Culture of Rhinosporidium seeberi: preliminary report

Rhinosporidiosis in Central India: A cross-sectional study from a tertiary care hospital in Chhattisgarh

Background and Aims:

Chhattisgarh is an endemic region for rhinosporidiosis infection in Central India. This high prevalence can be explained by suitable hot tropical environment as well as social practice of common bathing of public with animals outdoor, mainly in ponds and river. There are more than 200 ponds in and around Bilaspur district, mainly in Ratanpur region. However, due to limited literature describing rhinosporidiosis from this part of India, it remains neglected and still not recognized as a serious health-care issue and any definite government or private measures/initiatives are not taken to counter this problem.

Materials and Methods:

It is a retrospective demographic study analyzing 113 consecutive biopsies received from different clinical departments in a tertiary care center with a histological diagnosis of rhinosporidiosis over a period of 7 years from January 2011 to December 2017.

Results:

Most of the patients presented in the otorhinolaryngology (86.7%) department, followed by ophthalmology (10.6%). The mean age of the patients was 23.4 years, with a range of 3–70 years. A male-to-female ratio of about 3:2 was noted. Nasal cavity was the most common site of involvement (90/113), followed by conjunctiva (7/113), nasal cavity with oropharynx (6/113), and eyelid (3/113). Patients' complaints showed a varying range from nasal block, nasal mass, bleeding, bleed on touch, difficulty in breathing, and conjunctival mass. Two of the cases presented as recurrent rhinosporidiosis.

Conclusion:

Rhinosporidiosis is endemic and possesses a great health-care burden in Chhattisgarh. The socioeconomic status, outdoor bathing, and cultural practice in rural areas are the major factors contributing to newer cases. An urgent government initiative to decontaminate public water bodies and public health education through health-care workers and nongovernment organizations is the need of the hour to curtail the incidence of rhinosporidiosis.

Rhinosporidiosis and the pond

Rhinosporidiosis is a fungal disease caused by the organism Rhinosporidum seeberi. The life cycle and mode of infection are vague, and there are many hypothesis on it. Its prevalence in the world is unique as it is only limited to certain regions like India, Pakistan and Sri Lanka. We have tried to correlate the various factors, which will probably be associated with this pattern of prevalence of the disease. We have included factors like community practices, climatic conditions, rain fall pattern, water physiochemical properties, zoonotic and the aquatic organism composition in the specified regions. Thus, it serves as a wholesome idea of why the disease must only be prevalent in certain parts of the world.

A molecular approach (multiplex polymerase chain reaction) for diagnosis of rhinosporidiosis

A New multiplex PCR have been developed in our laboratory using primer sets, aiming amplification of both D.N.A target fragments obtained in 18S RNA of commonly encountered fungi in human being and in Rhinosporidium seeberi using F1-fw/F2-rev (500 bp target) and Rhino-fw/ Rhino-rev (.177 bp target). This multiplex PCR has been found to be able to delect R. seeberi from clinical samples and differentiate it from other fungi. Furthermore, by this multiplex PCR, R. seeberi, phylogenitically appears to belong to a member of so called DRIPs clade of fish parasite not a cyanobacterium as claimed previously, by some workers.

Rhinosporidiosis

Rhinosporidiosis is the disease resulting from infection by Rhinosporidiosum seeberi, an organism endemic in the Indian sub-continent, but rarely seen in the United Kingdom.

We describe the clinio-pathological features of a case presenting in a 14-year-old female.

Culture of the organism that causes rhinosporidiosis

The causative agent of rhinosporidiosis is a microscopic round body in polypoidal masses that is believed to be the sporangium of a fungus Rhinosporidium seeberi. But fungal aetiology can not be proved with certainty. Attempts to culture the fungus on various media have also been unsuccessful. In a recent study pond water samples, from water in which patients had been bathing, were analysed and a unicellular prokaryotic cyanobacterium Microcystis aeruginosa was isolated. The same cyanobacterium was demonstrated in clinical samples from patients with rhinosporidiosis. Consequent to these findings, attempts were made to culture the causative organism of rhinosporidiosis under conditions that support growth of cyanobacteria. This study describes a simple method for laboratory culture of this organism. Observations based on laser-scanning confocal microscopy, light and electron microscopy confirm that a cyanobacterium, Microcystis sp. is the causative agent of the disease. Rhinosporidiosis is the first human disease to be shown to be caused by a cyanobacterium. The findings have opened the way for development of therapy.

