An unexpected host in a soft-tissue lesion of thigh

Rhinosporidiosis is an enigmatic entity and poses a major health problem in the developing countries of South-East Asia. A soft friable polypoid nasal mass is the most common presentation, while sparse literature is available on extranasal involvement. We describe the case of a 35-year-old female patient who presented with a slow-growing soft-tissue swelling with ulceration over the thigh. On clinical and radiological examination, a provisional diagnosis of soft-tissue neoplasm was made. After resection, histopathological sections showed a closely packed cyst with innumerable endospores. The present case report documents the rare occurrence of an incidentally detected cutaneous rhinosporidiosis causing diagnostic difficulty.

Cluster of Nasal Rhinosporidiosis, Eastern Province, Rwanda

We report 4 recent cases of nasal rhinosporidiosis in Rwanda. All patients were boys or young men living in the same district (Gatsibo District, Eastern Province), suggesting a reservoir in the area. The recent reemergence of rhinosporidiosis in Rwanda might reflect increased availability of diagnostic services rather than emerging disease.

Lacrimal sac rhinosporidiosis: clinical profile and surgical management by modified dacryocystorhinostomy

PURPOSE

To describe the clinical profile and surgical management of patients with lacrimal sac rhinosporidiosis.

METHODS

This is a retrospective interventional case series. Eighteen patients, who were clinically diagnosed as isolated lacrimal sac rhinosporidiosis between October 2009 to January 2012, were included in the study. Detailed history, including whether there was exposure to stagnant bathing water, was noted. All patients underwent modified dacryocystorhinostomy (DCR) under general anaesthesia.

RESULT

Out of 18 patients, 14 were male and 4 were female. Rhinosporidiosis was more prevalent in the 25 to 34 years age group. The most common clinical presentation was a doughy swelling over the lacrimal sac area, present in all cases. Twelve patients (66.67%) had a history of bathing in stagnant water. After modified DCR operation, all patients were followed for one year and only two patients had recurrence of their disease.

CONCLUSION

Patients with lacrimal sac rhinosporidiosis usually present with a soft, doughy swelling in the lacrimal sac area. Bathing in stagnant water is a common risk factor. A modified DCR yields excellent outcomes.

The regional sero-epidemiology of rhinosporidiosis in Sri Lankan humans and animals

No data is available in the world literature on serum anti-rhinosporidial antibody levels in animals, and as far as we aware this is the first report. Although rhinosporidiosis in farm and domestic animals has been widely reported from other countries, rhinosporidiosis in animals has not been reported in Sri Lanka, though this country has the highest world-wide prevalence of human rhinosporidiosis on a unit-population basis. Serum IgG titres in 6 species of Sri Lankan animals (buffalo, cat, cattle, dog, goat, horse; total 291) were assayed by the Immuno blot (dot-ELISA) method on nitrocellulose paper and were compared with serum IgG titres in normal Sri Lankan human subjects (total 211) in different geographical areas, and in human Sri Lankan patients with rhinosporidiosis as reference values (total 36). Sensitization to rhinosporidial antigen(s) was detected in all 6 species of animals and the highest titres (1/3200) were found in cats, and free-grazing horses. Cattle showed higher levels of antibody than buffaloes. The titres in these animals are compared with world reports on overt rhinosporidiosis in these species, and with titres in normal Sri Lankan humans. Human, but not animal titres showed variations compatible with the regional prevalence of rhinosporidiosis. The variations in titres in animals especially horses, were probably more related to their mode of feeding, while in humans the titres in normal persons were probably related to the rhinosporidial-endemicity of their respective regions. No conclusions from sero-positivity in animals could be made regarding the absence of reports on rhinosporidiosis as an overt disease in these Sri Lankan animal species but the possibility of a genetically-determined insusceptibility to rhinosporidiosis in Sri Lanka, is considered. Rhinosporidium seeberi-specific PCR positive reactions were obtained with nasal scrapings from cattle that microscopically showed PAS+ bodies that were compatible with rhinosporidial sporangia. Sequence-analysis of the reactions products from five positive R. seeberi-specific PCR samples (four in this study and 1 in a previous study) gave results confirmatory of R. seeberi.

