Rhinosporidium Research Articles

Diversity and Distribution of Fungal Infections in Rwanda: High Risk and Gaps in Knowledge, Policy, and Interventions.

Fungal infections (FIs) are spreading globally, raising a significant public health concern. However, its documentation remains sparse in Africa, particularly in Rwanda. This report provides a comprehensive review of FIs in Rwanda based on a systematic review of reports published between 1972 and 2022. The findings reveal a rich diversity of fungal pathogens, including Blastomyces, Candida, Cryptococcus, Histoplasma, Microsporum, Pneumocystis, Rhinosporidium, and Trichophyton caused human infections. Candida infections predominantly affect the vagina mucosa, while Histoplasma duboisi was linked to disseminated infections. Other pathogens, such as Blastomyces dermatitidis and Rhinosporidium seeberi, were associated with cerebellar and nasal mucosa infections, respectively. The widespread observation of soilborne fungi affecting bean crops highlights the pathogens' threat to agricultural productivity, food security, and socioeconomic stability, as well as potential health impacts on humans, animals, and the environment. Of particular importance is that there is no information about FIs among animals in the country. Moreover, the analysis underscores significant limitations in the detection, reporting, and healthcare services related to FIs in the country, indicating gaps in diagnostic capacity and surveillance systems. This is underscored by the predominant use of traditional diagnostic techniques, including culture, cytology, and histopathology in the absence of integrating more sensitive and specific molecular tools in investigating FIs. Developing the diagnostic capacities and national surveillance systems are urgently needed to improve the health of crops, animals, and humans, as well as food security and socioeconomic stability in Rwanda. Also, it is important to indicate severe gaps in the evidence to inform policymaking, guide strategic planning, and improve healthcare and public health services, underscoring the urgent need to build national capacity in fungal diagnosis, surveillance, and research. Raising awareness among the public, scientific community, healthcare providers, and policymakers remains crucial. Furthermore, this report reveals the threats of FIs on public health and food insecurity in Rwanda. A multisectoral one health strategy is essential in research and intervention to determine and reduce the health and safety impacts of fungal pathogens on humans, animals, and the environment.

Rhinosporidiosis of Nasal and Nasopharyngeal Subsite from Raichur District, Karnataka – Case Reports

Rhinosporidiosis is a mucocutaneous infection, primarily involving the nose. It rarely presents as a disseminated disease, with a polypoidal lesion of the mucous membrane of the nose and its subsite. Rhinosporidiosis affects commonly the mucous membrane of the nasopharyngeal subsite, conjunctiva and palate. The causative organism is Rhinosporidium seeberi and this disease is more prevalent in tropical countries.

Management of Rhinosporidiosis: by Coblation.

Rhinosporidiosis is a granulomatous disease commonly affecting the mucous membrane. It is caused by Rhinosporidium seeberi, an aquatic parasite & seen affecting the nose, paranasal sinuses most commonly. A retrospective study was conducted at a tertiary care hospital situated in Indian peninsula and five patients who were diagnosed and treated for rhinosporidiosis were analysed. Surgical excision by coblator along with medical management using Dapsone 100mg once daily for 6 months given promising results in view of reducing recurrence. Combined approach of management including surgical excision using coblator and medical therapy with dapsone is effective in managing the rhinosporidiosis with no recurrence.

CLINICO-EPIDEMIOLOGICAL PROFILE OF PATIENTS WITH RHINOSPORIDIOSIS AT TERTIARY CARE CENTRE: AN OBSERVATIONAL STUDY

Introduction: Rhinosporidiosis is a rare chronic granulomatous infection of the mucous membranes caused by Rhinosporidium seeberi. It is mostly prevalent in India and Sri Lanka. In India, the disease is endemic to Chhattisgarh, South India (mostly Kerala & Tamil Nadu), West Bengal and Odisha. To observe the clinical presentati Aim: on and epidemiological factors in Rhinosporidiosis. We conducted a descriptive, cross-sectional Materials and Methods: study in 42 clinically diagnosed Rhinosporidiosis cases, who were surgically treated in the department over a period of 1 year, from October 2021 to October 2022 and diagnosis was confirmed by post excision histopathological examination. Results: This study involved 42 clinically diagnosed cases of Rhinosporidiosis. Majority (76.2%) of patients were males and 23.8% were females. The male to female ratio was found to be 3.2:1. Most common age group was 11-20 years. All 42 patients had history of pond bathing and 60% cases were from Rural area. 54.8% of cases belonged to lower middle and 40.5% cases belonged to lower socio-economic class. 97.6% cases had mass in Nose and nasopharynx, most common presenting complaint was Nasal obstruction (92.85%). Most common Site of attachment of mass was Inferior meatus (45.23%) and Nasopharynx (38%). O+ was most common blood group seen in 19 cases (45.23%) followed by A+ in 12 (28.57%), B+ in 8 (19%). The results of the study showed that the disease was associated with male g Conclusion: ender, young and middle age, low socio-economic status, rural population and pond bathing and O+ blood group. Most common site involved was Nose and Nasopharynx and most common attachment of mass was seen in inferior meatus

