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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].

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]
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]
  • History of exposure to contaminant water. Increased tearing and photo phobia in cases of infection of palpebral conjunctiva. Headache. Skin lesions begin as papillomas that gradually become verrucous.[easymbbs.org]
Aspiration
  • Fine needle aspiration cytology and histopathology of the cutaneous lesion confirmed the diagnosis as rhinosporidiosis. We report this rare case of disseminated cutaneous rhinosporidiosis.[ncbi.nlm.nih.gov]
  • We report the fine needle aspiration cytology (FNAC) of rhinosporidiosis occurring as a primary cutaneous lesion. FNAC of polypoidal and warty skin growths on leg in a 28-year-old male revealed numerous sporangia and spores of R. seeberi.[ncbi.nlm.nih.gov]
  • Fine needle aspiration cytology of the tumoural lesions may establish the diagnosis. Histopathology is confirmatory. The subcutaneous masses may be solid or cystic. Ulceroproliferative lesions need to be differentiated from malignancies.[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]
  • In an endemic area, one should be familiar with its morphologic features in fine-needle aspiration cytology even on scanty material, for it could be one of the investigations in the initial workup of a case.[ncbi.nlm.nih.gov]
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]
Sneezing
  • , resulting in hyperplasia of host tissue and localised immune response. infection of nose and nasopharynx - 70% infection of palpebral conjunctiva - 15% History Unilateral nasal obstruction Epistaxis Local pruritus Rhinorrhea Coryza (rhinitis) with sneezing[en.wikipedia.org]
  • Nasal rhinosporidiosis- The patient complains of swelling and foreign body sensation in the nose accompanied by itching, sneezing and bleeding.[histopathology-india.net]
  • Coryza with sneezing. Post nasal discharge with cough. Foreign body sensation. History of exposure to contaminant water. Increased tearing and photo phobia in cases of infection of palpebral conjunctiva. Headache.[easymbbs.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]
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]
Foreign Body Sensation
  • A 12-year-old boy presenting with redness and foreign body sensation in his right eye was found to have a granular, pedunculated mass in the upper palpebral conjunctiva near the lid margin.[ncbi.nlm.nih.gov]
  • body sensation History of exposure 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[en.wikipedia.org]
  • Nasal rhinosporidiosis- The patient complains of swelling and foreign body sensation in the nose accompanied by itching, sneezing and bleeding.[histopathology-india.net]
  • Foreign body sensation. History of exposure to contaminant water. Increased tearing and photo phobia in cases of infection of palpebral conjunctiva. Headache. Skin lesions begin as papillomas that gradually become verrucous.[easymbbs.org]
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].

Coccidioides Immitis
  • 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.[symptoma.com]
  • Rhinosporidium seeberi should be distinguished from another microrganism, Coccidioides immitis.[doi.org]

Treatment

  • CONCLUSION: An effective treatment for R. seeberi-a eukaryote belonging to the class Mesomycetozoea-is still elusive. Copyright 2016. Published by Elsevier Ltd.[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]
  • […] is not so effective but treatment with a year-long course of dapsone has been reported Disease endemic in Chhattisgarh South India, Sri Lanka, South America and Africa.[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.ro]

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.ro]
  • […] 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]
  • Causes: The etiologic agent of rhinosporidiosis, R seeberi, has traditionally been considered a fungus.[easymbbs.org]
  • DIAGNOSIS: Conjunctival Rhinosporidiosis DISCUSSION Etiology Rhinosporidiosis is an infection caused by Rhinosporidium seeberi.[webeye.ophth.uiowa.edu]

Epidemiology

  • Abstract 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[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]
  • These findings are applicable in both clinical and laboratory practice, while the basic advances have implications in further work on experimental pathogenicity, the biology of R. seeberi, and on the epidemiology and pathogenesis of rhinosporidiosis.[ncbi.nlm.nih.gov]
  • 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.com]
Sex distribution
Age distribution

Pathophysiology

  • 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.ro]
  • Pathophysiology: Rhinosporidiosis is a granulomatous disease affecting the mucous membrane of nasopharynx, oropharynx, conjunctiva, rectum and external genitalia.[easymbbs.org]
  • 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]
  • […] demonstrating the difficulties that arise when working with pathogens that cannot be maintained in the laboratory setting. [18, 19] Other molecular work has demonstrated evidence that R seeberi may have host-specific strains (eg, human vs dog vs swan). [20] Pathophysiology[emedicine.com]

Prevention

  • The site of the excised mass should be cauterized to prevent recurrence.[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]
  • 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]
  • 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.ro]
  • 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.

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Last updated: 2019-07-11 21:39