Rhinosporidiosis in Raipur, Chhattisgarh: a report of 462 cases

Rhinosporidiosis is endemic in the state of Chhattisgarh. 462 cases were encountered during the period of 12 years from January 1994 to December 2005. Maximum incidence was seen in men in the age group of 21-30 years. Nose and nasopharynx were the commonest site (81.1%), followed by ocular tissue (14.2%). Many rare sites of involvement were encountered. Seven cases of generalized rhinosporidiosis were seen. Rhinosporidium seeberi could be easily identified in Haematoxylin and eosin stained sections. Sporangias and spores are better delineated by periodic Acid Schiff, Mayer's mucicarmine, Verhoff's vonGieson and Grocott Gomori methamine silver stain.

Rhinosporidiosis of parotid duct: a rare case report

Although rhinsporidiosis caused by Rhinosporidium seeberi is known to mankind since hundred years, many aspects of this enigmatic disease have remained mysterious till date. Parotid duct as a site of involvement has rarely been reported. Our case interestingly presented with a cystic mass of left parotid duct accompanied by an ulcer and mucopurulent discharge was finally confirmed to be a case of rhinosporidiosis by histopathological examination.

Nasal rhinosporidiosis in a mule

A mass was removed from the nostril of a mule that exhibited unilateral epistaxis and nasal discharge. Impression smears revealed oval structures consistent with spores of Rhinosporidium seeberi. Microscopically, the mass was composed of fibrovascular granulomatous tissue containing sporangia R. seeberi. Surgical excision and antifungal treatment proved curative.

Oculosporidiosis in a tertiary care hospital of western Orissa, India: A case series

The authors present a case series of 54 subjects of Rhinosporidium. They were reported in two years at a tertiary care hospital of Western Orissa. The clinically diagnosed cases by ophthalmologists were confirmed by histopathological samples following surgery. In our series, we noted Rhinosporidium seeberi organisms as the main causative agent. Males were affected three times more than females. Children less than 10 years of age comprised more than 50% of our series. In 91% of cases, the conjunctiva was the site of this infection. Total excision of fungal mass was carried out in all cases and two cases had recurrence between 9 and 12 months following intervention. Although this is an endemic area for such infestation, unilateral manifestation observed in all cases is interesting to note. Low recurrence rate in limited follow-up period could be due to early detection and standard management.

Cytologic identification of immature endospores in a dog with rhinosporidiosis

An 8-year-old, intact, male Labrador Retriever was presented to the Boren Veterinary Medical Teaching Hospital at Oklahoma State University with a 2-month history of severe sneezing episodes that resulted in epistaxis and bilateral sanguineous discharge. Rhinoscopy revealed a small polypoid mass, and specimens were obtained for histopathology. Microscopic examination of formalin-fixed tissue specimens revealed organisms consistent with Rhinosporidium seeberi. The mass was surgically excised and impression smears were made for cytology examination. Smears revealed high numbers of endospores, typical of those previously described for R seeberi. In addition, numerous smaller structures, presumed to be immature endospores, were noted. The immature endospores were morphologically distinct from mature endospores and have not been described previously. Recognition of immature forms of Rhinosporidium may help prevent misidentification of the organism or misdiagnosis of a dual infection.

Histopathologically confirmed ocular rhinosporidiosis in two Canadians

CASE REPORT

In India and Southeast Asia, rhinosporidiosis is a common infectious disease, but it has rarely been reported in western countries. Infrequently, isolated ocular rhinosporidial infections have been reported, but to our knowledge, there are no reported cases in Canada. Two cases of rhinosporidiosis have been recently diagnosed and managed at our university-based hospital.

COMMENTS

Rhinosporidiosis presents with certain characteristic clinical features; however, the diagnosis is confirmed histopathologically. The presence of typical sporangia and spores in a fibrovascular stroma infiltrated by acute and chronic inflammatory cells including granulomas is diagnostic. Surgical excision is the treatment of choice, and recurrence is possible but rare.

Cytological diagnosis of rhinosporidiosis with skeletal involvement--a case report

A young Hindu male presented with painful swelling of left lower thigh for 6 months. The provisional diagnosis both clinically and radiologically was osteosarcoma. FNAC and biopsy proved the lesion to be a case of rhinosporidiosis. The present case is reported due to rare incidence of skeletal rhinosporidiosis.

Laryngeal rhinosporidiosis: report of a rare case

Extranasal manifestations of rhinosporidiosis are relatively uncommon. Laryngeal involvement is extremely rare, as only 3 cases have been previously reported. We describe a new case, which occurred in a patient with coexisting nasal rhinosporidiosis who presented with inspiratory stridor. Both lesions were completely excised under general anesthesia without the need for preliminary tracheostomy.

