[Application of enzyme linked immunosorbent assay (ELISA) for diagnosis of antibodies to lipopolysaccharide of Klebsiella rhinoscleromatis in patients with rhinoscleroma]

The ELISA were performed on polystyrene microtiter plates (Nunc, MaxiSorp) coated with LPS (2a antigen) at the final concentration of 10 microg/ml. The antigen was extracted from Klebsiella rhinoscleromatis Rh32 by the trichloroacetic acid and separated by ethanol (Boivin method). The antibodies against the LPS were detected by ELISA in serum samples collected from 65 patients suspected in clinical investigation for rhinoscleroma in Poland from 1970 to 2009. Additionally, the specificity of the antigen was tested using serum sample of immunized rabbit and 30 sera of patients from control group, with high level of antibodies to different bacterial pathogens. All serum samples were diluted 1:100. The concentrations of IgA, IgG and IgM antibodies were expressed as optical density (OD) measured at the wavelength of 450 nm. The cut-off limit of serum antibodies was set at mean antibody OD determined in the sera of 30 blood donors exceeded by three standard deviations. The presence of IgA and IgG antibodies were detected by ELISA in 33 (50,8%) and IgM in 28 (43,1%) of patients. Most of the serum samples (75%) with high level of specific antibodies were obtained from patients before 1980. On the other hand antibodies to K. rhinoscleromatis were detected only in 2 (6,7%) patients from the control group and none of blood donors. In conclusion, our home-made ELISA, based on purified LPS of K. rhinoscleromatis showed high specificity and sensitivity in the diagnosis of antibodies to K. rhinoscleromatis in comparison to the complement fixation test. The presence of high level of specific IgA, IgG and IgM antibodies in the sera obtained in different stages of disease may showed that during the rhinoscleroma is permanent stimulation of antibody production.

Modification of lymphocyte subsets in patients with rhinoscleroma

PURPOSE

Rhinoscleroma is a rare, chronic, granulomatous disorder of the upper airways. This disease presents some etiopathogenetic aspects that are not yet clear. Infection by Klebsiella rhinoscleromatis is fundamental for the onset of the disease, but it is impossible to reproduce rhinoscleroma experimentally only via infection with the bacteria both in man and in animals. Furthermore, this disease mainly affects blood-related people and occurs in certain geographic areas. In this context, we present a study that brings to light some of the quantitative abnormalities of the lymphocyte subsets.

MATERIALS AND METHODS

The study group consisted of 5 patients with rhinoscleroma. The following parameters were studied for each patient: clinical manifestations, histologic examinations, number of leukocytes, lymphocytes, and lymphocyte subsets.

RESULTS

In all patients, we noted the following: There was a relative reduction of the CD4+ cells, an absolute increase of the CD8+ cells, and an inversion of the CD4+/CD8+ ratio. There was an absolute increase of the CD56+ cells and cytotoxic cells that coexpress CD8+CD56+ antigens. There was a relative reduction of the CD3+ cells, and the CD19+ cells tended to show an ambiguous behavioral pattern.

CONCLUSION

We believe that K. rhinoscleromatis does not play a major role in the etiopathogenesis of rhinoscleroma. However, we do believe that the anomalous behavior of the immune system can favor rhinoscleroma.

[Clinicopathologic analysis of rhinoscleroma]

OBJECTIVE

To investigate the clinicopathologic characteristics and reason of tissue injury caused by klebsiella rhinoscleromatis(KR) infection.

METHODS

Twenty-four cases of rhinoscleromas in the nasal and pharyngeal region in this hospital from March 1983 to March 1998 were studied retrospectively. Warthin-Starry (W-S) stain was used in all cases and CD43, CD20, CD68, Lysozyme mark were observed in eleven specimens by ABC immunochemical method. Two cases were studied further with transmission electron microscopy.

RESULTS

A great number of KR were found in Mikulicz cells and were confirmed further in the phagosomes in cytoplasm of Mikulicz cells, where a small number of endoplasmic reticulums and lysozymes was squeezed to the side of cells. A few of T-lymphocytes was found within the granuloma.

CONCLUSION

Cellular immunity function of the patient with rhinoscleroma was depressed and the response to immunization of host which regards to KR was the major cause of tissue injury.

A case of rhinoscleroma cured with ciprofloxacin

The diagnosis of rhinoscleroma was confirmed in a 17-year-old female patient from Tehran, Iran, suffering from a roundish tumour of the nose. Prior treatment with streptomycin and tetracycline had been unsuccessful. A three-month course of high-dose oral ciprofloxacin (750 mg b.i.d.) led to prompt cessation of the growth of the granuloma which was removed later by plastic surgery. Although serology alone appeared to have little value for the specific diagnosis of rhinoscleroma, a significant increase of IgG antibodies during treatment with ciprofloxacin confirmed infection by Klebsiella rhinoscleromatis in this case.

Amyloid-like protein in children with rhinoscleroma

Mucosal specimens from two children with rhinoscleroma have been investigated by light-, fluorescent- and electron microscopy. Amyloid-like protein was found, located not only in the vessel walls but also impregnated in the basic substance of the connective tissue. In this paper the genesis of this protein is discussed, assuming that it could be a result of auto-immune reactions.

