease can potentially spread to involve the larynx and trachea causing dysphonia, stridor, and airway obstruction. To describe various nasal and laryngeal presentations of RS in our endemic area, to correlate between these findings and to alert physicians to suspect RS in any case of unexplained nasal or laryngeal lesion. The study included 100 patients admitted in our otorhinolaryngolgy department (Minia University, Minia, Egypt). Patients presented with various manifestations of Rhino-pharyngo-laryngo scleroma. Diagnosis based on clinical, bacteriological, and pathological examination. Patients had typical nasal stages of RS, however; only 12 % of patients had the typical described laryngeal presentations (ie, subglottic narrowing and subglottic membrane). Other patients presented with atypical laryngeal presentations (eg, unhealthy vocal folds, ventricular fold hypertrophy, and suproglottic sticky greenish discharge). There was significant correlation between nasal stages and laryngeal lesions. RS can present with atypical laryngeal presentations in endemic areas which should be kept in mind to avoid misdiagnosis. Possible laryngeal lesions of RS can be predicted from observing associated nasal lesions.

Rhinoscleroma in a Pediatric Patient

Rhinoscleroma (RS) is a chronic granulomatous disease caused by Klebsiella rhinoscleromatis. The nose is affected in all cases but sometimes extend to other parts of the airways. Diagnosis of this disease is done on the basis of the histopathological examination (HPE) or direct evidence of the bacteria in nasal exudates. The differential diagnoses of the RS are syphilis, malignancy, and midline granuloma. Streptomycin is a drug of choice although fluoroquinolones and cephalosporins also provide good results. Surgery is opted in case of obstruction or deformity. Here, we report a case of an 11-year-old girl diagnosed as RS on the basis of the HPE. The patient was treated by endoscopic excision of the nasal mass followed a course of ciprofloxacin. She was remained asymptomatic at the last visit of 1 year after treatment and has no evidence of recurrence.

Rhinoscleroma: a diagnosis not to be ignored

Rhinoscleroma: a diagnosis not to be ignored

Seemingly neoplastic destructive lesion of maxillary sinus, eroding the bone and extending into skull base- Atypical Rhinoscleromaor Antroscleroma

Rhinoscleroma (RS) is a chronic granulomatous infectious disease predominantly affecting the nose and upper respiratory tract caused by Klebsiella rhinoscleromatis (KR), a gram negative diplobacillus. In India, it is prevalent in Northern and central parts. Belinov, in 1932 proposed the term “scleromarespiratorium” as the disease process may involve not only the upper, but also lower respiratory pathways. A 35 year old male from South India, presented with mass in the right maxillary and ethmoid sinuses eroding the bone, extending into infratemporal fossa and skull base, clinically mimicking malignancy. Histopathological examination confirmed rhinoscleroma. Nasal cavity free, isolated ipsilateral involvement of sinusesmakes this case interesting and one among the few case reports reported in the past. Rhinoscleroma should be differentiated from other granulomatous conditions and neoplastic diseases like lymphoma & Sinonasal carcinoma. Correct diagnosis is very crucial as sinus-positive cases are linked with antibiotic resistance and early recurrence after medical treatment.

Assessment of serum iron and zinc levels in rhinoscleroma patients

Objective This study aimed to determine the relation of serum levels of iron and zinc trace elements during the course of rhinoscleroma and stage of disease. Background Several risk factors have been associated with rhinoscleroma such as poor hygiene and nutritional deficiencies. Therefore, iron and zinc deficiencies may be predisposing factors to the disease or may be a sequel of the disease as they are essential for cell-mediated immunity, which affects the pathophysiology of the disease. Patients and methods Seventy-eight participants (39 cases diagnosed with rhinoscleroma and 39 controls) were enrolled into the study. Patients were subjected to nasal biopsy and a histopathological examination to diagnose rhinoscleroma, and laboratory assessments of serum levels of iron and zinc to determine the changes in serum levels of iron and zinc in patients diagnosed with rhinoscleroma. Results There was a significant decrease in the serum level of iron in the case group compared with the control group (P = 0.00) and a significant decrease in the serum level of zinc in the case group compared with the control group (P = 0.00). Also, there was a significant decrease in the serum levels of iron and zinc in the late-stage cases. Conclusion Serum levels of iron and zinc were significantly lower in patients diagnosed with rhinoscleroma than controls, reflecting the crucial role of iron and zinc in cell-mediated immunity in such patients.

