Rhinosporidiosis: Experience in an Endemic Area in India

Abstract
This article discusses the personal experience of the author in the management of rhinosporidiosis. Living in an endemic area of disease, the author had the privilege of managing about 200 cases of rhinosporidiosis during 2005 to 2010. The commonest area of involvement happened to be nasal cavity. Inside the nasal cavity, rhinosporidiosis was commonly seen arising from the inferior meatus. All of these patients gave a history of bathing in ponds, which could account for the common etiopathogenic factor. All of the cases were managed by surgical resection, followed by a 9-month course of T Dapsone, to minimize risk of recurrence. Despite these measures, the author had a recurrence rate of about 19%. Imaging really provided a road map, as a majority of these lesions were removed endoscopically.

Introduction

Rhinosporidiosis has been defined as a chronic granulomatous disease characterized by production of polyps and other manifestations of hyperplasia of nasal mucosa. (1) The etiological agent is Rhinosporidium seeberi. Rhinosporidium seeberi was initially believed to be a sporozoan, but it is now considered to be a fungus and has been provisionally placed under the family Olipidiaceae, order chytridiales of phycomycetes by Ashworth. More recent classification puts it under DRIP's clade (2). Even after extensive studies, there is no consensus on where Rhinosporidium must be placed in the taxonomic classification. It has not been possible to demonstrate fungal proteins in Rhinosporidium even after performing sensitive tests like polymerase chain reactions.

History
It has been known for over 100 years, since it was first discovered in Argentina. (4)

1892 - Malbran observed the organism in a nasal polyp (3)
1900 - Seeber described the organism (3)
1903 - O'Kineley described its histology
1905 - Minchin & Fantham studied O'Kineley's tissue and named the organism as Rhinosporidium Kinealyi
1913 - Zschokke reported a similar organism in horses and named it Rhinosporidium equi
1923 - Ashworth described its life cycle (4, 5)
1924 - Forsyth described skin lesion
1924 - Thirumoorthy reported the first female patient (4)
1936 - Cefferi established the identity of R. Seeberi and R. Equi
1953 - Demellow described the mode of its transmission

Incidence and Geographical distribution
Of all the reported cases, 95% were from India and Sri Lanka (4). An all-India survey conducted in 1957 revealed that this disease is unknown in the states of Jammu & Kashmir, Himachal Pradesh, Punjab, Haryana, and the Northeastern states of India. In the state of Tamilnadu (4), endemic areas have been identified in the survey: Madurai, Ramnad, Rajapalayam, and Sivaganga. The common denominator in these areas is the habit of people taking baths in common ponds.
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This entry was posted in Otolaryngology (ENT), Primary Care and tagged . Volume: .

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