FergusonJL, McCaffreyTV, KernEB, MartinWJ2nd, 1990. Effect of Klebsiella ozaenae on ciliary activity in vitro: implications in the pathogenesis of atrophic rhinitis. Otolaryngol Head Neck Surg102: 207–211.
FergusonJLMcCaffreyTVKernEBMartinWJ2nd, 1990. Effect of Klebsiella ozaenae on ciliary activity in vitro: implications in the pathogenesis of atrophic rhinitis. Otolaryngol Head Neck Surg102: 207–211.)| false
Ozena, or atrophic rhinitis, is a chronic nasal process seen in Africa, India, and the Middle East. It is marked by the triad of fetid nasal discharge, crusting, and atrophy, and is often associated with Klebsiella infection. We present cases of ozena with nasal Klebsiella in three unrelated patients, including two east African children and one Saudi adult. All three patients grew Klebsiella species in culture and required prolonged treatment with multiple methodologies, including antibiotics, saline rinses, and surgical debridement. They differed greatly in time from presentation to diagnosis, and demonstrated various stages of the disease process. Ozena is rarely seen in the United States, and when it is seen, it is often misdiagnosed. Lack of prompt, adequate treatment can lead to long-term sequelae such as obliteration of nasal architecture, anosmia, sinus and skull base destruction, and social disenfranchisement due to the extreme foul smell of the nasal discharge. Clinicians should maintain a high index of suspicion for primary atrophic rhinitis when presented with its classic symptoms. Culture-directed and prolonged therapy with appropriate follow-up is a necessary component of a successful treatment plan.
* Address correspondence to Jonathan D. Alpern, Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, 420 Delaware Street Southeast, MMC 250 Mayo, Minneapolis, MN 55455. E-mail: email@example.com
Authors' addresses: Mallory J. Yelenich-Huss, Department of Surgery, University of North Dakota, Grand Forks, ND, E-mail: firstname.lastname@example.org. Holly Boyer and Derek Schmidt, Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis, MN, E-mails: email@example.com and firstname.lastname@example.org. Jonathan D. Alpern and William M. Stauffer, Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, E-mails: email@example.com and firstname.lastname@example.org.