Scleroma is a chronic infectious disease of the upper respiratory tract. It is characterized by a slow progressive course.
The causative agent is the Frisch-Volkovich wand. Ways and methods of infection have not been established. There are endemic foci in many countries of the world, in the CIS they are in Western Ukraine and Belarus.
The disease is characterized by a slow course, progressing over many years. In the initial stages, dense infiltrates are formed in the form of flat or tuberous elevations, which, as a rule, do not ulcerate, are located mainly in places of physiological narrowing: in the vestibule of the nose, choanae, nasopharynx, subglottic space of the larynx, at the bifurcation of the trachea, at the branches of the bronchi. In a later stage, the infiltrates are scarred, thereby causing a narrowing of the airway lumen and respiratory distress.
Usually, the scleroma captures several segments of the respiratory tract at the same time. Less commonly, the process is localized in one area.
Scleroma of the nose (rhinoscleroma)
Complaints of the patient are reduced mainly to a feeling of dryness and nasal congestion. In connection with atrophy of the mucous membrane, there is a scanty viscous discharge with the formation of crusts, sometimes a cloying smell reminiscent of the smell of rotting fruit. When rhinoscopy in the area of the entrance to the nose, tuberous infiltrates are visible. If they are located in the vestibule of the nose, then the deformation of the external nose begins. The wings of the nose are infiltrated, protruding.
Scleroma of the pharynx
The process traditionally spreads from the nasal cavity through the choanae. The soft palate is mostly affected. Scarring of infiltrates leads to deformation of the soft palate and palatine arches, more often the posterior ones. Sometimes the deformity can lead to an almost complete separation of the nasopharynx and oropharynx. More often these changes are combined with the pathology of the nose and larynx, characteristic of scleroma.
Scleroma of the larynx
Infiltrates are traditionally located symmetrically on both sides in the subglottic space, less often on the vestibular folds, vocal folds, arytenoid cartilages and epiglottis; being subjected to scarring, they often cause a violation of the voice and stenosis of the larynx. The scleroma process can spread to the trachea and bronchi, eventually leading to their stenosis.
To recognize the scleroma process, serological reactions of Wasserman, Bordet-Jangu, histological examination of biopsy material and sputum examination for Frisch-Volkovich sticks are used.
A favorable result is obtained with streptomycin therapy and X-ray therapy. Surgical methods of treatment include bougienage, removal and electrocoagulation of infiltrates.