View source for Klebsiella pneumoniae subspecies rhinoscleromatis

{{DISPLAYTITLE:''Klebsiella pneumoniae'' subspecies ''rhinoscleromatis''}}

== Background ==
* Causative organism of '''rhinoscleroma''', a chronic granulomatous disease of nasal and respiratory tract
* Also known as '''respiratory scleroma'''

=== Microbiology ===
* Subspecies of [[Stain::Gram-negative]] [[Shape::bacillus]] within the species [[Species::Klebsiella pneumoniae]]

=== Epidemiology ===
* Not found outside of human hosts
* Primarily found in developing countries worldwide, in particular Mexico, Central America, and the Middle East
* Transmitted by close contact

== Clinical Manifestations ==
* Non-specific early symptoms make it a challenging diagnosis
* Causes chronic inflammation of the nasal pathways and other parts of respiratory tract
* Starts with atrophic stage followed by granulomatous stage and finally fibrotic stage
* By the time it is diagnosed, it is often already quite disfiguring, with airway compromise
* Presents with nodules or masses in the nasal passages or other parts of the naso- or oropharynx or respiratory tract
* Can occasionally erode through bone to cause CNS infections

== Differential Diagnosis ==
* [[Tuberculosis]]
* [[Leprosy]]
* Fungal infections
* [[Granolumatosis with polyangiitis]]
* Malignancy, including less commonly [[T cell lymphoma]] and [[basal cell carcinoma]]
* [[Sarcoidosis]]

== Diagnosis ==
* Biopsy shows granulomatous inflammation with foamy macrophages (known as Mikulicz cells), which contain intracellular bacteria
* Grow in routine culture

== Manageemnt ==
* Treated with 6 to 8 weeks of antibiotics (or longer), with or without surgical debridement, but high relapse rate
* Traditionally treated with [[streptomycin]] or [[tetracycline]]; more recently, may be treated with [[co-trimoxazole]] or [[[fluoroquinolones]]

[[Category:Head and neck infections]]