Conjunctival rhinosporidiosis

Rhinosporidiosis is a rare ocular infection and a chronic granulomatous disease caused by Rhinosporidium seeberi. The disease is endemic in India and Sri Lanka but has been known to occur even in colder regions of North America and Eastern Europe. It is most commonly seen as a soft polypoidal pedunculated mass affecting mucus membranes of the nose, pharynx, and conjunctiva. We present a case of a 23 years male who presented with a flat, pedunculated, highly congested mass with a bumpy surface attached at the inferior border of the tarsal conjunctiva. It was initially suspected to be an epithelialized impacted foreign body but when completely excised and sent for histopathological examination revealed rhinosporidiosis. Diagnosis is based solely on microscopic features. Even though a rare clinical entity, it should be borne as a differential in case of any pedunculated conjunctival mass.

Urethral rhinosporidiosis – A case report

Rhinosporidiosis is an infectious disease caused by Rhinosporidium seeberi, an aquatic protistan parasite. It usually affects the nasal mucosa. Extranasal locations are reported limitedly in medical literatures. Here, we present a case report of an isolated urethral rhinosporidiosis, quite a rare entity, with mode of presentation and management in brief.

Recurrent rhinosporidiosis: A case report from Malaysia and review of literature

Over the decades, rhinosporidiosis has remained an enigma. It is a recalcitrant disease caused by Rhinosporidium seeberi, primarily affecting the nasal cavity, conjunctiva, and less frequently involved sites, including skin, urethra, and others. We report a case of a local from Sabah who has presented with recurring symptoms of nasal obstruction and epistaxis for two decades. He had previously undergone multiple endoscopic excisional surgeries before receiving treatment at our centre. Otorhinolaryngeal examination revealed polypoidal masses occupying bilateral nasal cavities with a perforation of the nasal septum. He underwent surgical resection of the lesions, and the histopathological examination confirmed recurrent rhinosporidiosis. Due to its sporistatic effects, dapsone was chosen as the pharmacological treatment in this case. However, after a year of follow-up, he developed similar symptoms and the endoscopic findings, indicated a recurrence of the disease. The histopathological samples obtained during the repeated surgery for recurrent polypoidal masses, confirmed the diagnosis of rhinosporiodiosis. As the disease poses diagnostic and therapeutic challenges, clinicians should be prudent in establishing the diagnosis in non-endemic areas, such as Malaysia, and evaluating the possibility of recurrence.

Cutaneous Rhinosporidiosis Masquerading as a Soft Tissue Tumour Diagnosed on FNAC

Background: Rhinosporidiosis refers to a granulomatous inflammation of mucocutaneous sites caused by Rhinosporidium Seeberi, presenting most frequently as polypoidal lesions in the nose and nasal cavity. Involvement of sites like the conjunctiva, trachea, nasopharynx, skin, and genitourinary tract are rare. Cases of nasal rhinosporidiosis with satellite skin nodules around head and neck region has been reported. Primary cutaneous involvement is however extremely rare [1]. We report the case of a 58 year old male who came with complaints of anterior chest wall swelling since 2 months with sudden increase in size. The patient was sent for FNAC with a clinical diagnosis of a soft tissue tumor. FNAC however revealed sporangia of varying sizes with endospores along with foreign body giant cell reaction. Histopathological examination confirmed the diagnosis. Cutaneous rhinosporidiosis may mimic a soft tissue tumor. FNAC being a minimally invasive and less expensive procedure gave a definitive diagnosis, and also aided to initiate prompt management of the condition.

Concurrent Occurrence of Nasopharyngeal and Disseminated Cutaneous Rhinosporidiosis: A Rare Presentation.

Concurrent Occurrence of Nasopharyngeal and Disseminated Cutaneous Rhinosporidiosis: A Rare Presentation.

Urethral rhinosporidiosis: Prolapsing mass from urethra in a Bangladeshi farmer

Rhinosporidiosis is a chronic granulomatous fungal infection caused by Rhinosporidium seeberi. Usual site of infection is the nasal mucosa & nasopharynx. Male urethra is extremely rare site involving this disease. Here we are reporting a rare case where rhinosporidiosis presented as a prolapsing mass from urethra during voiding.

