Classification

This organism was previously considered to be a fungus

Fungus

A fungus is a member of a large group of eukaryotic organisms that includes microorganisms such as yeasts and molds , as well as the more familiar mushrooms. These organisms are classified as a kingdom, Fungi, which is separate from plants, animals, and bacteria...

, and rhinosporidiosis is classified as a fungal disease under ICD-10

ICD-10

The International Statistical Classification of Diseases and Related Health Problems, 10th Revision is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as maintained by the...

.

It is now considered to be a parasite, classified under Mesomycetozoea

Mesomycetozoea

The Mesomycetozoea are a small group of protists, mostly parasites of fish and other animals.-Significance:...

.

Authors of detailed studies have revealed superficial similarities between Dermocystidium

Dermocystidium

Dermocystidium is a genus of cyst forming parasitic protists of fish, which are the causative agents of dermocystidiosis.- Taxonomic History :...

and Rhinosporidium when using light microscopy, but substantial morphological differences between the groups exist.

There is some evidence that DNA extracted from purified uncontaminated round bodies (Rhinosporidium seeberi) is of cyanobacterium origin.

Pathophysiology

Rhinosporidiosis is a granulomatous disease affecting the mucous membrane of nasopharynx, oropharynx, conjunctiva, rectum and external genitalia. Though the floor of the nose and inferior turbinate are the commonest sites, the lesions may appear in elsewhere too. Traumatic inoculation from one site to others is common. Laryngeal rhinosporidiosis too has been described and my be due to inoculation from the nose during endotracheal intubation. After inoculation the organism replicate locally resulting in the hyperplasia of host tissue and localised immune response.

• infection of nose and nasopharynx - 70%
• infection of palpebral conjunctiva - 15%

Epidemiology

Disease endemic in South India

South India

South India is the area encompassing India's states of Andhra Pradesh, Karnataka, Kerala and Tamil Nadu as well as the union territories of Lakshadweep and Pondicherry, occupying 19.31% of India's area...

, Sri Lanka

Sri Lanka

Sri Lanka, officially the Democratic Socialist Republic of Sri Lanka is a country off the southern coast of the Indian subcontinent. Known until 1972 as Ceylon , Sri Lanka is an island surrounded by the Indian Ocean, the Gulf of Mannar and the Palk Strait, and lies in the vicinity of India and the...

, South America

South America

South America is a continent situated in the Western Hemisphere, mostly in the Southern Hemisphere, with a relatively small portion in the Northern Hemisphere. The continent is also considered a subcontinent of the Americas. It is bordered on the west by the Pacific Ocean and on the north and east...

 and Africa

Africa

Africa is the world's second largest and second most populous continent, after Asia. At about 30.2 million km² including adjacent islands, it covers 6% of the Earth's total surface area and 20.4% of the total land area...

. It is presumed to be transmitted by exposure to the pathogen when taking a bath in stagnant water pools.

Clinical Features

• History
  • Unilateral nasal obstruction
  • Epistaxis
  • Local pruritis
  • Rhinorrhea
  • 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
• On examination
  • Pink to deep red polyps
  • Strawberry like appearance
  • Bleeds easily upon manipulation
• Diagnosis
  • confirmed by biopsy- several round or oval sporangia and spores which may be seen bursting through its chitinous wall

Treatment

• Surgical excision - wide excision with electro-coagulation of the lesion base
• Medical treatment is not so effective but treatment with a year long course of dapsone has been reported