OBJECTIVE: To identify the structural changes of the proliferative phase of @entity30558 which could be responsible for the chronicity of the disease. STUDY DESIGN: Observational research. METHODS: Samples of friable tissue taken from the nasal mucosa of nine untreated @entity1 were processed for light and ultrastructural microscopy. RESULTS: The majority of changes contributing to the chronicity of the disease occurred in the subepithelium and followed three closely related but distinct events. In the first (infiltrative), subepithelial invasion by the @entity4005 was followed by its active multiplication and proliferation of capillaries. In the second (neutrophilic), large numbers of neutrophils were delivered into this space. Neutrophils actively phagocytized the @entity4005 but appeared to die at an accelerated rate without completing digestion of the microorganisms. In the third event (histiocytic), histiocytes entered the subepithelium and engaged in unrestrained phagocytosis of decaying neutrophils, @entity4005 , and debris. During this process, the histiocytes' phagosomes underwent massive dilation, thus becoming Mikulicz cells. Mikulicz cells were unable to consistently destroy the @entity4005 and eventually ruptured, releasing them into the interstitium. Evidence was found that an autophagic process might contribute to phagosome distention and to the rupture of the vacuolar membranes and cell wall. CONCLUSIONS: Several critical changes responsible for the chronicity of @entity30558 occur during the proliferative phase of the disease. The majority of these take place in the subepithelium and include: 1) factors leading to the transformation of histiocytes into Mikulicz cells, 2) the inability of these cells to consistently destroy the @entity4005 , 3) their rupture releasing viable @entity4005 , and 4) the intrinsic resistance of the pathogen.

An interpretation of the structural changes responsible for the chronicity of XXXX .

@entity1 :: ('9606', 'Species') :: ['patients'] @entity30558 :: ('MESH:D012226', 'Disease') :: ['rhinoscleroma'] @entity4005 :: ('MESH:D007710', 'Disease') :: ['Klebsiella']
@entity30558 :: (MESH:D012226,Disease) :: ['rhinoscleroma']
