Rhinosporidiosis: All the information you should know
Rhinosporidiosis is a chronic, granulomatous infection caused by Rhinosporidium seeberi. It is characterised by the development of granular, polypoidal masses primarily affecting the mucous membranes of the nasal cavity and nasopharynx. The disease is more prevalent in South India and Sri Lanka. Cutaneous, laryngotracheal, genital and bony dissemination are rare, and can mimic soft tissue sarcoma.
Following the onset of nasal lesions, it usually takes many years for systemic dissemination to occur.
Very rarely rhinosporidiosis involves larynx and trachea with other nasophryngeal lesions. Rhinosporidiosis is a chronic disease which affects the mucous membrane of nose and larynx. however, tracheal dissemination is rare.
If the larynx and trachea get involved, then there is a potential risk of aspiring the contents.
Locally this can spread by spilling of the spores from pharynx into larynx during a surgery etc.
Rhinosporidiosis affects mucous lining of nose and pharynx. Rarely spreads to trachea and if spreads then it is very dangerous. It could spread due to dissemination of the spores during bleeding.
life cycle of Rhinosporiodosis
R seeberi could transmit it through it spores through dust or infectious clothing or even through dirty, unsanitary water. This could lead to suppression of the immune response and make the immunity fall below the required level.
Nasopharyngeal lesions are seen predominantly in males, while ocular infection is more prevalent among females. Infection produces granulomatous inflammation of the affected tissues.
The infection usually begin as papules but transform into large polypoidal masses which bleed on touching. They resemble strawberry with red-pink color and white specs, specially in the nose.
Masses are usually unilateral and pedunculated, and rarely exteriorise. Other mucosal sites are involved infrequently, including the palpebral conjunctiva, oropharynx,
asopharynx, maxillary antrum, larynx, external ear canal, parotid duct and genitalia. Oral and oropharyngeal lesions may interfere with breathing and/or eating.
Systemic dissemination to the trachea, lung, urethra, liver, genitalia, lacrimal sac and bone is very rare.
Dissemination can be fatal, and occurs more commonly in association with immunodeficiency disorders (such as acquired immunodeficiency syndrome). Infection can spread via body fluids such as ascites and blood. If the airways is blocked. Bleeding is a lot and all organs have failed, then this could result in death.
laryngotracheal dissemination could have been due to implantation of spores into the laryngeal and tracheal mucosa during episodes of recurrent bleeding from nasopharyngeal lesions and during previous surgery. Biopsy should not be done as it could bleed and cause aspiration which could be dangerous. Rather, a CT scan or computed tomography should be done to evaluate the extent of the lesions in larynx and trachea. Patients affected by it can complain of voice being hoarse over a period of time. Also, the sputum can be filled with blood on coughing. The throat could be affected the most by this. If the nose will be examined then red-pink strawberry like irregular lesions with nodules could have white specs on them and may extend further into the pharynx(naso and laryngopharynx).
Diagnosis is confirmed on the basis of histopathological
demonstration of the characteristic thick-walled giant sporangia (measuring 60–450μm or more in diameter) in various stages of development and containing sporangiospores (7–15 μm in diameter, and up to 12 000 in number). Rhinosporidium seeberi is easily identified in haematoxylin and eosin stained smears. Spores and sporangia can e observed by periodic acid Schiff, Mayer’s mucicarmine, Verhoff’s vonGieson and Grocott Gomori methamine silver stains.
Barring one report by Levy et al., cultivation has not been successful.
Recently, tests for assessing the viability of the organism have been developed. Spherical bodies, provisionally regarded as the electron-dense bodies of endospores, are able to reduce the salt 3-[4,5-dimethyl-2-thiazolyl]-2,5- diphenyl-2H-tetrazolium bromide to a formazan that can be visualised microscopically.
Nasal cavity examination revealed reddish, strawberry- like, nodular, irregularly surfaced lesions studded with whitish specs on the mucosa of both nasal cavities, including both vestibules and extending to the nasopharynx and oropharynx
Tele-laryngoscopy showed multiple, sessile, reddish, nodular, strawberry-like masses with whitish specs on their surface, involving the laryngeal inlet and extending to the subglottis. Fibre-optic laryngoscopic examination revealed multiple sessile lesions occluding the tracheal lumen, more on the right lateral wall than the left.
Opacities of the soft tissue in nose and pharynx, larynx, trachea can be diagnosed with the help of computed tomography (CT). Routine haematological investigations, chest radiography and fundoscopy can also be conducted.
Diode laser excision of lesions was performed under direct laryngoscopy and rigid bronchoscopy guidance.
Histopathological examination of the excised specimens revealed hyperplastic epithelium with globular cysts of various shapes, representing sporangia at various stages of development
Post-operatively, the patients can be commenced on dapsone 100 mg/day, which he was advised to continue for two years.
Strawberry-like rhinosporidial masses are commonly observed in this reddish colored masses with whitish specs are the characteristic feature which can be seen on the glottis and trachea. Bronchoscopy and laryngoscopy can also be performed.
Doctor and Scared patient
Surgical extirpation is the treatment of choice. Following surgical excision, cauterisation or ablation of the lesion base is strongly recommended, as local recurrences are common due spillage of sporangia. Rigid bronchoscopy combined with tracheotomy is useful in the removal of laryngotracheal lesions. The likelihood of bleeding from these lesions makes surgical intervention difficult. direct laryngoscopy and rigid bronchoscopy guided excision of the laryngeal and tracheal lesions can be perfomed. No rhinosporidial lesions were seen in either main bronchus. Nasal lesions recur following surgery in approximately 10 per cent of cases; the incidence of recurrence of laryngotracheal lesions is not known due to their extreme rarity.
If medicine is advised, then it should not allow the sporangia to mature, should cause it to degenerate, increase fibrosis, and should not allow it to recur by blocking the folic acid in these species.