Disseminated cutaneous rhinosporidiosis

Two cases of longstanding rhinosporidiosis developed widespread asymptomatic nodular skin lesions. Cutaneous examination showed multiple, discrete, sessile and pedunculated, smooth and warty, friable nodular lesions of variable sizes and shapes. Histopathology of representative skin lesions showed hyperplastic epidermis with sporangia containing spores in the upper dermis diagnostic of rhinosporidiosis. Epidemiological data about rhinosporidiosis at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India, is presented. Possible modes of dissemination to the skin and differential diagnosis are discussed in relation to this rare manifestation of rhinosporidiosis.

Nasal rhinosporidiosis in dogs: four cases from Europe and a review of the literature

This paper describes four cases of canine rhinosporidiosis which occurred in Italy in 1994 and 1995. Four dogs with a history of exposure to the muddy environment of rice fields, developed respiratory signs. Rhinoscopy revealed nasal polypoid lesions with a characteristic gross appearance due to the presence of multiple, tiny, white-yellowish spots representing sporangia filled with spores. In cytological samples obtained by brushing, many spores were present in an inflammatory background. Histologically, the polyps consisted of fibrovascular tissue embedding sporangia in different developmental stages, and free spores which elicited a severe pyogranulomatous inflammation. All the dogs were treated surgically and the condition did not recur in two cases during a year's follow-up and in the other two cases during two years.

Unusual subcutaneous infections

This article reviews various unusual subcutaneous infections, including rhinosporidiosis, lobomycosis, and protothecosis. Clinical findings, pathology, mycology, and treatment are discussed for each disease.

Rhinosporidiosis in India: a case report and review of literature

A 21-year-old male from Kerala, south India, who had been living in Chandigarh for the last 4 years presented with a nasal polyp in the left nasal cavity. On histopathological examination, it was found to be due to rhinosporidiosis. This disease is not uncommon in south India, but few case reports have been documented from north India. This paper presents a case report of rhinosporidiosis from the Government Medical College and Hospital, Chandigarh, and a review of literature of the disease.

Rhinosporidiosis: immunohistochemical and electron microscopic studies

Sixteen biopsies of rhinosporidiosis (15 nasal and one conjunctival) from 16 Southern Indian male immigrant workers showed mucosal lymphoplasmacellular infiltrates together with transepithelial elimination of nodular bodies and destruction of some late stage nodular bodies in histiocytic granulomata with central neutrophilic microabscesses. Early nodular bodies were immunohistochemically positive for alpha 1-AT, alpha 1-ACT, CEA, S100, fibronectin, amyloid-p-component, IgG, IgA, C1q and C3. Electron microscopy showed organized concentric lamellated bodies in early nodular bodies and not in end-stage nodular bodies which contained mostly amorphous electron dense materials. Structures formerly regarded as 'sporangia' and 'spores' are believed to be lysosomal bodies loaded with indigestible residues to be cleared via transepithelial elimination or segregated/destroyed by secondary immune/granulomatous responses.

Rhinoscleroma and rhinosporidiosis

For North American otolaryngologists, rhinoscleroma and rhinosporidiosis are moving more into the differential diagnosis of chronic inflammatory diseases of the upper airway, particularly the nasal cavity. This change is occasioned by the influx of immigrants from parts of the world to which the diseases are endemic. Diagnosis is established by identification of the causal organisms, the readily seen Rhinosporidium seeberi for rhinosporidiosis and the more elusive Klebsiella rhinoscleromatis for rhinoscleroma.

Rhinosporidiosis associated with squamous cell carcinoma in the tongue

The peritumoural region of a squamous cell carcinoma of the tongue when examined with light and electron microscope showed nodular bodies in the submucosa with all the distinctive features of 'sporangium and 'spores' of rhinosporidiosis. The occurrence of rhinosporidiosis in the tongue along with malignancy has not been reported hitherto. Some interesting observations and causal relationships are discussed.