Gaafar Hazem A, Gaafar Alaa H, Nour Yasser A
Department of Otolaryngology, Alexandria Faculty of Medicine, Alexandria University, Egypt.
Acta Otolaryngol. 2011 Apr;131(4):440-6. doi: 10.3109/00016489.2010.539264. Epub 2011 Jan 3.
Rhinoscleroma is a chronic, specific, granuloma of the nose and other parts of the respiratory system. The disease is endemic in Egypt and many other countries. The causative organism is Klebsiella rhinoscleromatis bacillus, proved by fulfilling Koch's postulates. The mode of infection is not known and its worldwide irregular geographical distribution is not understood. Lines of treatment are unsatisfactory and a tendency for recurrence is the rule.
Our aim was to study the clinical presentation, microbiology, pathological staging, follow-up, and lines of treatment of new rhinoscleroma patients admitted or seen at Alexandria Main University Hospital from January 1999 until January 2009.
Demographic data and the results of clinical, bacteriological, and histological examinations were reviewed. Medical and surgical treatments were evaluated. Follow-up as regards the results of treatment and incidence of recurrence was assessed.
Fifty-six patients were included in the study. There were 26 males and 30 females, and 85% of patients presented in the third and fourth decades of life. The nose was affected in 100% of patients. Other regions affected were the nasopharynx in 13 patients, palate in 7 patients, skin in 2 patients, larynx in 3 patients, trachea in 17 patients, nasolacrimal duct in 2 patients, and premaxilla in 1 patient. No lymph node affection was reported. Klebsiella rhinoscleromatis strain III was isolated from 100% of patients. Antibiotics used were a combination of trimethoprim-sulfamethoxazole 400 mg and rifampicin 300 mg twice daily for 3 months. Since 2003, this was replaced by ciprofloxacin 500 mg twice daily for 3 months. Surgical procedures performed were removal of nasal granulations, bronchoscopic dilatation, bipolar coagulation of skin lesions, tracheostomy, and repair of pharyngeal stenosis. Results were disappointing, as a large number of patients did not attend for follow-up. A high incidence of recurrence was found, reaching up to 25% within 10 years.
鼻硬结病是一种发生于鼻腔及呼吸系统其他部位的慢性特异性肉芽肿。该病在埃及及许多其他国家呈地方性流行。病原体为鼻硬结克雷伯菌，通过满足科赫法则得以证实。感染方式尚不清楚，其在全球不规则的地理分布也未得到解释。治疗方法并不令人满意，复发倾向是常有的事。
我们的目的是研究1999年1月至2009年1月在亚历山大主大学医院收治或诊治的新发鼻硬结病患者的临床表现、微生物学、病理分期、随访情况及治疗方法。
回顾人口统计学数据以及临床、细菌学和组织学检查结果。对药物和手术治疗进行评估。评估治疗结果及复发率方面的随访情况。
56例患者纳入研究。其中男性26例，女性30例，85%的患者年龄在第三和第四个十年。所有患者的鼻子均受累。其他受累部位包括13例患者的鼻咽部、7例患者的腭部、2例患者的皮肤、3例患者的喉部、17例患者的气管、2例患者的鼻泪管以及1例患者的前上颌骨。未报告有淋巴结受累情况。100%的患者分离出鼻硬结克雷伯菌III型菌株。使用的抗生素为复方新诺明400毫克和利福平300毫克，每日两次，连用3个月。自2003年起，改为环丙沙星500毫克，每日两次，连用3个月。所进行的外科手术包括清除鼻腔肉芽、支气管镜扩张、皮肤病变的双极电凝、气管切开术以及咽部狭窄修复术。结果令人失望，因为大量患者未进行随访。发现复发率很高，10年内高达25%。
