Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Beijing, China.
J Otolaryngol Head Neck Surg. 2011 Apr;40(2):167-74.
Rhinoscleroma, a chronic granulomatous bacterial disease of the nasal mucosa that often extends through the lower respiratory tract, is caused by infection with the gram-negative bacillus Klebsiella rhinoscleromatis (KR). We report the clinicopathology and histology associated with KR infection-induced rhinoscleroma in patients admitted to the Beijing Tongren Hospital over a 30-year period.
The clinical and pathologic features of 40 cases of upper aerodigestive tract infections were retrospectively studied. Histochemical examination of biopsy samples was performed, including periodic acid-Schiff, modified Warthin-Starry, and acid-fast stains. In addition, immunohistochemical staining for CD43, CD20, CD68, and lysozymes was performed in 11 specimens, and 8 specimens were analyzed by transmission electron microscopy.
KR infection was confirmed in each of the 40 samples. Twenty-seven patients remained relapse free 1 to 10 years following treatment with antibiotic supplemented in some cases with surgery or radiotherapy, and all 13 cases of relapse were successfully eradicated by the end of treatment. KR infection was localized to phagosomes within Mikulicz cells, as determined by immunohistochemistry and electron microscopy. Significant tissue injury was observed in most cases.
Long-term antibiotic therapy successfully eradicated KR infection in all cases. Although late diagnosis was common in this cohort, retrospective examination of biopsy samples suggests that diagnosis can be improved by combining clinical findings with histologic analysis.
鼻硬结杆菌（KR）引起的硬结病是一种慢性肉芽肿性细菌疾病，常累及下呼吸道，导致鼻黏膜感染。本研究报告了 30 年来北京同仁医院收治的硬结病患者的临床病理和组织学特征。
回顾性研究了 40 例上呼吸道感染患者的临床和病理特征。对活检样本进行了组织化学检查，包括过碘酸雪夫、改良华-斯特利染色和抗酸染色。此外，对 11 例标本进行了 CD43、CD20、CD68 和溶菌酶的免疫组织化学染色，8 例标本进行了透射电镜分析。
在 40 例样本中均证实了 KR 感染。27 例患者在接受抗生素治疗后 1 至 10 年无复发，部分患者联合手术或放疗，13 例复发患者均在治疗结束时成功根除。免疫组织化学和电镜检查显示，KR 感染定位于巨噬细胞内的吞噬体。大多数病例均观察到明显的组织损伤。
长期抗生素治疗成功根除了所有病例的 KR 感染。尽管本队列中晚期诊断较为常见，但对活检样本的回顾性检查表明，通过将临床发现与组织学分析相结合，可以提高诊断水平。
