A CASE OF OZENA IN A REFUGEE CAMP MIGRANT

Abstract

Ozena is a type of primary atrophic rhinitis caused by the bacterium Klebsiella pneumoniae ssp. ozaenae. A 45-year-old female patient who had migrated from Syria to Türkiye presented with complaints of foul-smelling rhinorrhea and persistent nasal crusting for several years. On examination, abundant yellow-green crusts, enlarged nasal cavities, and atrophic turbinates and mucosa were observed in both nasal passages. Klebsiella pneumoniae ssp. ozaenae was isolated in the nasal tissue culture. The patient was hospitalized and treated with ceftriaxone and metronidazole for two weeks, as these antibiotics were found to be effective based on culture results. Nasal irrigation with physiological saline and glycerin-based moisturizer was recommended. Additionally, daily nasal crust removal was performed using an endoscope. After discharge, the patient was prescribed ceftriaxone 1 g IM twice daily for two weeks. Regular follow-ups were recommended for the recovering patient.We present this case because the condition is relatively unknown and often diagnosed late.

Keywords

• Ozaene
• atrophic rhinitis
• Klebsiella pneumoniae ssp. ozaenae

Mülteci Kampında Yaşayan Bir Göçmende Ozaena Olgusu

Abstract

Ozaena, Klebsiella pneumoniae’nın ozaenae alttürü bakterisinin neden olduğu bir tür primer atrofik rinittir. Suriye'den Türkiye'ye göç eden 45 yaşında bir kadın hasta, birkaç yıldır kötü kokulu burun akıntısı ve kalıcı burun kabuğu şikayetiyle başvurdu. Muayenede, her iki burun pasajında bol miktarda sarı-yeşil kabuklar, genişlemiş burun boşlukları, atrofik konkalar ve mukoza görüldü. Burun doku kültüründe Klebsiella pneumoniae’nın ozaenae alttürü izole edildi. Hasta hastaneye yatırıldı ve kültür sonuçlarına göre bu antibiyotiklerin etkili olduğu görüldüğünden iki hafta boyunca seftriakson ve metronidazol ile tedavi edildi. Fizyolojik tuzlu su ve gliserin bazlı nemlendirici ile burun irrigasyonu önerildi. Ayrıca, bir endoskop kullanılarak günlük burun kabuğu temizliği yapıldı. Taburcu olduktan sonra hastaya iki hafta boyunca günde iki kez 1 g IM seftriakson reçete edildi. İyileşen hastaya düzenli takipler önerildi. Bu vakayı sunuyoruz çünkü durum nispeten bilinmiyor ve genellikle geç teşhis ediliyor.

Keywords

• Ozaena
• atrofik rinit
• Klebsiella pneumoniae’nın ozaenae alt türü

References

1. Maalej F, Chaabouni MA, Ayadi S, Sellami M, Charfeddine I. Therapeutic management of primary atrophic rhinitis (Ozene): About 4 cases. Ear Nose Throat J. 2024;14:1455613241252586.
2. Flint PW, Haughey BH, Lund VJ, et al. Nonallergic rhinitis. Cummings Otolaryngology, 5th edition. Elsevier, 2010:696–697.
3. Yelenich-Huss MJ, Boyer H, Alpern JD, Stauffer WM, Schmidt D. Ozena in immigrants of differing backgrounds. Am J Trop Med Hyg. 2016;95(1):35-37.
4. Awad OGAN, Hasan MM. Topical Mitomycin-C can help as an adjunct to alkaline nasal wash and rifampicin in primary atrophic rhinitis. Am J Otolaryngol. 2019;40(2):137-142.
5. Yuca SA, Yuca K, Kiroglu AF, et al. A forgotten difficult entity: ozena report of 2 cases . E J Med. 2010;15:114–117.
6. Dutt SN, Kameswaran M. The aetiology and management of atrophic rhinitis. J Laryngol Otol. 2005;119(11):843-852.
7. Chhabra N, Houser SM. The diagnosis and management of empty nose syndrome. Otolaryngol Clin North Am. 2009;42(2):311-330
8. Tomooka LT, Murphy C, Davidson TM. Clinical study and literature review of nasal irrigation. Laryngoscope. 2000;110(7):1189-1193.

9. Brown AC, Slocum PC, Putthoff SL, Wallace WE, Foresman BH. Exogenous lipoid pneumonia due to nasal application of petroleum jelly. Chest. 1994;105(3):968-969.
10. Sumaily IA, Hakami NA, Almutairi AD, et al. An Updated review on atrophic rhinitis and empty nose syndrome. Ear Nose Throat J. 2023;1455613231185022.
11. AlJindan R. Epidemiological characteristics of Klebsiella ozaenae infection and its antibiotic susceptibility: Experience of a tertiary care hospital in the Eastern Province of Saudi Arabia. J Family Community Med. 2024;31(2):148-152.