Edit concept Create issue ticket

Rhinosporidiosis

Rhinosporidioses

Rhinosporidiosis is a relatively rare, chronic and recurrent granulomatous disease caused by Rhinosporidium seeberi. It typically involves the upper respiratory tract but can affect other parts of the body too and its lesions have a characteristic appearance. Clinical manifestations are variable based on the location of the granulomas and the diagnosis depends on history, identifying the granulomas by their appearance, and imaging studies to delineate extent. The gold standard test for confirmation, however, is the histopathological examination of the lesions in the affected tissue.


Presentation

Rhinosporidiosis was first reported in Argentina but it is prevalent in many countries [1] and is endemic to Sri Lanka and parts of India [2]. The condition is caused by Rhinosporidium seeberi which is difficult to isolate or grow in culture media [3]. It is transmitted during swimming in infected waters and enters the human body through mucosal or cutaneous abrasions [4]. It typically affects young male adults, especially divers, farmers and sand workers [2]. Female patients with Rhinosporidiosis are rarely encountered probably because they are less active outdoors in the affected areas [5].

Patients can present several years after the initial infection as the lesions are slow growing. The granulomas can be identified by their classical appearance - pedunculated or sessile, soft, polypoidal, strawberry shaped masses which can occur on the mucous membrane of the nose, throat, soft palate, nasopharynx, conjunctiva, nasolacrimal duct, lacrimal gland, larynx, rectum [6] and even genitalia [2] [4]. The nasal septum and inferior turbinates are the most common sites in the nose to be involved [4]. The oral cavity is rarely affected. Sexual partners of men with rhinosporidiosis of the urethral meatus have not been reported with rhinosporidiosis and therefore it is presumed to be non-contagious. The polypoidal lesions tend to recur despite treatment.

Cutaneous granulomas, as well as disseminated forms of the disease with brain involvement and even fatal cases, have been reported [4] [7].