Clinical outcomes of subcutaneous multiple inflammation and calluses induced by facial injection lipolysis

Objective To explore the treatment protocols and the occurrence and developmental rule of subcutaneous multiple inflammation and indurations by facial injection lipolysis, and to summarize the treatment experience. Methods Six cases of subcutaneous indurations were females patients with facial injection lipolysis, and the lesions increased slowly after about one month. The local temperature raised and pinching pain appeared in the facial area. The other secondary post-traumatic swelling and scleroma areas were treated with piercing or cutting, spread to the surrounding tissues. Red scleroma became osmosis, by local open decompression, debridement, irrigation and drainage lasting almost 3 months. The area had burst out mucoid funicular materials gradually. Results The facial injection lipolysis caused regionally red swelling and scleroma gradually with 1 month of continuous irrigation drainage. The red scleroma area was limited with debridement again after maturation, closed incision after discharge mucus-shape substance by its organization. In the redness induration period, pathological results showed the homogeneous materials without structure could be seen in the fibrous tissue, with surrounding hyperemia, hemorrhage associated with inflammation. Festering burst period showed that local tissue presented suppurative inflammation, multiple abscesses and granuloma formation. Conclusions Conservative treatment can lead to swelling, bursting and developing into deep tissues. Surgical treatment can spread redness scleroma area and lead to a large area of skin depression, soft tissue scar and deformity. Key words: Injection lipolysis; Induratum; Suppuration; Complications

Role of Histopathology in Differentiating Primary Atrophic Rhinitis from Atrophic Stage of Rhinoscleroma.

Atrophic rhinitis (AR) is a chronic debilitating nasal mucosal disease of unknown aetiology and the definitive treatment is still elusive. This often leads to the patient suffering during the entire life span often depleting the individual psychologically. On the contrary, Rhinoscleroma (RS) for which the aetiology is clearly known and is completely curable has atrophic stage which is clinically indistinguishable from AR. Many cases of atrophic stage of RS are undetected and often they end up being treated as AR. This study was conducted to know the role of histopathology and other factors in differentiating AR and Atrophic stage of RS, which can significantly alter the course of treatment and outcome. Forty-five cases of clinically diagnosed AR were included in the study. Punch biopsy of nasal mucosa was obtained from the anterior end of inferior turbinate. Core culture was performed on one sample and histopathological examination for the other sample. Among the 45 patients, 38 (84.44%) of cases were diagnosed to be AR and 7 (15.56%) cases were diagnosed to be RS by histopathology. Core culture of RS subjects showed positive culture for Klebsiella rhinoscleromatis in five subjects (71%). To conclude, AR cases should be confirmed by histopathological examination to rule out RS, for effective management and to prevent complications.

Effects of the rapid decompression on intervention tourniquet on line via radial artery path of coronary artery

Objective To investigate the effect of the rapid decompression on intervention (TRI) of the TR Band tourniquet on line via radial artery path of coronary artery. Methods 270 postoperative patients with TRI were divided into A, B, C groups according to random number table. TR Band hemostat inflated 17 ml, group A deflated once every 30 min, group B deflated once every 1 hour, group C deflated once every 2 hours, inflated 2 ml each time, each group was deflated 6 times and removed oppression after 12 hours. The differences of postoperative bleeding, the local complications and comfort were observed 24 hours after surgery. Results The difference of patients with postoperative hemorrhage, degree of numbness among three groups was not statistical significant (χ2=0.25-0.78, P > 0.05). Difference of incidence on local fiber scleroma, palm and forearm swelling degree, pain intensity was statistical significant (χ2 =6.35, 7.70, 12.16, P < 0.05). Conclusions TRI rapid decompression does not increase the risk of bleeding in postoperative patients, which not only can reduce fiber scleroma local complications, still can improve the comfort. Key words: Radial artery; Intervention therapy; Oppression; TR Band

Clinical effect of penile lengthening and augmentation with autologous granular fat graft on short penis

