(P2) Infect Dis: Rhinoscleroma (the nasal cavity)

Question 1

Name this Slide

1. Classify Bacteria:
2. Name type of Infection:
3. Name type of Disese:
4. Name Pathogen:

Answer 1

• Rhinoscleroma (the nasal cavity)*
  1. (Gram Negative)
  2. chronic infectious
• 3.* granulomatous disease

caused by

4. Klebsiella

rhinoscleromatis

Question 2

Rhinoscleroma (the nasal cavity)

What is the most common site of infection?

Answer 2

The nasal cavity is the most common site of involvement and although lesions may arise in any area of the respiratory airway, the sinuses are rarely affected

Question 3

Rhinoscleroma (the nasal cavity)

name the 3 atrophic stages:

Answer 3

1. catarrhal atrophic stage is characterized by blood streaked mucus or mucopurulent nasal discharge & fetid crusts – does not respond to conventional antibiotics

2. infiltrating or granulomatous stage is characterized by non-specific symptoms such as epistaxis, nasal obstruction and anosmia. During that sate granulomatous nodules may develop

• marked cellular granulation tissue rich in plasma cells, lymphocytes and foamy macrophages

3. Sclerotic stage where nodules are replaced by fibrosis tissue causing nasal stenosis and external deformity

Question 4

Rhinoscleroma (the nasal cavity)

Mirosocpically?

Answer 4

1. Granulomatous and necrotizing lesions
2. Vacuolated histocytes containing the klebsiella rhinoscleromatis (Mikulicz cells) which are Large vacuolated histocytes (macrophages w/clear to foamy cytoplasm) containing phagocytosed bacilli (Mikulicz cells)
3. Plasmocytes w/Russel bodies
   - Degenerated plasmocytes w/eccentric nucleus and deep eosinophilic cytoplasm (Russel bodies)

Question 5

Rhinoscleroma (the nasal cavity)

1. name the most common site:
2. name other sites of infection:
3. What is the visible gothic sign:

Answer 5

1. Nasal cavity (septum) is the most common site
2. paranasal sinuses, orbit, larynx, tracheobronchial tree, middle ear
3. d/t fibrosis on the nose (potato nose)

Rhinoscleroma nodules

Russel bodies

Mikulcz cells

Question 6

Rhinoscleroma (the nasal cavity)

Russel bodies contain are?

Answer 6

Deposits of hyalinized IgG outside the cells

Question 7

Name this slide:

1. Name the white Foam looking cells & describe them :
2. Name the Darker cells with eosinophilic nucleus:
3. Name the pink cells (Dots)

Answer 7

Rhinoscleroma (the nasal cavity)

1. Makulcz Cells- (inflammatory cells) Foamy macrophages w/ clear abundant cytoplasm and small Dark Nucleus

2. Plasma Cells

3. Russel bodies

Question 8

Rhinoscleroma (the nasal cavity)

Stains used for bacteria:

Answer 8

1. PAS
2. Giemsa
3. Gram and Silver Staining

Question 9

Name this slide:

1. name the white foamy cells
2. name the cell with eosinophilic nucleus
3. What bacteria causes this?
4. Where does this infection occur in the body?

Answer 9

Rhinoscleroma (the nasal cavity)

1. Makulicz cells
2. Russell bodies
3. Klebsiella Rhinoscleromatis

Question 10

• name this slide*
  5. Name and describe the 3 stages of this infection?

Answer 10

Rhinoscleroma (the nasal cavity)

1) Catarrhalatropic Stage: blood in mucous or in nasal discharge
2) Granulomatous stage: plasma cells, lymphocytes, foamy macrophage causes inflammatory reaction causing granulomatous nodules
3) Sclerotic stage: nodules are replaced by fibrous titmouse causing external deformity