A Rare Case Of Conjunctival Rhinosporidiosis Mimicking A Neoplasm In Ghana.

Introduction: Rhinosporidiosis has not been reported in the literature, in Ghana. It is however endemic in India, mostly presenting as tumorous growths within the nasal cavity and conjunctiva. Rhinosporidiosis is a chronic granulomatous infection caused by Rhinosporidium seeberi an organism initially thought to be a fungus, but now newly classified as belonging to a group of fish parasite DRIP clade (Mesomycetozoa) located in the middle (-meso) of the animal(-zoea) and fungal(-myceto) divergence. It has been proposed to be acquired by direct inoculation of traumatized mucosal membranes through contact with contaminated water bodies with aquatic animals as natural hosts. It usually presents as a red granular polypoid mass which may mimick a neoplasm.
 Case Presentation: An 8-year-old boy was seen at the Eye clinic with a four-week history of a painless right palpebral conjunctival growth which progressively increased in size over the period. It was excised because it was suspicious for a neoplasm (Papilloma). Histopathological examination confirmed conjunctival Rhinosporidiosis. We report the clinical and histopathological findings of this entity and review the existing literature.
 Conclusion: Conjunctival Rhinosporidiosis although rare occurs in our setting. Rhinosporidium seeberi is found in river bodies within our communities and Health care givers should be aware of this infection, which may mimick a neoplastic lesion. It should be included in their differential diagnoses of individuals who present with polypoid conjunctival and nasal masses, who hail from areas with stagnant freshwater bodies in which they routinely bathe or swim.

RHINOSPORIDIOSIS - AN UNILATERAL NASAL MASS

Rhinosporidiosis is a rare chronic granulomatous disease caused by Rhinosporidium seeberi, which affects both humans and animals. Rhinosporidiosis does not satisfy Koch`s postulates as the oraganism cannot be cultured and transferred from human to animal host. Most of cases reported from India, Pakistan, Srilanka, South America, and Africa. It exists as benign and malignant form of diseases. Most common mode of transmission is water borne and rarely airborne. The disease mostly affects the Nose and Nasopharynx, other sites like oral cavity, conjunctiva, Larynx, Trachea. Clinical presents as pinkish polypoidal mass with complaints of unilateral nasal obstruction, epistaxis, local pruritus. Diagnosis based on clinical presentations and history of water contamination, biopsy with histopathological examination. Here we are going to discuss the various presentation ,diagnosis and treatment of Rhinosporidiosis cases.

Epidemiological, clinical and anatomopathological characterization of nasal rhinosporidiosis in a horse

The objective of this study is to describe the clinical, epidemiological and anatomopathological aspects of a case of nasal rhinosporidiosis in a horse in the Northeast of Brazil. A 15-year-old female horse of mixed breed presented a nodule in the mucosa of the right nasal septum. Surgical excision was performed and sent for histopathological examination. Macroscopically, the nodule had an irregular and reddish surface, and when cut it was soft, whitish, and polypoid in shape. Microscopically, myriads of sporangia with endospores inside were observed in the lamina propria, morphologically similar to Rhinosporidium seeberi in various stages of maturation. The structures were also evidenced and marked by periodic acid Schiff (PAS), Grocott methenamine silver (GMS) and toluidine blue. The diagnosis of rhinosporidiosis was made based on macroscopic aspects and confirmed through histopathological examination. The presence of myriads of sporangia measuring 115 to 220 µm, containing endospores in its interior allowed the diagnosis. Although rhinosporidiosis is considered rare in Brazil, in the Northeast region there are descriptions of the disease in humans, suggesting that the disease in animals occurs and has possibly not been diagnosed. Therefore, it is important to include it as a differential diagnosis of diseases that affect the nasal cavity of horses in the region and that present similar lesions.

Human Rhinosporidiosis of the Nasal Cavity: a Case Report

ABSTRACT Background: Rhinosporidiosis is a rare chronic granulomatous disease caused by Rhinosporidium seeberi. It is endemic in some parts of Asia and commonly involves the mucous membrane of the nose presenting with nasal obstruction, a nasal mass, and epistaxis. The main treatment for rhinosporidiosis remains surgical excision, although it may recur after excision. Rhinosporidiosis is a condition that clinicians should keep in mind when managing patients with nasal masses even in non-endemic areas. Case presentation: A 52-year-old housewife presented with a 9-month history of left progressive nasal obstruction and progressive enlarging left nasal growth associated with recurrent nasal bleeding and nasal discharge. She had a history of rearing animals and bathing in ponds as well as engaging in farming activities. Examination revealed a fleshy polypoid mass attached to the nasal septum by pedicle and filling the whole of the left nasal cavity covered with a mucopurulent nasal discharge with associated contact bleeding. She had endoscopic resection under local anaesthesia with cauterization of the base of the mass with a silver nitrate pencil. A histopathological diagnosis of rhinosporidiosis was made. Conclusion: Rhinosporidiosis is rare in our environment, its presentation mimics that of nasal tumours. Therefore, it should be part of the differential diagnosis; both clinicians and pathologists should have it at the back of their minds when managing patients with nasal masses even in non-endemic areas.