Lymphadenitis, trans-epidermal elimination and unusual histopathology in human rhinosporidiosis

From a study of rhinosporidial tissues of 64 human cases of ocular, urethral and nasopharyngeal disease, unusual histopathological features of 27 cases are described. Histopathological evidence of lymphadenitis in rhinosporidiosis is presented for the first time. The phenomenon of 'trans-epidermal elimination' of sporangia of the causative pathogen Rhinosporidium seeberi is illustrated and it is argued that this phenomenon is rather the pathogen's mechanism for endospore-dispersal than a non-specific defence reaction of the host as has previously been suggested. Other unusual appearances described include variations in the intensity and composition of the host-cell infiltrate in tissues from different patients and in different portions of the same tissue, pitfalls in histopathological diagnosis, and unusual appearances of the pathogen. Histopathological clues to the pathogenesis of rhinosporidiosis and mechanisms of anti-rhinosporidial immunity in the host are discussed, illustrating the probable occurrence of immunesuppressive reactions to account for the variations in the density and composition of the host-cell infiltrate and the state of the rhinosporidial sporangia--intact or degenerate--, relating these variations to the chronicity, recurrences and systemic dissemination of rhinosporidiosis.

[Two cases of nasal rhinosporidiosis]

The rhinosporidiosis is an illness caused by Rhinosporidium Seeber, which affects not only the man but also other animals. The usual pattern of manifestations are located and characterized either by the development of big polyps, tumours, papillomas or wart lesions. These lesions are soft and hyperplastic, highly vascular and they can be fixed or pedunculated. Our study reports two cases in young people, from the same geographical area, who showed papillomatoses tumours in the nasal cavity. The diagnoses of rhinosporidiosis nasal was done through a histopathological study.

Rhinosporidiosis and peripheral keratitis

Report of a case of peripheral keratitis caused by Rhinosporidium seeberi. The patient was seen in a referral practice. Corneal scraping was performed on a middle-aged female patient presenting with peripheral keratitis and progressive nasal obstruction that revealed spores suggestive of rhinosporidiosis. The patient was started on topical amphotericin B 0.15% eye drops. Ear, nose, and throat (ENT) examination showed presence of a polypoid lesion in the left nostril for which a polypectomy was performed. Histopathological examination confirmed rhinosporidiosis. Complete resolution of the keratitis was observed. Topical amphotericin B is an effective drug in the management of this condition. Keratitis secondary to rhinosporidial infection has not been described although occasional patients with limbal and scleral involvement have been reported. Corneal scraping was effective in helping us make a tentative diagnosis.

Rhinosporidiosis in a cat

A polypoid nasal mass from an adult cat was submitted for routine biopsy examination and was found to contain sporangia and sporangiospores consistent with Rhinosporidium seeberi. Inflammatory infiltrates were moderate and pyogranulomatous to lymphohistiocytic and were associated with hyperplasia of the transitional nasal epithelium. Apparently, this is the first reported case of rhinosporidiosis in a cat.

Rhinosporidiosis--a clinicopathological study of 34 cases

Rhinosporidiosis was the commonest (68%) fungal lesion encountered during the period of 11 1/2 years from January 1987 to July 1998. Men in 2nd, 3rd, 4th decade were commonly affected. Nose and nasopharynx were the commonest (85%) sites involved followed by ocular tissue (9%). One patient had involvement of bone (tibia). Generally a lymphoplasmacytic response was observed in all cases. Polymorphonuclear leukocytic response mostly observed at the site of rupture of sporangia. Epithelioid cell granulomatous and giant cell response observed in 47% of cases. Transepithelial migration of sporangia observed in 76% of cases. Rhinosporidium seeberi could be easily identified in haematoxylin and eosin stained sections. The walls of young trophic forms are delineated well with the PAS stain and verhoeff van Gieson stain.

