Rhinosporidiosis

Author: Robert Rivard, MD; Chief Editor: Burke A Cunha, MD more...

Updated: Feb 22, 2010

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Background
Pathophysiology
Epidemiology
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Background

Rhinosporidiosis is a chronic granulomatous infection of the mucous membranes that usually manifests as vascular friable polyps that arise from the nasal mucosa or external structures of the eye. Initially described by Seeber in 1900 in an individual from Argentina,^[1]rhinosporidiosis is endemic in India, Sri Lanka, South America, and Africa. Many cases from the United States and Southeast Asia, as well as scattered occurrences throughout the world, have been reported. Most cases of rhinosporidiosis occur in persons from or residing in the Indian subcontinent or Sri Lanka.

Granulomatous mass involving structures of the eye. Image used with permission from doctorfungus.org.

The etiologic agent, Rhinosporidium seeberi, has never been successfully propagated in vitro. Initially thought to be a parasite for more than 50 years, R seeberi had been considered a water mold. Molecular biological techniques have recently demonstrated that this organism is an aquatic protistan parasite. It is currently included in a new class, the Mesomycetozoea, along with organisms that cause similar infections in amphibians and fish.

Pathophysiology

Rhinosporidiosis is an infection that is typically limited to the mucosal epithelium. Infection usually results from a local traumatic inoculation with the organism. The disease progresses with the local replication of R seeberi and associated hyperplastic growth of host tissue and a localized immune response.

Infection of the nose and nasopharynx is observed in 70% of persons with rhinosporidiosis; infection of the palpebral conjunctivae or associated structures (including the lacrimal apparatus) is observed in 15%.

Other structures of the mouth and upper airway may be sites of disease. Disease of the skin, ear, genitals, and rectum has also been described. Genital disease has been described in the vagina, penile urethra or meatus, and scrotum. Dissemination of infection has been described in only 3 individuals.

Frequency

United States

Cases in the United States are rare but are more common in Texas and the Southeast.

International

Rhinosporidiosis usually affects persons in or from southern India and Sri Lanka. Cases have been reported worldwide, with an increased incidence in South America and Africa.

Mortality/Morbidity

Rhinosporidiosis can cause prolonged painless disease with limited morbidity. Disease of up to 30 years' duration has been reported. Secondary bacterial infection can cause morbidity. Death has been reported in only the few rare reports of disseminated disease.

Race

Rhinosporidiosis has no known racial predilection.

Sex

Men are affected more commonly than women, with a male-to-female ratio of 4:1.

Age

The disease most commonly occurs in children and in individuals aged 15-40 years.

Proceed to Clinical Presentation

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

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