Objective To evaluate the effectiveness and safety of autologous granular fat graft applied for penile lengthening and augmentation. Methods After all the superficial ligment and 1/3-2/3 part of the deep suspensory-ligament had been cut off for penile lengthening, local pedicaled fascia-adipose flap was designed to fill the depression, the pre-centrifuged autologous granular fat was injected into the space beneath Buck's fascia for penile augmentation. Normal length, pulling penis length, diameter, circumference and complications were evaluated. Results 34 cases were performed and followed up for 3-18 months, both ideal length and diameter increase of penis were achieved. The differences of nomal length, pulling-length, the diameter and circumference were (2.8±0.1) cm, (2.1±0.2) cm, (0.9±0.1) cm, (2.8±0.1) cm, respectively. The common complications included poor wound healing in 4 cases, preputial edema and subcutaneous scleroma in 8 cases for 3 months. Conclusions Autologous granular fat graft for penile augmentation during the lengthening surgery is a reliable and effective method and easy procedure. Detail processing can decrease the complications. Key words: Penile lengthening; Penile augmentation; Fat particles, autologous; Fat fascia flap

Comparison of different injection sites effects for recombinant human interleukin

Objective To explore the efficacy and side effects of recombinant human interleukin by adopting abdominal subcutaneous injection method and the traditional deltoid subcutaneous injection method. Methods A total of 106 patients were admitted to either intervention group or control group by course of treatment. The patient of control group (5-8 course of treatment) adopted traditional deltoid injection method and the intervention group (1-4 course of treatment) received abdominal injection method (1 times a day and 14 days per course of treatment). Then we observed the incidence of pain and local adverse reactions in patients with injection sites. Results In the intervention group patients was 22.6% in the incidence of moderate to severe pain, and 14.2% subcutaneous scleroma rate, 18.9% local redness and swelling occurred rate, that all were lower than those of the control group (χ2=2.80, 4.71, 5.22; P<0.05). Conclusions The implementation of abdominal subcutaneous injection can reduce the patient′s pain, promote successful completion of treatment and deserve further clinical dissemination. Key words: Recombinant human interleukin; Subcutaneous injection; Pain; Adverse reaction

Facial cosmetic zonation and its application of adipose injection for facial juvenescence

Objective To study the facial cosmetic zonation and its application of adipose injection for facial juvenescence. Methods According to standard of aesthetics, we divided total face into ten cosmetic units and 49 cosmetic sub-units. 23 patients, injected adipose for facial juvenescence, were evaluated. Results 149 cosmetic units from 23 patients were injected with adipose granules, and involved 300 sub-units. Each unit was injected with adipose from 1 to 35 ml. After injection, the faces showed swelling in varying degrees, which resolved from ten to fourteen days. Local ecchymosis occurred in 11 cases, and resolved from five to twenty days. No any complication appeared, such as infection, scleroma and vascular embolism and so on. The follow-up results showed that one month later post-operation, swelling on injective sites resolved, and appearances were stable. 3-6 months later post-operation, the injective sites were fuller. One year later, the good juvenescence effect achieved, and the patients felt satisfactory. Conclusions On the basis of facial cosmetic zonation, the whole cosmetic evaluation combined with local cosmetic evaluation might be helpful to carry out adipose injection for facial juvenescence, and reach a satisfactory result. Key words: Face; Cosmetic zonation; Cosmetic evaluation; Adipose transplantation; Facial juvenescence

Nursing of insulin pump therapy for type 2 diabetes

objective To investigate the efficacy of comprehensive nursing care for the patients with type 2 diabetes taking insulin pump therapy.Method Before,during,and after the insulin pump therapy for 64 patients with type 2 diabetes,comprehensive nursing care was carried on them.Improvement of blood glucose,low blood glucose,and adverse reactions,such as red scleroma around the puncture point,were observed.Results After being treated by insulin pump therapy and comprehensive nursing care,the patients' blood glucose was obviously better.There were statistical differences in fasting and postprandial 2 hours blood glucose before and after the treatment (P ＜ 0.05 or P ＜ 0.01).The incidences of low blood glucose and red scleroma around the puncture point were low.Conclusion If insulin pump is correctly used and the nursing staff have good command of the professional skill and a solid theoretical foundation,the blood glucose of the patients with type 2 diabetes can be stably controlled and the incidences of adverse reactions can be lowered. Key words: Insulin pump; Type 2 diabetes mellitus; Comprehensive nursing care

