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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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