Hoarseness
  • A 45-year-old South Indian man presented with complaints of a mass in both nostrils for 2 years, associated with progressive hoarseness of voice and difficulty in breathing for 6 months.[ncbi.nlm.nih.gov]
  • A 32-year-old, South Indian man presented with a nasal mass of four years' duration, with progressive hoarseness for one year. Strawberry-like rhinosporidial masses were seen in both nasal cavities.[ncbi.nlm.nih.gov]
  • The technique was atraumatic and also avoided the potential for autoinoculation, which is a frequent cause of recurrence of this disease. [7] Madana et al . reported a case of nasal rhinosporidiosis with progressive hoarseness of voice for 1 year.[laryngologyandvoice.org]
Stridor
  • We describe a new case, which occurred in a patient with coexisting nasal rhinosporidiosis who presented with inspiratory stridor. Both lesions were completely excised under general anesthesia without the need for preliminary tracheostomy.[ncbi.nlm.nih.gov]
  • Both were excised under local anesthesia. [4] In 2004 Kumar et al . described a new case of laryngeal rhinosporidiosis, which occurred in a patient with coexisting nasal rhinosporidiosis who presented with inspiratory stridor.[laryngologyandvoice.org]
  • The patient has no respiratory complaints or stridor.[lungindia.com]
Inspiratory Stridor
  • We describe a new case, which occurred in a patient with coexisting nasal rhinosporidiosis who presented with inspiratory stridor. Both lesions were completely excised under general anesthesia without the need for preliminary tracheostomy.[ncbi.nlm.nih.gov]
  • Both were excised under local anesthesia. [4] In 2004 Kumar et al . described a new case of laryngeal rhinosporidiosis, which occurred in a patient with coexisting nasal rhinosporidiosis who presented with inspiratory stridor.[laryngologyandvoice.org]
Respiratory Distress
  • It poses diagnostic and therapeutic challenges and has high chance of mortality because of presentation with respiratory distress. We report such a case of a 35 years old man who presented with respiratory distress and dry irritating cough.[ncbi.nlm.nih.gov]
  • Tracheo-bronchial rhinosporidiosis, a rare complication of nasopharyngeal infection, should be considered in a known case presenting with severe respiratory distress.[ncbi.nlm.nih.gov]
Soft Tissue Mass
  • Fiberoptic laryngoscopy revealed a reddish soft tissue mass below the vocal cord level. Magnetic Resonance Imaging showed a soft tissue opacity within the trachea occluding the airway. Direct endoscopic biopsy was done after securing the airway.[ncbi.nlm.nih.gov]
  • Computed tomography of the head and neck revealed soft-tissue mass lesions involving the bilateral nasal cavities and nasopharynx, extending to the oropharynx and involving the larynx and trachea.[ncbi.nlm.nih.gov]
  • Various imaging modalities were useful in identifying a soft tissue mass within the left nasolacrimal duct.[ncbi.nlm.nih.gov]
  • The lesion presents as a soft tissue mass of the nose (primary site), eye and urethra. The organism is difficult to culture and the diagnosis is based on microscopy and histological examination of the lesion.[casereports.in]
  • CT scan revealed a soft tissue mass in the nasopharynx with the impression of a polyp or a neoplasm. Histological examination revealed variable sized cysts with a chitinous wall consistent with rhinosporidiosis.[pjms.com.pk]
Exposure to Contaminated Water
  • […] to contaminated water Increased tearing and photo phobia in cases of infection of palpebral conjunctiva On examination Pink to deep red polyps Strawberry like appearance Bleeds easily upon manipulation Diagnosis confirmed by biopsy and histopathology[en.wikipedia.org]
Soft Tissue Swelling
  • Radiograph of the hand revealed soft-tissue swelling with destruction of the distal part of 5 th metacarpal and whole of proximal phalanx. There was no periosteal reaction or soft tissue calcification [Figure 3] .[ijoonline.com]
Skin Lesion
  • Rhinosporidiosis in an Indian male with a tumorous skin lesion is reported.[ncbi.nlm.nih.gov]
  • The diagnosis was suggested by the presence of nasal rhinosporidiosis and confirmed by fine-needle aspiration cytology (FNAC) from the skin lesion. This is the second report of giant skin lesions in rhinosporidiosis, from our department.[ncbi.nlm.nih.gov]
  • The occurrence of skin lesions is occasional and due to dissemination from the adjacent mucosa, direct inoculation or hematogenous dissemination.[ncbi.nlm.nih.gov]
  • The diagnosis was confirmed by FNAC (Fine Needle Aspiration Cytology) and skin biopsy from the skin lesions. To the best of my knowledge, such an unusual occurrence has not been reported earlier in literature.[ncbi.nlm.nih.gov]
  • In the past year, he develops skin lesions over the right arm and over back.[ncbi.nlm.nih.gov]
Irritability
  • We report such a case of a 35 years old man who presented with respiratory distress and dry irritating cough. Fiberoptic laryngoscopy revealed a reddish soft tissue mass below the vocal cord level.[ncbi.nlm.nih.gov]
  • A 16 year old girl presented with irritation and watering of the right eye for 3 months. On examination, the superior perilimbal sclera was ectatic with incarcerated uveal tissue covered by conjunctiva.[ncbi.nlm.nih.gov]
  • Case Report An 8-year-old female presented to our clinic with a history of foreign body sensation, irritation and occasional epiphora in the right eye of 8 months duration. Visual acuity in both eyes was 20/20 N6.[ijo.in]
Vaginal Discharge
  • The girl was admitted to hospital with profuse watery vaginal discharge. Excision of the mass was followed by histopathological examination which confirmed the diagnosis Rhinosporidiosis.[ncbi.nlm.nih.gov]

Workup

The workup of rhinosporidiosis involves a detailed history and examination findings of the characteristic polypoidal, strawberry shaped appearance of the friable mass covered with white dots [2]. There are no laboratory tests for diagnosing the condition.

The extent of rhinosporidiosis can be determined using computed tomography (CT) scans which show enhancing lesions of moderate to severe intensity [8].

