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Scleroma

A kind of chronic infectious disease of the upper and lower respiratory tract caused by Klebsiella scleroma (Frisch-Volkovich bacillus). The disease is manifested by the formation of specific scleroma infiltrates, localized mainly in places of physiological narrowing of the respiratory tract - the vestibule of the nose, choana, the underlap space of the larynx, bifurcation of the trachea, bronchus (Fig. 2.10.1). That is why it was called by M.V. Volkovich (1888) “scleroma respiratorium”, which extends the original definition of scleroma as “rhinoscleroma” proposed by F. Gebra (1870). Currently, based on modern ideas about this disease as a general infection, it is customary to call it simply scleroma (Myakinnikova M.V., 1994). Scleroma refers to endemic diseases. The most famous and large foci are located in Western Ukraine, Western Belarus, Poland. The spread of scleroma to other regions of the globe is associated with the movement of military contingents, wars and mass migration of the population (Puchkovsky A.M., 1934). There is enough evidence to confirm the contagious nature of scleroma, affecting mainly people in close family contacts. Most often, people living in rural areas suffer from scleroma.

The pathomorphological substrate of scleroma is a granuloma infiltrate, consisting of fibrous connective tissue with a large number of plasma cells and blood vessels. Pathogonic for scleroma are large vacuolated Mikulich cells and hyaline formations in the form of balls (Roussel's body), as well as gram-negative Frisch-Volkovich sticks, which have a narrow yellow capsule, found both in and outside the protoplasm of cells.

Clinic. The incubation period of scleromas is unknown. The disease develops gradually, lasting for years, sometimes decades. It is not accompanied by pain and fever. Scleroma often begins with a prolonged persistent runny nose with thick, viscous discharge. The main complaints of patients are associated with hoarseness, difficulty breathing, shortness of breath, dryness in the nose and throat, and the formation and drying of crusts. Often, when patients breathe, a peculiar sweetish smell can be noted.
Scleroma granulosa infiltrates are usually located symmetrically, do not show a tendency to disintegration and ulceration, but undergo scarring, causing stenosis of individual sections of the respiratory tract (Fig. 2.10.2).

At first, the infiltrate macroscopically represents browning or dark red diffuse growths, covered with epithelium (in anticipation of the nose) or mucous membrane (in other parts of the respiratory tract). On the surface of the mucous membrane of the infiltrate there are fine tuberous formations, erosion occurs. In the section, the foci of compaction have a yellowish-grayish color (according to Mikulich - the color of the old fat).

The diagnosis of the disease is made on the basis of an epidemiological history (patient’s place of residence, contact with scleroma patients), clinical picture, endoscopy data, X-ray examination of the respiratory tract (larynx, trachea, bronchi), as well as histological and serological studies. The most reliable diagnostic method is the Borde-Zhang complement binding reaction with the scleral antigen.

Treatment. Currently, due to the possibility of conducting etiotropic treatment aimed at directly suppressing the causative agent of the disease - Klebsiella scleroma, as well as conducting a wide medical examination of the population of endemic foci, timely revealing scleroma patients, the results of treatment of scleroma can be quite successful.

The main etiotropic drug in the treatment of scleroma is streptomycin. It is administered in doses of 500,000 units 2 times a day. The course of treatment, depending on the form and severity of the disease, lasts from 20 to 80 days. Additionally, other antibiotics can be prescribed (chloramphenicol, tetracycline, oleandomidine). Surgical treatment (biting scleroma infiltrates) is used for respiratory failure caused by narrowing of the lumen of the airways. To reduce the symptoms associated with atrophic processes in the mucous membrane of the nasal cavity and other parts of the respiratory tract, adequate symptomatic treatment is used, which is used for atrophic lesions of the nose, pharynx, larynx, trachea and bronchi.
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Scleroma

