{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T01:46:48Z","timestamp":1777340808041,"version":"3.51.4"},"reference-count":13,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,7,6]]},"abstract":"<jats:p>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 <jats:italic>Klebsiella<\/jats:italic> infection. We present cases of ozena with nasal <jats:italic>Klebsiella<\/jats:italic> in three unrelated patients, including two east African children and one Saudi adult. All three patients grew <jats:italic>Klebsiella<\/jats:italic> 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.<\/jats:p>","DOI":"10.4269\/ajtmh.15-0885","type":"journal-article","created":{"date-parts":[[2016,4,26]],"date-time":"2016-04-26T02:54:25Z","timestamp":1461639265000},"page":"35-37","source":"Crossref","is-referenced-by-count":11,"title":["Ozena in Immigrants of Differing Backgrounds"],"prefix":"10.4269","volume":"95","author":[{"given":"Mallory J.","family":"Yelenich-Huss","sequence":"first","affiliation":[{"name":"Department of Surgery, University of North Dakota, Grand Forks, North Dakota."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Holly","family":"Boyer","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan D.","family":"Alpern","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William M.","family":"Stauffer","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derek","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"ref1","series-title":"Curr Opin Allergy Clin Immunol","first-page":"1","article-title":"Atrophic rhinosinusitis: progress toward explanation of an unsolved medical mystery","volume":"11","author":"deShazo","year":"2011"},{"key":"ref2","series-title":"Am J Rhinol","first-page":"355","article-title":"Atrophic rhinitis: a review of 242 cases","volume":"15","author":"Moore","year":"2001"},{"key":"ref3","series-title":"BMJ Case Rep","article-title":"A report of a rare case of Klebsiella ozaenae causing atrophic rhinitis in the UK","author":"Lee","year":"2011"},{"key":"ref4","series-title":"Cummings Otolaryngology","first-page":"696","article-title":"Nonallergic rhinitis","author":"Flint","year":"2010"},{"key":"ref5","series-title":"Indian J Otolaryngol Head Neck Surg","first-page":"21","article-title":"Study of histopathological changes in atrophic rhinitis","volume":"51","author":"Singh","year":"1999"},{"key":"ref6","series-title":"Otolaryngol Head Neck Surg","first-page":"207","article-title":"Effect of Klebsiella ozaenae on ciliary activity in vitro: implications in the pathogenesis of atrophic rhinitis","volume":"102","author":"Ferguson","year":"1990"},{"key":"ref7","series-title":"ISRN Otolaryngol","first-page":"269479","article-title":"Study of histopathological changes in primary atrophic rhinitis","volume":"2011","author":"Bist","year":"2011"},{"key":"ref8","series-title":"Otolaryngol Head Neck Surg","first-page":"S1","article-title":"Clinical practice guideline: adult sinusitis","volume":"137","author":"Rosenfeld","year":"2007"},{"key":"ref9","series-title":"Lancet","first-page":"147","article-title":"Noma (cancrum oris)","volume":"368","author":"Enwonwu","year":"2006"},{"key":"ref10","series-title":"J Am Acad Dermatol","first-page":"911","article-title":"Cutaneous and mucocutaneous leishmaniasis: differential diagnosis, diagnosis, histopathology, and management","volume":"73","author":"Handler","year":"2015"},{"key":"ref11","series-title":"Rhinology","first-page":"338","article-title":"Rhinoscleroma of the sinuses","volume":"46","author":"Bailhache","year":"2008"},{"key":"ref12","series-title":"Acta Otorrinolaringol Esp","first-page":"160","article-title":"Rhinoscleroma [in Spanish]","volume":"61","author":"Navazo Eguia","year":"2010"},{"key":"ref13","series-title":"Cochrane Database Syst Rev","first-page":"CD008280","article-title":"Interventions for atrophic rhinitis","volume":"2","author":"Mishra","year":"2012"}],"container-title":["The American Society of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/95\/1\/article-p35.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/95\/1\/article-p35.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/95\/1\/article-p35.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T22:02:19Z","timestamp":1723068139000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/95\/1\/article-p35.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,7,6]]},"references-count":13,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.15-0885","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,7,6]]}}}