Histological examination of the lesions under the microscope is necessary to confirm the diagnosis. Fungal stains like Gomori methenamine silver and periodic acid-Schiff, as well as standard hematoxylin and eosin stains and potassium hydroxide preparations, can help to view the organism in different stages. Aspirates from rhinosporidiosis granuloma can provide cytological evidence while its identity can be confirmed due to the electron dense bodies within its endospores [4]. It is important to differentiate these endospores from those of Coccidioides immitis.

Currently, enzyme-linked immunosorbent assay (ELISA) is not available for routine testing but is used for epidemiological studies [9] [10].

Treatment

  • An effective treatment for R. seeberi-a eukaryote belonging to the class Mesomycetozoea-is still elusive.[ncbi.nlm.nih.gov]
  • Complete excision is the treatment of choice for this disease. Recurrences are common despite anti-microbial treatment.[ncbi.nlm.nih.gov]
  • Its manifestation is a polypoid mass growing inside the affected cavity and the only treatment is surgical excision.[ncbi.nlm.nih.gov]
  • The only effective treatment is radical surgical excision followed by thermal and chemical coagulation, nevertheless relapse is the rule rather the exception. No such medical treatment has proved to be effective.[ncbi.nlm.nih.gov]
  • [ edit ] Surgical excision - wide excision with wide area electro-coagulation of the lesion base Medical treatment is not so effective but treatment with a year-long course of dapsone has been reported Epidemiology [ edit ] Disease endemic in Chhattisgarh[en.wikipedia.org]

Prognosis

  • Well-organized Major Infectious Diseases chapters break down content by etiologic agent and epidemiology, clinical signs and their pathophysiology, physical examination findings, diagnosis, treatment and prognosis, immunity, prevention, and public health[books.google.de]
  • Prognosis is excellent, but recurrence is not unusual Keywords: Computed tomography scan, lacrimal sac, Rhinosporidium seeberi, rhinosporidiosisCase Report Rhinosporidiosis is a chronic granulomatous disease affecting the mucous membrane primarily.[parjournal.net]
  • The patient was counselled for ray amputation and prognosis discussed at length. A racket shaped incision was made and wide margin excision was carried out.[ijoonline.com]
  • There are no antifungals or antimicrobials that interfere with the prognosis, but we suggest the prolonged use of Dapsone (100 mg/day for several months) may help prevent the disease recurrences (1,2,4).[arquivosdeorl.org.br]

Etiology

  • Well-organized Major Infectious Diseases chapters break down content by etiologic agent and epidemiology, clinical signs and their pathophysiology, physical examination findings, diagnosis, treatment and prognosis, immunity, prevention, and public health[books.google.de]
  • […] revealed no retinal abnormalities unlike in previous cases reported from Sri Lanka; c) atypical histopathology that resulted in an initial mis-diagnosis of chronic inflammation with mucus cysts and a missed diagnosis of rhinosporidiosis; the rhinosporidial etiology[dovepress.com]
  • Abstract Rhinosporidiosis is a chronic granulomatous disorder of infective etiology and it frequently affects the nasal cavity and nasopharynx.[e-ijd.org]
  • DIAGNOSIS: Conjunctival Rhinosporidiosis DISCUSSION Etiology Rhinosporidiosis is an infection caused by Rhinosporidium seeberi.[webeye.ophth.uiowa.edu]

Epidemiology

  • One hundred forty-three cases of rhinosporidiosis, confirmed by smear or biopsy, treated in two major General Hospitals in Sri Lanka over a 14 year period (1995-2009) were analyzed in regard to their epidemiological, clinical, clinicopathological, immunological[ncbi.nlm.nih.gov]
  • Comprehensive Approach to Infections in Dermatology is a guide to all types of skin infection, with detailed information on epidemiology, presentation, diagnosis and management.[books.google.de]
  • Currently, enzyme-linked immunosorbent assay (ELISA) is not available for routine testing but is used for epidemiological studies.[symptoma.com]
  • Socio-demographic Correlates of Rhinosporidiosis: A Hospital-Based Epidemiologic Study in Purulia, India. Indian J Otolaryngol Head Neck Surg . 2017 Mar. 69 (1):108-112. [Medline] .[emedicine.medscape.com]
  • An epidemiological study of Rhinosporidiosis in and around Raipur. Indian Journal of Med Res1976;64-1293 KarunaratneWAE. The pathology of Rhinosporidiosis.[medresearch.in]
Sex distribution
Age distribution

