Rhinoscleroma

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Information about Rhinoscleroma

Published on June 15, 2019

Author: RaafiulZargar

Source: slideshare.net

1. RHIN OSCLE R O M A R A A F I U L B A S H E E R

2. • I N T R O D U C T I O N • I N C I D E N C E • E T I O PAT H O G E N E S I S • C L I N I C A L F E AT U R E S • D I A G N O S I S • T R E AT M E N T TABLE OF CONTENTS OVERVIEW

3. INTRODUCTION • COINED BY:- VON HEBRA IN 1870 DEFINITION • Respiratory scleroma or rhinoscleroma is a progressive granulomatous disease commencing in the nose and later extending into the nasopharynx and oropharynx, the larynx and sometimes the trachea and bronchi. • Respiratory scleroma or rhinoscleroma is a progressive granulomatous disease commencing in the nose and later extending into the nasopharynx and oropharynx, the larynx and sometimes the trachea and bronchi.

4. INCIDENCE

5. INCIDENCE (INDIA)

6. ETIOPATHOGENESIS ETIOLOGY K l e b s i e l l a r h i n o s c l e r o m a t i s • F r i s c h b a c i l l u s • G r a m n e g a t i v e • I n t r a c e l l u l a r

7. RISK FACTORS MULTIFACTORIAL LOW SOCIO ECONOMIC STATUS POOR DOMESTIC HYGIENE OVERCROWDING 1 2 3 4

8. ROUTE OF ENTRY • DROPLET NUCLEI

9. ROUTE OF ENTRY • DROPLET NUCLEI ENTRY INTO MUCOSA • OF OROPHARYNX & LARYNGOPHARYN X

10. ROUTE OF ENTRY • DROPLET NUCLEI ENTRY INTO MUCOSA • OF OROPHARYNX & LARYNGOPHAR YNX INTRACELLULAR SURVIVAL • ENGULFED BY MACROPHAGES • MUCKLICZ CELLS • MUCOPOLYSACC HARIDES SUPPORT INTRACELLULAR SURVIVAL

11. CLINICAL FEATURES • SUBDERMAL INFILTRATION • PROGRESSES THROUGH 4 STAGES- 1. CATARRHAL STAGE 2. ATROPIC STAGE 3. GRANULOMATOUS STAGE 4. CICATRICIAL STAGE STAGE-I RPENTER’S STAGE-II STAGE-III STAGE-IV

12. KEY POINTS STAGES CLINICAL FEATURES CATARRHAL CARPENTERS GLUE ATROPHIC CRUST FORMATION NODULAR HEBRA NOSE CICATRICIAL STENOSIS+FIBROSIS

13. I N V E S T I G A T I O N S • SUBMUCOSA INFILTRATED WITH PLASMA CELLS, LYMPHOCYTES, EOSINOPHILS, MIKULICZ CELLS AND RUSSEL BODIES • MIKCULICZ CELLS (DIAGNOSTIC) • FOAM CELLS • CONTAIN CAUSATIVE ORGANISM • RUSSEL BODIES (DIAGNOSTIC) • FOUND IN PLASMA CELLS • ACCUMULATION OF Ig’s B I O P S Y

14. D I A G N O S I S • BASED ON REACTION OF PATIENT’S SERUM WITH SUSPENSION OF Klebsiella rhinoscleromatis. • HIGH TITRES OF ANTIBODIES AGAINST K. rhinoscleromatis INDICATES INTACT HUMORAL IMMUNITY. C O M P L E M E N T F I X A T I O N T E S T ( L E V I N T E S T )

15. D I A G N O S I S • INTRACRANIAL EXTENSION OF RHINOSCLEROMA INTO ANTERIOR CRANIAL CAVITY VIA DESTRUCTION OF POSTERIOR BONY WALL OF LEFT SPHENOIDAL SINUS C T S C A N

16. D I A G N O S I S • T1-WEIGHTED • NASAL MASS EXTENDING INTO NASOPHARYNX M R I

17. D I A G N O S I S • MUCOID • DOME SHAPED • STICKY • PINK COLOURED • LACTOSE FERMENTING COLONIES C U L T U R E ( M a c C o n k e y A G A R )

18. D I A G N O S I S 1. PAS 2. GIEMSA 3. WARTHIN STARRY SILVER S T A I N S PAS STAIN • INCLUSION BODIES • CONTAIN CAUSATIVE ORGANISM

19. C O M P L I C AT I O N S 1. EXTERNAL NOSE DEFORMITY 2. VESTIBULAR STENOSIS 3. CICATRIZATION OF SOFT PALATE 4. NASAL REGURGITATION 5. TRACHEAL STENOSIS

20. • DISEASE FOLLOWS A PROTRACTED BUT USUALLY SELF LIMITING COURSE • ENDING IN CICATRIZING STAGE • ORGANISM CAN BE EXTREMELY DIFFICULT TO ERRADICATE BY ANTIMICROBIALS • ONCE DIAGNOSIS IS CONFIRMED THE TREATMENT SHOULD BE INTENSE AND PROLONGED • LINES OF TREATMENT 1. ANTIBIOTICS 2. STEROIDS 3. RADIOTHERAPY 4. SURGERY TREATMENT MEDICAL

21. • DRUGS 1. STREPTOMYCIN • I.M 1GM FOR 4-6 WEEKS 2. TETRACYCLINE • 500MG Q.I.D 3. RIFAMPICIN • 400MG FOR 6 WEEKS ORALLY • NASAL INSTILLATION • NASAL INFILTRATIOMN 4. COTRIMOXAZOLE+CIPROFLOXACIN 5. ACRIFLAVIN • 2% LOCALLY • 8 WEEKS B A C T E R I C I D A L A N T I B I O T I C S • LARGE DOSES GIVEN FOR MIN. DURATION OF 4-6 WEEKS • CONTINUED TILL 2 CONSECUTIVE CULTURES FROM BIOPSY MATERIAL ARE PROVEN NEGATIVE

22. • CONTENT 1. CARBOLIC ACID(0.2ML) 2. GLACIAL ACETIC ACID(0.2ML) 3. GLYCERIN(0.4ML) 4. D/W(10ML) • ROUTE • INJECTED LOCALLY • MECHANISM • CHEMICAL NECROSIS OF GRANULOMA • 8-10 INJ. LEADS TO COMPLETE REGRESSION OF GRANULOMAAND RESTORATION OF NORMAL NASAL PATENCY K a l i s a r e g i m e n

23. • DOSE • 3000-3500 GY • DURATION • 3 WEEKS • MECHANISM • DESTROYS SCLEROMA BY RADIATION • CURRENTLY NOT REQUIRED I R R A D I AT I O N

24. • COMBINED WITH ANTIBIOTICS TO REDUCE FIBROSIS I N T R A L E S I O N A L S T E R O I D S

25. • REQUIRED IN 4TH STAGE OF FIBROSIS AND STENOSIS • PLASTIC RECONSTRUCTIVE SURGERY • CARRIED OUT BY LASER AND NASAL ENDOSCOPY • SILASTIC STENT FACILITATES RE- EPITHELISATION • USES • ESTABLISHES AIRWAY • CORRECT THE NASAL DEFORMITY S U R G E R Y

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