The three cases of fetid ozena from two Africans and a Saudi Arabian immigrant reported from Minnesota by Yelenich-Huss and others1 reminded me of polymicrobial sinus infections among leprosy patients seen in Carville, LA, in the 1980s. Klebsiella pneumoniae ozaenae grew mostly as a commensal from the upper respiratory tract of lepromatous leprosy patients with rhinorrhea.2 Klebsiella pneumoniae ozaenae was found among 16 of 40 or 40% of all Klebsiella bacterial isolates from the Gillis Long National Hansen's Disease Center, Carville, LA, in 1980. Carville's leprosy patients then were mostly from North, Central, and South America, Hawaii, or southeast Asia. Among U.S. bloodstream infections reported in 1981 with K. pneumoniae ozaenae septicemia and underlying leprosy or Mycobacterium leprae infection, Case 2 was a 16-year-old teenage survivor born in the Philippines in 1964.2 I suspect today that K. pneumoniae ozaenae is a ubiquitous, potentially invasive pathogen present among polymicrobial sinus infections on all continents, including North America.3 The Klebsiella strain invades the upper respiratory tract of susceptible human hosts around the world. Indeed, among refractory cases of ozena, might one consider adding acid-fast smears to routine nasopharyngeal microbiology evaluations to rule out coinfection with M. leprae? Purulent smear-positive, culture-negative acid-fast sinus specimens might prompt acid-fast skin snips or biopsies of the earlobes to exclude early, subclinical lepromatous leprosy.
Yelenich-Huss MJ, Boyer H, Alpern JD, Stauffer WM, Schmidt D, 2016. Case report: ozena in immigrants of differing backgrounds. Am J Trop Med Hyg 95: 35–37.
Murray KA, Clements BH, Keas SE, 1981. Klebsiella ozaenae septicemia associated with Hansen's disease. J Clin Microbiol 14: 703–705.
Goldstein EJC, Lewis RP, Martin WJ, Edelstein PH, 1978. Infections caused by Klebsiella ozaenae: a changing disease spectrum. J Clin Microbiol 8: 413–418.