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Ozena in Immigrants of Differing Backgrounds

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  • 1 Department of Surgery, University of North Dakota, Grand Forks, North Dakota.
  • | 2 Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota.
  • | 3 Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
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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.

Author Notes

* 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: alper054@umn.edu

Authors' addresses: Mallory J. Yelenich-Huss, Department of Surgery, University of North Dakota, Grand Forks, ND, E-mail: yelen004@umn.edu. Holly Boyer and Derek Schmidt, Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis, MN, E-mails: boyer011@umn.edu and schmi134@umn.edu. Jonathan D. Alpern and William M. Stauffer, Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, E-mails: alper054@umn.edu and stauf005@umn.edu.

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