Rhinosporidiosis of the lacrimal sac in a tertiary care hospital of India - A retrospective case study.

Purpose:Though rhinosporidiosis of the lacrimal sac is a rare disease across the globe, the frequency with which these patients come to the outpatient department in western Odisha is quite alarming. This study was undertaken to upgrade the knowledge about the clinical profile and management of rhinosporidiosis of the lacrimal sac.Methods:This is a retrospective study comprising 32 clinically diagnosed and histopathologically proved cases of lacrimal sac rhinosporidiosis who were managed with dacryocystectomy with meticulous excision. Intraoperative copious irrigation with 5% povidone–iodine for 5 min and postoperative dapsone therapy for 3–6 months had been administered to all the patients. The mean follow-up period was 16.7 months. The study was conducted over 5 years from August 2015 to July 2020.Results:Rhinosporidium seeberi, an aquatic protistan parasite, was found to be the causative agent. Males and females were affected equally. Children less than 10 years of age comprised 56.2% (18 cases). History of pond bathing was found in 100% of cases. The most common presentation was boggy swelling over the lacrimal sac. The involvement was unilateral in all the cases. None of the patients were found to have nasal involvement. In 65.6%, the lesion was limited within the sac. Recurrence was noted in 25% of cases.Conclusion:Rhinosporidiosis of the lacrimal sac should be excluded in all patients presenting with boggy swelling of the lacrimal sac with a history of pond bath. The recurrence can be minimized by meticulous excision, intraoperative betadine, and postoperative dapsone therapy.

Endonasal endoscopic removal of intra-orbital (extralacrimal, extraconjunctival) oculosporidiosis: Anatomical and surgical considerations.

This report illustrates the successful removal of a proper intra-orbital oculosporidiosis (extralacrimal, extraconjunctival) exclusively by the endonasal endoscopic approach. It also introduces the naso-orbital pseudofontanelle as an important surgical landmark and describes a hitherto undefined intra-orbital extramucosal three-dimensional potential wedge that harbored the Rhinosporidium seeberi infestation as a nodular conglomerate. The patient, a 50-year-old woman, was operated on three years ago for rhinosporidiosis of the nasal cavity and the distal lacrimal drainage system (lacrimal sac and nasolacrimal duct). The resulting alterations in regional anatomy were evident on imaging. They could explain the present recurrence and formation of the pseudofontanelle that allowed the conglomerate to bulge through the lateral nasal wall on digital pressure, making endoscopic intervention feasible. The primary principle for adopting this approach was to protect the facial skin from possible seeding. With an angled endoscope, the pseudofontanelle was breached and the intra-orbital extramucosal wedge between the bony orbital wall and the peri-orbita entered. The nodules that formed the conglomerate were densely adherent with the peri-orbita and skin. They were carefully and meticulously removed to avoid inadvertent injury to vital intra-orbital structures. Endonasal endoscopic intervention for a true intra-orbital oculosporidiosis has never been documented before. The surgical approach, the newly defined anatomical domain for the intra-orbital extramucosal oculosporidiosis, and the concept of pseudofontanelle characterize this report as a novel clinical experience worth presenting.

A new technique to resolve Nasal Rhinosporidiosis: A case report with review of literature.

Introduction and importanceRhinosporidiosis is a chronic, localized granulomatous infectious disease caused by Rhinosporidium seeberi that predominantly affects the mucosal membranes of the nose and nasopharynx, conjunctiva, and urethra. Rhinosporidium seeberi is a eukaryotic pathogen that spreads in certain geographical areas, particularly in tropical and subtropical areas, through aquatic exposure.Case presentationWe present the case of a young man who had been suffering from a right nasal mass for four months, and whose diagnosis was confirmed after surgical excision and histopathological examination, which revealed distinct pathognomonic findings. Laser-assisted endoscopic excision, in combination with Dapsone, is recommended as a more effective treatment to prevent a recurrence.Clinical discussionFor clinicians, it has been advised to obtain a detailed case history of exposure in patients diagnosed with Rhinosporidiosis. Rhinosporidiosis can be diagnosed with a simple examination of H&E-stained histopathological sections. Because chemotherapy has not been proven to be effective, Laser-assisted endoscopic excision, in combination with Dapsone is the recommended treatment for Rhinosporidiosis.ConclusionOne of the differential diagnoses for Rhinosporidiosis in the nasal cavity is masses or abnormal growths without bleeding, which should be kept in mind by clinicians and pathologists.

