Rhinosporidiosis Clinical Presentation

  • Author: Robert Rivard, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Feb 22, 2010
 

History

  • Nasal disease may present with unilateral nasal obstruction or epistaxis. Other symptoms may include local pruritus, coryza with sneezing, rhinorrhea, and postnasal discharge with cough. Patients often report a sensation that a foreign body is present in their nasal canal.
  • Eye involvement is initially asymptomatic. Increased tearing may be reported as the disease progresses. Photophobia, redness, and secondary infection may occur.
  • Skin lesions begin as papillomas that gradually become verrucous.
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Physical

  • Soft polyps may develop on the nose or eye. These polyps are pink to deep red, are sessile or pedunculated, and are often described as strawberrylike in appearance. Because the polyps of rhinosporidiosis are vascular and friable, they bleed easily upon manipulation.
  • This appearance results from sporangia, which is visible as gray or yellow spots in the vascular polypoid masses.
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Causes

  • The etiologic agent of rhinosporidiosis, R seeberi, has traditionally been considered a fungus. Recent 18S ribosomal ribonucleic acid (rRNA) gene analysis has placed R seeberi into a novel group of aquatic parasites of the class Mesomycetozoea, some of which cause similar diseases in amphibians and fish.
  • Most persons with rhinosporidiosis have had bathing or working exposure to stagnant water.
  • No immune deficiency has been associated with infection.
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Contributor Information and Disclosures
Author

Robert Rivard, MD  Infectious Disease Fellow, Department of Medicine, Brooke Army Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Duane R Hospenthal, MD, PhD  Chief, Infectious Disease Service, San Antonio Military Medical Center, Brooke Army Medical Center; Professor of Medicine, Uniformed Services University of the Health Sciences

Duane R Hospenthal, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Society for Infectious Diseases, International Society of Travel Medicine, and Medical Mycology Society of the Americas

Disclosure: Nothing to disclose.

Specialty Editor Board

Gary L Gorby, MD  Program Director of Adult Infectious Diseases Fellowship, Associate Professor, Department of Internal Medicine, Division of Infectious Disease, St Joseph Medical Center, Creighton University School of Medicine

Gary L Gorby, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and New York Academy of Sciences

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Thomas M Kerkering, MD  Chief of Infectious Diseases, Virginia Tech, Carilion School of Medicine, Roanoke, Virginia

Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

  1. Seeber GR. Un neuvo esporozoario parasito del hombre: dos casos encontrades en polipos nasales. Thesis, Universidad Nacional de Buenos Aires. 1900.

  2. Ashworth JH. On Rhinosporidium seeberi with special reference to its sporulation and affinities. Trans R Soc Edinburgh. 1923;53:301-342.

  3. Arseculeratne SN. Rhinosporidiosis: what is the cause?. Curr Opin Infect Dis. Apr 2005;18(2):113-8. [Medline].

  4. Fredricks DN, Jolley JA, Lepp PW, Kosek JC, Relman DA. Rhinosporidium seeberi: a human pathogen from a novel group of aquatic protistan parasites. Emerg Infect Dis. May-Jun 2000;6(3):273-82. [Medline].

  5. Gaines JJ Jr, Clay JR, Chandler FW, Powell ME, Sheffield PA, Keller AP 3rd. Rhinosporidiosis: three domestic cases. South Med J. Jan 1996;89(1):65-7. [Medline].

  6. Herr RA, Ajello L, Taylor JW, Arseculeratne SN, Mendoza L. Phylogenetic analysis of Rhinosporidium seeberi's 18S small-subunit ribosomal DNA groups this pathogen among members of the protoctistan Mesomycetozoa clade. J Clin Microbiol. Sep 1999;37(9):2750-4. [Medline].

  7. Hospenthal DR. Uncommon Fungi. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Churchill Livingstone; 2005:3068-79.

  8. Hospenthal DR, Bennett JE. Entomophthoramycosis, Lobomycosis, Rhinosporidiosis, and Sporotrichosis. In: Guerrant RL, Walker DH, Weller PF, eds. Tropical Infectious Diseases. Principles, Pathogens, & Practice. Philadelphia, Pa: Churchill Livingstone; 1999:665-71.

  9. Job A, Venkateswaran S, Mathan M, Krishnaswami H, Raman R. Medical therapy of rhinosporidiosis with dapsone. J Laryngol Otol. Sep 1993;107(9):809-12. [Medline].

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  11. Kennedy FA, Buggage RR, Ajello L. Rhinosporidiosis: a description of an unprecedented outbreak in captive swans (Cygnus spp.) and a proposal for revision of the ontogenic nomenclature of Rhinosporidium seeberi. J Med Vet Mycol. May-Jun 1995;33(3):157-65. [Medline].

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  14. Mendoza L, Taylor JW, Ajello L. The class mesomycetozoea: a heterogeneous group of microorganisms at the animal-fungal boundary. Annu Rev Microbiol. 2002;56:315-44. [Medline].

  15. Mohan H, Chander J, Dhir R, Singhal U. Rhinosporidiosis in India: a case report and review of literature. Mycoses. May-Jun 1995;38(5-6):223-5. [Medline].

  16. Moses JS, Shanmugham A, Kingsly N, et al. Epidemiological survey of rhinosporidiosis in Kanyakumari district of Tamil Nadu. Mycopathologia. Mar 1988;101(3):177-9. [Medline].

  17. Rippon JW. Rhinosporidiosis. In: Medical Mycology. The Pathogenic Fungi and the Pathogenic Actinomycetes. 3rd ed. Philadelphia, Pa: WB Saunders Co; 1988:362-72.

  18. Sasidharan K, Subramonian P, Moni VN, Aravindan KP, Chally R. Urethral rhinosporidiosis. Analysis of 27 cases. Br J Urol. Jan 1987;59(1):66-9. [Medline].

  19. Satyanarayana C. Rhinosporidiosis with a record of 255 cases. Acta Otolaryngol. Mar 1960;51:348-66. [Medline].

  20. Pushker N, Kashyap S, Bajaj MS, Meel R, Sood A, Sharma S, et al. Primary lacrimal sac rhinosporidiosis with grossly dilated sac and nasolacrimal duct. Ophthal Plast Reconstr Surg. May-Jun 2009;25(3):234-5. [Medline].

  21. Capoor MR, Khanna G, Rajni, Batra K, Nair D, Venkatchalam VP, et al. Rhinosporidiosis in Delhi, north India: case series from a non-endemic area and mini-review. Mycopathologia. Aug 2009;168(2):89-94. [Medline].

  22. Deshpande AH, Agarwal S, Kelkar AA. Primary cutaneous rhinosporidiosis diagnosed on FNAC: a case report with review of literature. Diagn Cytopathol. Feb 2009;37(2):125-7. [Medline].

 
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Granulomatous mass involving structures of the eye. Image used with permission from doctorfungus.org.
Sporangia of Rhinosporidium seeberi within nasal polyp (periodic acid-Schiff [PAS] stain). Image used with permission from doctorfungus.org.
Sporangia of Rhinosporidium seeberi in polyp (Gomori methenamine silver [GMS]) stain. Image used with permission from doctorfungus.org.
 
 
 
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