tetracycline and Rhinoscleroma

Dyspnea is a fairly common complaint during pregnancy. However, if one excludes allergic nasal congestion of pregnancy, upper airway obstruction is a distinctly uncommon cause of dyspnea in the pregnant patient. Three cases of laryngeal rhinoscleroma in pregnant women requiring tracheostomy for airway management are reported. All three delivered healthy infants vaginally. Postpartum, two of the three were successfully decannulated, while the third became pregnant again before decannulation was accomplished. Treatment options and a review of the literature are presented.

Topics: Adolescent; Adult; Airway Obstruction; Combined Modality Therapy; Female; Humans; Infant, Newborn; Laryngeal Diseases; Pregnancy; Pregnancy Complications; Rhinoscleroma; Tetracycline; Tracheostomy

Topics: Adolescent; Adult; Age Distribution; Biopsy, Needle; Female; Humans; Immunohistochemistry; Incidence; Klebsiella pneumoniae; Male; Prognosis; Rhinoscleroma; Risk Factors; Severity of Illness Index; Sex Distribution; Tetracycline

Topics: Adult; Anti-Bacterial Agents; Biopsy; Drug Therapy, Combination; Endoscopy; Female; Humans; Lymph Node Excision; Lymphadenitis; Nasal Obstruction; Rhinoscleroma; Streptomycin; Tetracycline; Tomography, X-Ray Computed

Rhinoscleroma is a rare, chronic granulomatous disease of infective causation. It usually begins in the nose and may progress to involve the larynx and trachea and cause dysphonia, stridor, and airway obstruction. Early rhinoscleroma is usually successfully treated with oral tetracycline, yet laryngotracheal disease may require operative intervention. The disease is rare in the United States, but with an increase in immigration from endemic areas, otolaryngologists should be familiar with the management of this rare disease. Current literature contains only a few reports describing the manifestations of this disease, mostly in the form of case studies. This study is a retrospective review of our institutional experience with the management of 22 patients with rhinoscleroma, 13 of whom had laryngotracheal involvement. The focus of this report is on the clinical manifestations of laryngotracheal scleroma. All of the patients were treated with long-term antibiotics. Nine patients underwent endoscopy with or without dilation and laser excision. Three patients required emergency tracheostomy, all of whom were ultimately decannulated without any sequelae. A rational approach to management of this unusual disease is provided.

Topics: Adult; Aged; Ampicillin; Anti-Bacterial Agents; Drug Therapy, Combination; Dyspnea; Female; Humans; Klebsiella pneumoniae; Larynx; Male; Middle Aged; Retrospective Studies; Rhinoscleroma; Steroids; Tetracycline; Trachea; Tracheostomy; Voice Disorders

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.

Topics: Adolescent; Humans; Immunoenzyme Techniques; Laryngeal Diseases; Male; Rhinoscleroma; Tetracycline

Rhinoscleroma is a chronic granulomatous disease of the respiratory tract endemic to Eastern Europe and Central America which is being recognized with increasing frequency in other countries, including the United States. It was initially described as a lesion of the nose and upper respiratory tract, but is now known to involve the larynx, trachea and bronchi as well to cause slowly progressive asphyxia. Eleven cases of rhinoscleroma with varying degrees of involvement of the lower respiratory tract (larynx, trachea and bronchi) are presented. Present day treatment is both medical, consisting primarily of streptomycin and tetracycline, and endoscopic dilatation. Prolonged medication with careful dose control is necessary. Lower respiratory tract involvement should be considered in patients with chronic destructive granulomatous nasal pathology. This should be especially emphasized if they have an Eastern European or Central American background, or have travelled in these areas in which rhinoscleroma is endemic.

Topics: Adult; Europe; Female; Humans; Klebsiella Infections; Klebsiella pneumoniae; Laryngitis; Male; Mexico; Middle Aged; Pharyngitis; Recurrence; Rhinitis; Rhinoscleroma; Streptomycin; Tetracycline; Time Factors; United States

Rhinoscleroma may present a diagnostic problem when encountered outside endemic region. Two young men from Gaza with tumor-like masses of scleroma in the nasal cavities and the nasopharynx are described. Histological examination of biopsy material from the nasal lesions showed pathognomonic Mikulicz cells, and cultures grew Klebsiella rhinoscleromatis. Both patients responded well to antibiotic treatment.

Topics: Adult; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Respiratory Tract Infections; Rhinoscleroma; Streptomycin; Sulfamethoxazole; Tetracycline; Trimethoprim

This investigation showed that the organism klebsiella rhinoscleromatis was present consistently in our cases. It was found to be difficult to eradicate completely although seemingly sensitive to common antibiotics in vitro. A prolonged treatment with bactericidal antibiotics is therefore necessary to eradicate it. Nasal dilatation rather than excision of granulations is required to restore nearly-normal physiological nasal function. Excision or cautery of granulations inside the nose is discouraged so as to avoid atropic changes.

Topics: Ampicillin; Anti-Bacterial Agents; Chloramphenicol; Dilatation; Humans; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Rhinoscleroma; Streptomycin; Tetracycline; Uganda

Topics: Adult; Egypt; Humans; Klebsiella; Male; Netherlands; Rhinoscleroma; Streptomycin; Tetracycline

Topics: Adrenal Cortex Hormones; Ascorbic Acid; Biopsy; Child; Humans; Male; Nasal Mucosa; Plasma Cells; Rhinoscleroma; Streptomycin; Tetracycline

Topics: Adult; Dexamethasone; Ethmoid Sinus; Humans; Male; Maxillary Sinus; Neoplasm Recurrence, Local; Radiography; Rhinoscleroma; Tetracycline

Topics: Adolescent; Anti-Bacterial Agents; Chloramphenicol; Humans; India; Klebsiella; Oxytetracycline; Penicillins; Rhinitis; Rhinitis, Atrophic; Rhinoscleroma; Streptomycin; Tetracycline

Topics: Adrenocorticotropic Hormone; Anti-Bacterial Agents; Argentina; Epidemiology; Humans; Larynx; Nose; Pathology; Prognosis; Protein Synthesis Inhibitors; Rhinoscleroma; Streptomycin; Tetracycline; Toxicology