Purification of the endospores and sporangia of Rhinosporidium seeberi on Percoll columns

Human rhinosporidial tissue was used as the source of the various developmental stages of Rhinosporidium seeberi--endospores with electron dense bodies, juvenile, and immature sporangia. After homogenisation in phosphate buffered saline (PBS) and removal of tissue fragments by centrifugation, the rhinosporidial bodies were isolated on centrifuged Percoll columns with gradients of densities or on triple-layered columns of varying density. The separated bands, after repeated washing in PBS gave bodies free from human tissue as shown on Leishman and PAS staining and indirect immunofluorescence with rabbit and human patients' anti-rhinosporidial sera. Sonicates of these bodies were tested on agarose gel for precipitation with antisera, and on SDS-PAG electrophoresis and Coomassie Blue staining. Percoll columns were shown to be capable of isolating these stages of R. seeberi, free from human tissue and contaminating bacteria.

Rhinosporidium seeberi: a human pathogen from a novel group of aquatic protistan parasites

Rhinosporidium seeberi, a microorganism that can infect the mucosal surfaces of humans and animals, has been classified as a fungus on the basis of morphologic and histochemical characteristics. Using consensus polymerase chain reaction (PCR), we amplified a portion of the R. seeberi 18S rRNA gene directly from infected tissue. Analysis of the aligned sequence and inference of phylogenetic relationships showed that R. seeberi is a protist from a novel clade of parasites that infect fish and amphibians. Fluorescence in situ hybridization and R. seeberi- specific PCR showed that this unique 18S rRNA sequence is also present in other tissues infected with R. seeberi. Our data support the R. seeberi phylogeny recently suggested by another group. R. seeberi is not a classic fungus, but rather the first known human pathogen from the DRIPs clade, a novel clade of aquatic protistan parasites (Ichthyosporea).

Fungus-like hyphochytrids associated with human disease

We report two cases, with liver and brain abscess, respectively, where fungus-like organisms belonging to the Hyphochytriomycota were found at the site of inflammation together with Peptococcus in the first and Cysticercus cellulosae in the second case. This is the first time these groups of organisms have been reported in human material. The role of hyphochytrids in human pathology remained uncertain as they were found together with already known human pathogens.

[Nasal rhinosporidiosis]

Rhinosporidiosis is a granulomatous disease of uncertain mycotic origin that is characterized by polypoid lesions, predominantly of the nasal mucous membrane and conjunctiva. It is endemic to India and Sri Lanki, but occasionally occurs in other regions of the world. We report a case in Spain. The modes of infection and transmission, as well as treatment, are discussed.

Verrucoid cutaneous rhinosporidiosis

Verruca vulgaris like lesions of cutaneous rhinosporidiosis are reported in a middle aged Indian male. He also had nasal rhinosporidiosis. Imprint smears from skin lesions showed sporangia with endospores, confirming the diagnosis.

Infection of the conjunctiva by Rhinosporidium seeberi

Rhinosporidiosis is an unusual fungal disease that rarely affects the eye. It was first described as a pathogen in humans at the turn of the century. The etiologic agent, Rhinosporidium seeberi, commonly produces granulomatous inflammation of the upper respiratory mucosa. Most reported ocular infections have occurred in hot, dry climatic regions. We present a case of conjunctival rhinosporidiosis in an 11-year-old boy from western New York state, the first such report from the temperate zones of North America. The clinical characteristics, histopathologic features, and recommended therapeutic measures are discussed.

Conjunctival oculosporidiosis in east Africa caused by Rhinosporidium seeberi

BACKGROUND AND OBJECTIVE

Conjunctival rhinosporidiosis is an infectious disease rarely recorded outside the Indian subcontinent. The disease is caused by Rhinosporidium seeberi, an endosporulating microorganism of uncertain taxonomic classification. We report a series of cases manifesting this infection.

MATERIAL AND METHODS

The demographic, clinical, and histopathologic data of 14 cases of conjunctival rhinosporidiosis on record at our Ophthalmic Pathology Laboratory were reviewed.

RESULTS

All cases were from East Africa; 10 were from Malawi and 4 from Kenya. Ten specimens were from males and three from females. Their age ranged from 7 to 20 years. All patients were treated by surgical excision, and no recurrence was recorded. None of the cases was diagnosed clinically as rhinosporidiosis. Histologically, all stages of the organism's life cycle could be found in the excised tissue, from small trophocytes to large sporangia-containing sporoblasts. There were changes in histochemical stainings with growth and maturation. In general, the inflammation was of chronic nongranulomatous type.

CONCLUSIONS

Conjunctival rhinosporidiosis is a rare infectious disease that typically appears in young males in rural regions, and that can be treated by surgical excision. It typically causes chronic nongranulomatous inflammation. Various stages of the R seeberi life cycle can be seen in the affected tissue.