Rosai-Dorfraan disease in nasal cavity：two case reports and literature review

Objective To study the clinical manifestations, pathological features and differential diagnosis of extranodal Rosai-Dorfman disease （RDD） in nasal cavity. Methods The clinical, pathologic, immunohistochemical and special staining features of 2 cases of RDD were evaluated and related literatures were reviewed. Results Extranodal RDD in nasal cavity and various degrees of stromal fibrosis were seen association with mixed inflammatory cells （especially plasma cells）.The large polygonal histiocytes varied in number and were distributed in clusters or patches. Conclusion Extranodal RDD of nasal cavity is relatively rare and pathologic diagnosis may be difficult. It can easily mimic rhinoscleroma, hyperplasia of langerhans cells, granulomatous inflammation and fibrous tumors. Immunohistochemical and histochemical study is helpful in the differential diagnosis. Key words: Rosai-Dorfman disease; Nasal cavity; Histiocytosis; Immunohistochemistry; Differentialdiagnosis

Application of autologous fat granules graft in improving facial appearance

Objective To explore the methods and effects of improving facial appearance on volume defect and aging,and recovery of aesthetic looks by autologous fat granules graft.Methods We designed the filling areas according to gender,age,individual face characteristics and desire of the case before operation.By liposuction technology with low pressure from the trunk,fats were taken with cleaning and purifying.Then pure fats were injected to the marked areas of the face by multi-level and multi-tunnel injection.It was able to supply the facial volume for lost soft tissue,to improve the aging appearance and to achieve smooth facial contour.Results All cases were followed-up for 3 months to 2 years,facial appearances were satisfied or improved,without fat liquefaction,infection,scleroma and other complications.Only a few cases needed complementary transplantation.The overall results were satisfactory.Conclusions Autologous fat granules graft is a safe and effective facial soft tissue filling technology.It can effectively improve facial aging appearance,restore natural,young and beautiful looks,and be worth for clinical application. Key words: Fat granules; Graft; Face

Effect of two posture fixing in pediatric muscle injection

Objective To discuss the posture of fixing method to reduce the rate of amyxis,subcutaneous scleroma,olisthy needles,subcutaneous passive congestion and spill solution in pediatric muscle injection,so as to prevent and reduce accident injuries and complications.Methods Totals of 800 children within the age of 1 to 7 were randomly divided into the experimental group and the control group,each with 400 cases.The experimental group used embracing posture fixing while the control group used lateral recumbent posture fixing.Two groups' rates of amyxis,subcutaneous scleroma,olisthy needles,subcutaneous passive congestion and spill solution were compared.Results There were 2 cases of amyxis,0 cases of subcutaneous scleroma,1 case of otisthy needles,2 cases of subcutaneous passive congestion and l case of spill solution in the experimental group,while there were 11 cases of amyxis,7 cases of subcutaneous scleroma,9 cases of olisthy needles,11 cases of subcutaneous passive congestion and 9 cases of spill solution in the control group,and the differences were statistically significant (x2 =5.811,5.905,5.712,5.811,5.712,respectively; P ＜ 0.05).Conclusions Embracing posture has better fixing effect than traditional lateral recumbent posture in pediatric muscle injection. Key words: Children ; Posture; Muscle injection ; Fixing

Application of centipede oil with hydrocolloid paste in high-risk drugs extravasation

Objective To explore the effects and clinical nursing of combination of centipede oil with hydrocolloid paste in high-risk drug extravasation.Methods 90 patients with high-risk drug extravasation were randomly divided into control group 1,control group 2 and experimental group.Control groups 1 and 2 received centipede oil only and hydrocolloid paste only respectively.The experimental group was given both centipede oil and hydrocolloid paste.The medicine in each group was all applied to sore,blister,scleroma,erythema and hematoma parts of the patients.The effects of the treatment were compared.Results No significant difference was found between control group 1 and control group 2 (P ＞ 0.05).However,the effectiveness of experimental group was 96.7％ and was significantly higher than that of control groups 1 (73.3％) and 2 (70.0％),the differences were statistically significant (x2 =6.41,7.68,respectively; P ＜ 0.05).Conclusions Combination of centipede oil with hydrocolloid paste in high-risk drugs extravasation treatment was effective for tissue repair. Key words: Treatment results; Centipede oil; Hydrocolloid ; High-risk drugs; Extravasation