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Geographic Distribution

Although originally endemic in parts of central and eastern Europe, Asia, and northern Africa, the disease in recent decades has become widespread geographically, with increasing frequency in the Western Hemisphere, especially in Central America and northern South America. As of 1963, there were 4,000 reported infections in the world literature and unquestionably many thousands more have gone unrecorded.

The early reports of scleroma were primarily from Russia, the Ukraine, Poland, and other countries of Europe, including Hungary, France, Switzerland and Italy, but the condition is uncommon or absent in most of Europe today. In Russia it is occasionally seen along the northern shores of the Black Sea and Caspian Sea, as well as in Tomsk in Siberia and in Turkestan. Currently, scleroma occurs most often among the rural and poor populations of Central America, principally in Mexico, El Salvador, and Costa Rica and in the South American countries of Colombia, Brazil, Peru, Chile, and Argentina. Other important endemic foci are in northern Africa, principally Morocco and Egypt, and to a lesser extent in West, Central and East Africa. It is also seen in the Middle East, eastern and central China, northern India, the Philippines, New Guinea, and Indonesia. There have been sporadic infections in Canada and the United States, with 171 cases reported in North America as of 1967; 47 of these patients were native-born citizens.

In some areas in Central America, especially El Salvador, scleroma is relatively common and accounts for up to 15% of all hospital otorhinolaryngology patients. Astacio from El Salvador(cited in Spencer 1973) noted the nose was involved in 39% of cases, the larynx in 2.3%, and the pharynx in less than 1%, with the remainder being combined infections. He noted also that it was more common in women and that approximately 95% of patients were found in the lowest socioeconomic groups living amid poor sanitation and housing in rural areas. Other investigators have noted that scleroma is most common in young and middle-aged adults, primarily between the ages of 16 and 35 years, with a slight predominance in women. There is no racial predilection.

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Copyright: Palmer and Reeder
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