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Published on: September 22, 2023
[An etiological and pathologic study of Rhinoscleroma]
1Department of Pathology, Beijing Tong Ren Hospital, Beijing 100730, China. pc-technician@sohu.com
Objective:
To investigate the clinicopathologic characteristics and mechanism of tissue injury caused by Klebsiella rhinoscleromatis (KR) infection.
Methods:
Thirty-three cases of rhinoscleromas in the nasal and pharyngeal region seen in this hospital from Jan. 1980 to Mar. 2000 were studied retrospectively. Warthin-Starry (W-S) stain was used to study all cases. Five cases were studied further with transmission electron microscope.
Results:
W-S stain revealed a great number of KR in Mikulicz cells within the granuloma. Electron microscopy demonstrated a number of phagosomes in the cytoplasm of Mikulicz cells where many KR were found. A small number of other organelles such as endoplasmic reticulums and lysozymes were squeezed to the side of cells. There were many granular substances on the surface of intracellular bacteria, which were not found on the extracellular KR.
Conclusion:
KR is a facultative intracellular bacteria that is able to resist the digestion of macrophages and to proliferate in them. Formation of granulomas and fibrosis in KR infiltrated regions is the major cause of tissue injury.
Insights
Klebsiella rhinoscleromatis (KR) survives within macrophages, resisting digestion and causing tissue damage through granuloma and fibrosis formation in rhinoscleroma infections.
Area of Science:
- Microbiology
- Pathology
Background:
- Rhinoscleroma is a chronic granulomatous disease affecting the upper respiratory tract.
- Klebsiella rhinoscleromatis (KR) is the causative agent, but its intracellular survival mechanisms remain incompletely understood.
Purpose of the Study:
- To elucidate the clinicopathologic features of Klebsiella rhinoscleromatis infection.
- To investigate the mechanism of tissue injury induced by KR.
Main Methods:
- Retrospective analysis of 33 rhinoscleroma cases from nasal and pharyngeal regions.
- Utilized Warthin-Starry (W-S) stain for bacterial visualization.
- Employed transmission electron microscopy on five selected cases.
Main Results:
- Warthin-Starry stain identified numerous KR within Mikulicz cells in granulomas.
- Electron microscopy revealed KR within phagosomes in Mikulicz cells, with compressed organelles.
- Intracellular KR exhibited granular substances on their surface, unlike extracellular bacteria.
Conclusions:
- Klebsiella rhinoscleromatis functions as a facultative intracellular bacterium, evading macrophage digestion and proliferating intracellularly.
- Tissue injury in rhinoscleroma is primarily driven by granuloma formation and subsequent fibrosis in KR-infected areas.