Pathophysiology

  • Rhinosporidium when using light microscopy, but substantial morphological differences between the groups exist. [5] There is some evidence that DNA extracted from purified uncontaminated round bodies (Rhinosporidium seeberi) is of cyanobacterial origin. [6] Pathophysiology[en.wikipedia.org]
  • Well-organized Major Infectious Diseases chapters break down content by etiologic agent and epidemiology, clinical signs and their pathophysiology, physical examination findings, diagnosis, treatment and prognosis, immunity, prevention, and public health[books.google.de]
  • Pathophysiology Local infection from exposure to the organism appears to be implicated in the pathogenesis of R. seeberi , but thus far, it has not been possible to intentionally infect an animal model (2).[webeye.ophth.uiowa.edu]

Prevention

  • The site of the excised mass should be cauterized to prevent recurrence.[ncbi.nlm.nih.gov]
  • Surgical excision with electrocoagulation of the base is the main treatment, and dapsone therapy is recommended in order to prevent recurrences in multiple sites of affection and inadequate surgically excised cases.[ncbi.nlm.nih.gov]
  • Many a times, surgical ablation or amputation of the involved area of the limb is carried out to prevent recurrences.[ncbi.nlm.nih.gov]
  • In a concise and user-friendly format, it offers authoritative coverage of epidemiology, diagnosis, differential diagnosis, pathology, laboratory tests, management, and prevention for both common and rare conditions .[books.google.de]

References

Article

  1. Morelli L, Polce M, Piscioli F, et al. Human nasal rhinosporidiosis: an Italian case report, Diagn Pathol. 2006; 1:25
  2. Das S, Kashyap B, Barua M, et al. Nasal rhinosporidiosis in humans: new interpretations and a review of the literature of this enigmatic disease.Med Mycol. 2011; 49(3): 311-315
  3. Ahluwalia KB. New interpretations in rhinosporidiosis, enigmatic disease of the last nine decades. J Submicrosc Cytol Pathol. 1992;24: 109 -114
  4. Arseculeratne SN. Recent advances in rhinosporidiosis and Rhinosporidium seeberi. Indian J Med Microbiol. 2002;20: 119 -131
  5. Makannavar JH, Chavan SS. Rhinosporidiosis — a clinicopathological study of 34 cases. Indian J Pathol Microbiol. 2001; 44: 17 -21
  6. Pal DK, Moulik D, Chowdhury MK. Genitourinary rhinosporidiosis, Indian J Urol. 2008; 24: 419 -421
  7. Ho MS, Tay BK. Disseminated rhinosporidiosis. Ann Acad Med Singapore. 1986; 15: 80 -83
  8. Prabhu SM, Irodi A, Khiangte HL, Rupa V, Naina P. Imaging features of rhinosporidiosis on contrast CT. Indian J Radiol Imaging. 2013 Jul; 23(3):212-8.
  9. Arseculeratne SN, Sumathipala S, Eriyagama NB. Patterns of rhinosporidiosis in Sri Lanka: comparison with international data. Southeast Asian J Trop Med Public Health. 2010 Jan; 41(1):175-91.
  10. Sudasinghe T, Rajapakse RP, Perera NA, Kumarasiri PV, Eriyagama NB, Arseculeratne SN. The regional sero-epidemiology of rhinosporidiosis in Sri Lankan humans and animals. Acta Trop. 2011 Oct-Nov; 120(1-2):72-81.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2018-06-22 08:29