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Laboratory Diagnosis

Although the patient's clinical appearance may suggest rhinoscleroma, the diagnosis must be confirmed by tissue biopsy. A smear can be made and stained and the characteristic foam cells containing Klebsiella bacilli can be identified within 30 minutes (by Pappenheim's method). The intracellular Klebsiella organisms may be seen in Gram and Giemsa stains, but are more easily identified by the Warthin-Starry silver impregnation method (Fig. 38.2). Also of use in tissue diagnosis is the Brown Hopps tissue gram stain, which can be done in 20 minutes once the sections are prepared. Mikulicz cells and bacilli are most common during the proliferative phase of scleroma, decreasing in frequency as the disease progresses to the cicatricial stage.

An immunoperoxidide technique has been developed to specifically identify the capsular antigen of K. rhinoscleromatis. Antibodies to this antigenic material are specific and may be used for complement fixation and hemagglutination tests. The complement fixation test is more often used in diagnosis, but the Middlebrook-Dubos hemagglutination test is more specific and sensitive, although not widely used.

Fig. 38.2 Numerous Klebsiella rhinoscleromatis bacilli are well demonstrated in material obtained from an intranasal scleromatous lesion, using the Warthin-Starry silver impregnation method. X970. AFIP 75-3118. (From C.H. Binford and D.H. Connor (eds): Pathology of Tropical and Extraordinary Diseases. Armed Forces Institute of Pathology, Washington DC, 1976).

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