Elusive treatment for human rhinosporidiosis

Janardhanan, Jeshina; Patole, Shalom; Varghese, Lalee; Rupa, Vedantam; Tirkey, Amit Jiwan; Varghese, George

doi:10.1016/j.ijid.2016.04.013

Cited by 10 publications

(8 citation statements)

References 3 publications

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“…However, in view of the molecular characterization of the aetiological agent, further research to discover effective treatment options is urgently needed 37 …”

Section: Discussionmentioning

confidence: 99%

Lacrimal sac rhinosporidiosis: case report and review of literature with a new grading system to optimize treatment

Gupta

Singla

Pradhan

et al. 2019

Saudi Journal of Ophthalmology

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Rhinosporidiosis is a chronic granulomatous disease affecting the mucous membrane primarily and is caused by Rhinosporidium seeberi, an aquatic protistan parasite. The nose is the most common site of involvement and is seen in 83.3% cases, followed by ocular involvement in 11.2% cases and other sites like larynx, trachea and bronchus in 5.5% cases. In various oculosporidiosis case series, lacrimal drainage system involvement was seen to vary from 14.3% to 59.6% cases. Isolated lacrimal sac involvement in rhinosporidiosis was found in 45.8% (72 out of 157) cases of the lacrimal drainage system in a review of 31 studies.A variety of surgical procedures have been used to treat rhinosporidiosis of lacrimal sac like dacryocystorhinostomy, Dacryocystectomy, lateral rhinotomy and local lesion excision with a success rate varying from 28.5% to 92.3%. This wide variation in the success rate was due to the fact that a uniform surgical procedure was performed in all the cases of a particular series irrespective of the extent of disease.Grading the lacrimal sac rhinosporidiosis to decide the extent of surgical excision may help achieve better results. We present a grading system based on our own experience in a case of extensive rhinospodiosis of lacrimal sac and review of 31 studies published in the literature.A 24-year-old male from Nepal presented with the complaints of watering from his right eye of 13 years duration, swelling in the right medial canthal area with an extension to the inferior part of the orbit for 12 years and nasal blockage for 1.5 years. The patient had a history of previous intervention in which biopsy was taken from the nose and sent for histopathology that confirmed rhinosporidiosis. An extended intranasal endoscopic dacryocystectomy was done along with debridement and coblation of the lesion over the septum and nasopharynx. Intraoperatively a large rhinosporidiosis mass was seen filling the sac and was removed in toto along with the sac and nasolacrimal duct. Recurrence of a tiny lesion after 6 months in our case despite wide excision with the drilling of bony nasolacrimal duct and coblation, made us review the literature.

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“…However, in view of the molecular characterization of the aetiological agent, further research to discover effective treatment options is urgently needed 37 …”

Section: Discussionmentioning

confidence: 99%

Lacrimal sac rhinosporidiosis: case report and review of literature with a new grading system to optimize treatment

Gupta

Singla

Pradhan

et al. 2019

Saudi Journal of Ophthalmology

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“…Rhinosporidiosis and its causative pathogen R. seeberi have been known for over a hundred years. 1,8,9 The organism is aquatic in nature and difficult to isolate in culture. Prevention will be the best option to be safe from this organism as the disease takes a chronic course which makes diagnosis difficult.…”

Section: Resultsmentioning

confidence: 99%

“…Most patients with localized disease respond to treatment with Tablet Dapsone (which appears to arrest the maturation of the sporangia and to promote fibrosis in the stroma) following surgical excision. [1][2][3] Tablet Dapsone is recommended up to 1-2 years to avoid recurrence & dessimination. 2,3 Local surgical excision of Nasal Rhinosporidiosis performed (Fauzia et al 2015).…”

Section: Discussionmentioning

confidence: 99%

“…Total excision of the mass, preferably by electro-cautery, is recommended. 1,3,5,6 However Laser provides adequate cauterization with good haemostasis thereby reducing the chances of complications and recurrence. 7 Hence in our case CO 2 laser was used over the surface attachments at nasal septum upto posterior choana and nasopharynx roof to minimise recurrence .Laser can be used as an adjunct during surgery and all measures to be taken so that the disease is removed completely and its attachments are cauterized or laserised after disease bulk removal.…”

Section: Discussionmentioning

confidence: 99%

“…R. seeberi has been variously classified as a prokaryote cyanobacterium of the genus Microcystis, a eukaryote pathogen belonging to the class Mesomycetozoea, and a fungus. 1 Yet unresolved enigmas in Rhinosporidiosis include the mode of infection mechanisms of spread, mechanisms of immunity, some aspects of histopathology e.g. the significance of trans epidermal elimination of sporangia, the cause of the variation in cell infiltration patterns in Rhinosporidial tissues and their correlations with immune status, and the absence of the Splendore-Hoeppli reaction which is wellmarked in invasive, classical mycoses.…”

Section: Introductionmentioning

confidence: 99%

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Recurrent rhinosporidiosis: a case report

Singh

Phogat

2018

JOENTR

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Rhinosporidiosis is rare infective chronic granulomatous lesion cause by Rhinosporidium seeberi which occurs universally although endemic in South Asia, notably in Southern India and in Srilanka. The causative agent Rhinosporidium seeberi is intractable to isolation and microbiological culture and shows features of both fungi and protozoa. The great majority of cases occur in upper respiratory sites, notably the anterior nares, nasal cavity-the inferior turbinate's, septum and floor. It is a chronic disease, with frequent recurrence after surgery and occasional dissemination from initial focus .Rhinosporidial lesions in the nasal passages are Polypoidal, granular, red in colour due to pronounced vascularity, with a surface containing yellowish pin head sized spots which represents underlying mature sporangio. The organism is difficult to culture and diagnosis is based on microscopy and histological examination of the lesion. The mainstay of treatment is meticulous complete and wide surgical excision, followed by electro-cautery of the base may ablate recurrence resulting from the spillage of endospore on the adjacent mucosa and recently use of laser is also indicated. We present a thrice operated recurrent case of extensive Rhinosporidiosis involving left nose & nasopharynx where the disease was removed using bipolar cautery, microdebrider and laser assisted.

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