English

BACKGROUND Rhinosporidiosis is a chronic granulomatous disease caused by the eukaryotic organism, Rhinosporidium seeberi affecting humans and animals. This disease is endemic in several parts of South Asia. The principal purpose of this study was to assess the clinical features of rhinosporidiosis and the demographic profile of the disease in the Ernakulam district. The role of predisposing factors like bathing in ponds, nose-picking habits and the postoperative recurrence rate in the patients were also studied. METHODS This retrospective record-based study was conducted in a tertiary care centre in Ernakulam district of Kerala, India, from January 2014 to June 2016. Clinicopathological profile, demographic data of the patients including their area of residence were retrieved from the records. All patients underwent routine haematological investigation and nasal endoscopy. All rhinosporidial masses were excised and their base cauterised under general anaesthesia, with the aid of endoscope. All patients were given dapsone for 6 months. All cases were followed up for a one-year postoperative period. The retrospective data obtained were entered in Microsoft Excel spreadsheet and analysed. RESULTS The patients in the series were between 14 to 60 years of age. There were 12 male and 3 female patients. Most patients came from the urban areas of the Ernakulam district. The main symptoms were nasal obstruction, epistaxis and nasal mass. The nose and nasopharynx were the commonest sites involved. The inferior meatus and floor of the nasal cavity were the common sites of attachment. Most of the nasal masses were pedunculated and multiple. Recurrent cases, which had previously been operated elsewhere formed the majority in the case series. None of the operated cases in the series showed recurrence during one year follow up. Most cases were associated with the O+ blood group. Nasal synechia was the most common sequelae of repeated surgeries. CONCLUSIONS This study revealed the endemic nature of this disease in Ernakulam and surrounding districts. The results showed the disease was associated more with the male gender, the young, bathing in stagnant water and the O+ blood group. Most of the cases came from an urban background. The study showed the complications of recurrent surgeries and the need for careful removal of the rhinosporidial masses under general anaesthesia. It also emphasises the need for educating the general public against bathing in contaminated water bodies. KEY WORDS Rhinosporidiosis, Rhinosporidium, Epidemiology, Recurrence, Retrospective Studies

Ocular Rhinosporidiosis and Recurrence Postsurgery: A Case Series

Rhinosporidiosis, a chronic granulomatous disease, is caused by Rhinosporidium seeberi. It is an endosporulating microorganism causing polypoidal ocular mass. A clinician needs to have high degree of suspicion for oculosporidiosis, as it is more common in nasal cavity and other respiratory passage as compared to ocular lesion. The authors intend to increase awareness among ophthalmologists through this case series. It was intended to evaluate profile, clinical presentation and recurrence rate of ocular rhinosporidiosis in a tertiary care setting in Eastern India. The present case series is about 15 patients diagnosed with rhinosporidiosis, that was reported within one year. Age range was 6-50 years, with male:female was 9:6. All patients underwent total excision with around 2 mm lesion free margin and electrocautery of base. Postoperatively, antibiotic and lubricant eye drops were given, a follow-up schedule was day 1, 7, 30, six months and one year. Majority of the patients showed involvement of lower tarsal conjunctiva (eight), followed by upper (four), then bulbar conjunctiva (one), lower lid (one), and lacrimal sac (one). All patients recovered completely postoperatively. At one year follow-up no patient had any recurrence. Ocular rhinosporidiosis may have diverse presentation from chalazion, papilloma, keratoconjunctivitis etc. This disease is often missed because of poor pathological back up at many centres. In an endemic area, a high degree of suspicion should be there to detect this relatively rare entity.

An unusual palatal mass in a 54-year-old male: report of a rare case

Rhinosporidiosis is a chronic, granulomatous, muco-cutaneous infection caused by Rhinosporidium seeberi. The infection is non-contagious and sporadic in humans, affecting predominantly the mucous membrane of the upper respiratory tract. It is quite an uncommon condition and seldom affects the oral mucosa. The clinical presentation of this condition in the oral cavity can mimic many other conditions. Here, we report a unique case of recurrent rhinosporidiosis affecting the palate in a 54-year-old male.