Rhinosporidiosis: three domestic cases

Three cases of rhinosporidiosis in Americans who had not traveled abroad are reported. We believe this is the largest cluster of indigenous cases reported in the United States. The three patients had lived in rural northeast Georgia all of their lives. One had a polypoid conjunctival lesion, and the two others had nasal polyps. In each case, the diagnosis was made by demonstrating morphologically distinctive fungal elements in histopathologic sections. Clinically, rhinosporidiosis had not been suspected.

Cytologic and differential diagnosis of rhinosporidiosis

Rhinosporidiosis is a mycotic infection caused by Rhinosporidium seeberi. The fungus occurs in tissues as spherules measuring 0.25-3 mm. The spherules contain endospores. Diagnosis is usually made histologically on biopsy specimens from polypoid lesions on the mucous membranes of the nasopharynx, larynx, trachea, bronchus and conjunctiva. In our experience two cases of rhinosporidiosis were diagnosed by cytology. The cytologic features are typical. On direct examination the spherules are well-circumscribed, globular structures with several endospores within. The spherules show great variability in size, up to 10-fold. The diameter ranges from 30 to 300 microns. Permanent stains for detecting R seeberi are Giemsa, Gridley and toluidine blue. Numerous mycotic infections (Coccidioides immitis, Histoplasma capsulatum, Mucor, Aspergillus, Blastoschizomya capitatus, Paracoccidioides brasilienses, Cryptococcus neoformans) can be definitively diagnosed or strongly suspected on cytology. In immunocompromised patients it is important to commence the diagnostic study on unstained material. By direct examination R seeberi organisms are identified readily by their brown color. Much more information can be gained from material stained with special stains, especially periodic acid-Schiff, in differentiating R seeberi from Coccidioides immitis.

Conjunctival rhinosporidiosis. Report of three cases from Zaire

The authors report three cases of conjunctival rhinosporidiosis from Zaire, two of which are believed to be the first documented in the northeastern part of the country. All patients were males. Two patients were very young children, respectively 5 and 6 years old. The third patient was a 35-year-old man. The diagnosis was based on histopathology which revealed the characteristic features of Rhinosporidium seeberi. Total excision was the elective treatment. The disease recurred eleven months later in one case, probably from local dissemination of the parasite during surgery.

Cytodiagnosis of rhinosporidiosis

Two clinically suspected cases of nasal rhinosporidiosis were studied cytologically using a wipe out technique. The smears showed the typical spores of the fungus and the cytological diagnosis of rhinosporidiosis was confirmed by excisional biopsy. The smear is recommended as a routine preliminary screening technique in the diagnosis of suspected cases of rhinosporidiosis.

Culture of Rhinosporidium seeberi: preliminary report

Every year 400 to 450 cases of Rhinosporidium are reported from Trivandrum Medical College. Twenty-five swabs were collected from patients suffering from Rhinosporidiosis and cultured in standard media. Positive results were obtained in 23 cases. The conidia produced from the colony were compared with the structures obtained from the patient material. Light microscopy using histopathological techniques were used. The consistent appearance of the organism in patient material, the repeatability of growth in subcultures and the negative growth in controls indicated that the organism grown in culture is the causative agent of the disease. The effect of parameters like pH, temperatures, etc, were also studied.

Description of a case of rhinosporidiosis in Spain

Rhinosporidiosis is reviewed, and the first autochthonous case in Spain is presented (site: in the nasal cavity of a 19-year-old male from a rural background). Diagnosis was established morphologically after eliminating the possibilities of Cryptococcus neoformans, Coccidioides immitis, and Chrysosporium crescens. Clinico-pathological features are described. Preparations were stained with hematoxylin-eosin, PAS, and methenamine silver, and studied for fluorescence. Certain aspects of the epidemiology and diagnosis are commented upon.

Rhinosporidiosis: ultrastructural study of an infection in South Carolina

We have morphologically described and ultrastructurally analyzed Rhinosporidium seeberi, the causative agent of rhinosporidiosis, obtained from a nasal polyp of a man who had never traveled to India or Ceylon. The morphology, endosporulation phases, and cell wall were similar to those in previously described infections. A common etiology is suggested and potential therapy is discussed.

Rhinosporidiosis in The Netherlands. A case report including ultramicroscopic features

A case of rhinosporidiosis in a 34-year-old male is presented. The histological findings are discussed.