  1. Upper respiratory scleroma
    Scleroma, an endemic disease that is prevalent mainly in Western Ukraine, in Western Belarus and its adjacent regions, is rare in Russia. Scleroma refers to chronic diseases in which the mucous membrane of the upper respiratory tract is affected mainly. The disease usually develops at a young age. The causative agent of scleromas is the stick
  2. Ear scleroma
    Ear scleroma is very rare. Scleromic infiltrates are observed in the area of ​​the mouth of the auditory tube, tympanic cavity, and external auditory canal. In their properties, they do not differ from upper respiratory infiltrates.
  3. SCLEROMA UPPER WILD SLOTS (SCLEROMA RESPIRATORIUM)
    Scleroma (a form of the Greek skleroma — infringement) є a chronic specific ignitory catchment of the dichal grooms. All endemic. On the territory of the formerly Bilorus, part of Ukraine, Lithuania and Poland, there are one of the most important scholars. Zagvoryuvannya for the named territorial nature of the nature of the natural-vnishchevy zagvoryuvannya. Scleroma is more important in the marshy
  4. CHRONIC INFLAMMATION. GRANULEMATOSIS. REASONS, MECHANISMS OF DEVELOPMENT. MORPHOGENESIS OF GRANULES. GENERAL CHARACTERISTICS. MORPHOLOGY OF SPECIFIC (TUBERCULOSIS, SYPHILIS, LESCASE, SCLEROMA) AND NON-SPECIFIC GRANULEMATOSIS. SCLEROSIS
    The tissue response to damage is divided into three phases. The initial vascular and exudative manifestations of acute inflammation are replaced by a phase of elimination of the damaging agent, accompanied by an increase in the activity of macrophages. The third and final phase is healing, during which the processes of repair and regeneration of damaged tissue develop. Obviously, complete healing is only possible
  5. INFECTIONS OF GRANULOMI OF THE UPPER WILD SLUTS
    To the group I conquer, I’ve been condemned with the title of "infectious granulomas", to introduce such conquests: scleroma, syphilis, tuberculosis. Until the group, there is also leprosy, Odnak, vrakhovuychi, who are not seized for Ukraine, are not characteristic, I will not go at it. All zvoryuvannya cієї groups ob'єdnuє those that have their morphological substrate є a productive process, which leads to the approval
  6. Specific inflammation
    Specific inflammation is inflammation that is caused by a specific pathogen and is characterized by certain morphological signs that allow us to talk about its etiology. The signs of a specific inflammation include the presence of a certain pathogen, the predominance of productive inflammation, often granulomatous, a change in the course of inflammation of tissue reactions with its wave-like
  7. INFECTIOUS GRANULEMS, VEGENERA DISEASE
    Diseases that are considered granular or granulomatous have a different etiology and pathogenesis. They are united by known pathomorphological signs, manifested by the formation of granulomas. The latter are limited, peculiarly constructed morphological structures - nodules of productive inflammation, consisting of cells of young connective tissue. Most
  8. Test tasks to determine the initial level of knowledge
    Select one or more correct answers. 1. The primary tuberculosis complex includes 1) endoarteritis 2) lymphangiectasia 3) vasculitis 4) osteomyelitis 5) lymphadenitis 2. A HEALED PRIMARY PULMONARY AFFECT IS CALLED: 1) focal lesion 4) focal lesion 4) focal lesion 4) focal lesion Bullet 3. FORM OF HEMATOGENIC TUBERCULOSIS: 1) primary tuberculosis complex 2) chronic
  9. Chronic stenosis of the larynx: causes, therapeutic tactics
    Chronic stenosis occurs as a result of persistent morphological changes in the larynx or neighboring areas. Causes of chronic stenosis: • Chondroperichondritis is traumatic, infectious, radiation; • Impaired mobility of the cricoid joints: • Dysfunction of the lower throat nerves as a result of toxic neuritis, after a stumectomy, with pressure
  10. Productive inflammation of granulomatous diseases
    The following types of productive inflammation are distinguished: 1) interstitial (interstitial inflammation), 2) productive inflammation with the formation of polyps and genital warts, 3) granulomatous inflammation, 4) productive inflammation around foreign bodies and animal parasites. Interstitial (interstitial) inflammation is characterized by the formation of focal or diffuse inflammatory cellular infiltrate in
  11. Tracheobronchoscopy
    The study of the Ibronchus trachea is performed for diagnostic and therapeutic purposes, using the same instruments as when examining the esophagus. Examination of the respiratory tract can be single or multiple. Diagnostic examination of the trachea and bronchi is indicated in case of respiratory dysfunction during neoplasms, the formation of tracheoesophageal fistula, cicatricial stenosis of the trachea, atelectasis (any
  12. CHRONICLE TONZILIT
    Chronic tonsilitis can be specific and non-specific. Specific chronic tonsillitis is an occurrence of migratory infections with granulomas (tuberculosis, syphilis, scleroma). Chronic non-specific tonsilitis є zavoryuvannyam іninfektsіyno-allergic nature with special views in the eye of the eye of the initial ignition reaction of the migdala, which is morphologically violated alteration, that is
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