Scleroma (Rhinoscleroma). A histologic immunohistochemical study with bacteriologic correlates

Scleroma was diagnosed in nine of 30 Spanish-surnamed patients who had inflammatory lesions of the nose, pharynx, and larynx during the two-year period from Jan 1, 1978, through Dec 31, 1979. A total of 19 biopsy specimens were taken from these nine patients. In six of the 19 specimens, a histologic diagnosis of scleroma was not possible. Seventeen of the specimens with characteristic histologic findings stained with the peroxidase-antiperoxidase method for detection of Klebsiella capsular antigen III, although in 11 of these specimens, simultaneous cultures failed to reveal the characteristic Klebsiella rhinoscleromatis. These specimens showed the features of one of the three histopathologic forms of scleroma: ozena, granuloma, or scleroma. A range of tissue reactions was identified: histiocyte and plasma cell nodules, vasculitis, acute inflammation, pseudoepitheliomatous hyperplasia, ulceration, and submucosal keratin cyst. Comparison with histochemical bacterial stains revealed that the PAS and Hotchkiss-McManus stains gave unequivocal positive results less frequently than the immunoperoxidase method, and were less specific. Methenamine silver, Giemsa, Deiterle, Brown and Brenn, and Brown and Hopps were unreliable for the detection of the organism. The immunoperoxidase method can be appropriately used when the spectrum of histopathologic findings suggests a differential diagnosis of scleroma.

Rhinoscleroma--a diagnostic challenge

Rhinoscleroma is a rare chronic granulomatous infection predominantly affecting the upper respiratory tract. The patient presented here exemplifies several features of the disease, including the fact that diagnosis may elude the clinician for years, and this delay may increase morbidity substantially. The most common initial complaint is nasal obstruction, and physical examination frequently reveals erythematous granular or nodular swellings covered with crusts. Its tumor-like appearance and local spread arouses suspicion of malignancy, but differential diagnosis also includes fungal infections and numerous granulomatous diseases. The classic histopathology consists of large vacuolated Mikuliz's cells and transformed plasma cells with Russell bodies. Numerous antibiotics have been used for treatment of this infection with varying degrees of success. Long-term follow-up is important because these patients can have numerous relapses. Geographic distribution is also discussed.

In situ demonstration of T lymphocyte subsets in granulomatous inflammation: leprosy, rhinoscleroma and sarcoidosis

T lymphocyte subpopulations in frozen tissue sections of four granulomatous conditions (five patients with tuberculoid leprosy, five with lepromatous leprosy, seven with sarcoidosis and four with rhinoscleroma) were studied using monoclonal antibodies and a modified immunoperoxidase technique. Two immunohistological patterns were observed. In tuberculoid leprosy and sarcoidosis, lymphocytes expressing the helper/inducer phenotype were present within the aggregates of mononuclear phagocytes (epithelioid cells); however, cells with the suppressor/cytotoxic phenotype were predominantly in the lymphocytic mantle surrounding each granuloma. In lepromatous leprosy and rhinoscleroma the helper/inducer T cells and suppressor/cytotoxic T cells were both diffusely distributed among the mononuclear phagocytes (histiocytes) without any discernible mantle. The segregation of the helper/inducer and suppressor/cytotoxic phenotypic subsets was associated with an epithelioid cell differentiation of mononuclear phagocytic cells, bacterial elimination and a delayed type hypersensitivity response. The intimate admixture of helper/inducer and suppressor/cytotoxic subsets was associated with undifferentiated mononuclear phagocytes, bacterial proliferation and the absence of a delayed type hypersensitivity response. Thus the different distributions of T cell subpopulations in granulomas may be associated with differences in the host's immune response in several forms of granulomatous reactions.

Clinical update on rhinoscleroma

Rhinoscleroma is recognized more frequently now because of the recent influx of immigrants from endemic Central America. This chronic infectious disease presents with three overlapping clinical stages and can involve any part of the respiratory tract. A review of the clinical presentation leads to a patient evaluation plan consisting of physical examination and radiographic studies. A highly sensitive and specific method is introduced for identification of Klebsiella rhinoscleromatis in the biopsy specimen using the immunoperoxidase technique. A study of the immune status of the patient revealed general immunological competence except in effective phagocytosis of the organism by the Mikulicz cells. The choice of chronic antibiotic therapy should be guided by individual patient consideration with respect to age and sex. Repeat biopsies help determine the duration of antibiotic therapy. Relapses do occur and close observation is the key to long-term follow-up of the patient.

The skin window test in rhinoscleroma

The skin window test was applied to evaluate the state of immunity in patients with rhinoscleroma. The use of the patient's own Klebsiella micro-organisms as antigen led to a negligible change in the percentage of lymphoblasts, whereas the use of foreign Klebsiella micro-organisms as antigen resulted in a pronounced change. This finding indicates an impaired cellular immune response. Application of Klebsiella microorganisms as antigen to normal subjects led to a comparatively high percentage of lymphoblastic transformation. This finding suggests the possible use of a standard Klebsiella antigen as a vaccine. The possible use of the skin window test to identify people with deficient T lymphocyte function is discussed as well as its use in monitoring the efficacy of such a vaccine in influencing the cellular immune response.