An unusual cause of recurrent bloody tear.

We describe a female patient who presented with watering followed by swelling in the left infraorbital area of 5 years duration. She had previously been prescribed topical antibiotics on several occasions with no improvement. On pressure over the swelling, there was blood-tinged discharge from the left eye and nostril. Magnetic resonance imaging revealed an enhancing, well-defined mass lesion in the inferomedial aspect of the left orbit, likely of nasolacrimal origin. Computed tomography dacryocystogram with three-dimensional reconstruction showed a well-circumscribed mass with an irregular surface, originating from the lacrimal sac. Gram staining and potassium hydroxide mount from the regurgitant fluid revealed thick-walled cysts with sporangia suggestive of Rhinosporidium seeberi infection. Excision biopsy of the lesion confirmed R. seeberi as the causative agent. The patient has been put on long-term dapsone therapy to prevent a recurrence and has been asked to follow-up 6 months later.

Detection of 16S rRNA gene in round bodies isolated from polyps of rhinosporidiosis.

Polyps of rhinosporidiosis contain microscopic round bodies, believed to be causative agents of the disease. The source and identity of these round bodies has been debated ever since the first case was described in the year 1900. Most patients have a history of exposure to pond water. Collection and microscopic analysis of pond water samples where patients had been dipping led to the idea that a cyanobacterium could possibly develop into round bodies after entering the patient's nose. Molecular genomic studies based on PCR, cloning, and sequencing were, therefore, carried out using purified DNA, extracted from individually separated round bodies from polyp samples. Parallel investigations were also conducted on DNA extracted from cyanobacterium Microcystis isolated from pond water samples. The results of these experiments presented here provide evidence of the presence of 1458 bp 16S rRNA gene in round bodies. This is the first molecular study indicating the prokaryotic identity of round bodies in rhinosporidiosis.

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.

Tropical dermatology: fungal tropical diseases.

UNLABELLED: Fungal infections are common in tropical countries and can have an important impact on public health. Lobomycosis is a common fungal infection in the tropical rain forest of South America, and paracoccidioidomycosis (South American blastomycosis) is a widespread and sometimes severe illness. Penicilliosis marneffei is an opportunistic infection of AIDS patients in southeast Asia. Chromoblastomycosis and mycetomas are causes of morbidity around the world. Sporotrichosis is a worldwide subcutaneous mycosis with a high incidence in tropical countries and is an important illness in immunocompromised patients. Rhinosporidiosis was classed as a fungal infection but is now considered a protistan parasite that belongs to the class Mesomycetozoea. It is included in this review because of its historical classification. In the past, most of these mycoses were restricted to specific geographic areas and natural reservoirs. There are, however, situations in which people from other regions come in contact with the pathogen. A common situation involves an accidental contamination of a traveler or worker who has contact with a tropical mycosis. Even minor trauma to the skin surface or inhalation of the fungal conidia can infect the patient. Thus recognition of the clinical symptoms and the dermatologic findings of the diseases, as well as the geographic distribution of the pathogens, can be critical in diagnosis of the tropical mycoses. This review discusses some of the more common tropical subcutaneous and systemic mycoses, as well as their signs, symptoms, methods of diagnosis, and therapies. LEARNING OBJECTIVE: At the completion of this learning activity, participants should be able to recognize the clinical and histologic presentations of tropical fungal diseases with cutaneous manifestations and be familiar with the appropriate therapies.

Lacazia loboi and Rhinosporidium seeberi: a genomic perspective.

In the past five years, with the use of molecular strategies the phylogenetic affinities of the two more resilient pathogens studied in medical mycology, Lacazia loboi and Rhinosporidium seeberi were finally deciphered. These studies found that L. loboi was the sister taxon to Paraccidioides brasiliensis, and R. seeberi was closely related to protistan spherical aquatic fish pathogens, located at the point were animals diverged from the fungi, in the class Mesomycetozoea. These initial studies indicated that a molecular strategy was the ideal approach to further understand these anomalous pathogens. However, the limited amount of information gathered so far from few DNA sequences, although crucial to place these organisms in the tree of life and to take a glance to their ecological preferences, did not provide answers to other important traits. In the following pages we discuss a genomic perspective for both pathogens and the benefit that such information could generate to understand more about these two uncultivated pathogens.

Immunolocalization of an endogenous antigenic material of Rhinosporidium seeberi expressed only during mature sporangial development.

We investigated the immunolocalization of Rhinosporidium seeberi's antigens using sera from individuals infected with R. seeberi and tissue from Sri Lankan patients with rhinosporidiosis. The tissues were fixed in LR white resin, thin sectioned fixed onto nickel grids and evaluated by transmission electron microscopy for the presence of R. seeberi's sporangia. The tissue samples were reacted with the patients's sera and then labeled with protein A colloidal gold (PACG) for immunolocalization. It was found that the PACG had fixed to antibodies that specifically recognized an internal electron lucent layer situated immediately under the mature sporangium's wall. Strikingly, the endospores, the juvenile and intermediate sporangia did not undergo PACG labeling. This study found that the expression of this antigen occurs only in the final developmental stages of R. seeberi's mature sporangia. Our data may explain why circulating antibodies to R. Seeberi were not detected before in studies that used endospores as antigen in immunoassays. This is the first report in which an antigenic material with a potential role in the immunology of rhinosporidiosis has been detected.

Conjunctival rhinosporidiosis associated with scleral melting and staphyloma formation: diagnosis and management.

PURPOSE: Although conjunctival rhinosporidiosis is endemic in India, associated scleral melting and staphyloma formation are quite rare. We report clinical features and management in three patients with this unusual presentation. METHODS: Retrospective review of case records of three patients with conjunctival rhinosporidiosis. RESULTS: Infection occurred in young, healthy adults and was localized to the forniceal conjunctiva in all patients. The affected conjunctiva had numerous grey-white spherules, but a polyp-like lesion was not present in any patient. Diagnosis was based on clinical features and examination of scrapings from the involved conjunctiva. Treatment was surgical, with excision of infected conjunctival tissues and staphyloma repair with homologous sclera or autogenous periosteum. Failure to recognize the conjunctival pathology in one patient resulted in recurrence of the staphyloma. CONCLUSION: Conjunctival rhinosporidiosis can be associated with scleral staphyloma in young, healthy, adults. Differentiating this entity from idiopathic scleral ectasia requires knowledge of the clinical features of conjunctival rhinosporidiosis and a high index of clinical suspicion.

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.

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.

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.

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.

Disseminated rhinosporidiosis.

This paper reports a case of rhinosporidiosis which presented with widespread subcutaneous nodular lesions which failed to respond to surgical excision or to intravenous amphotericin B. Lesions in sites away from the nasal cavities are usually believed to be brought about by direct infection or by fingerborne autoinoculation. In this case, haematogenous dissemination was shown by the presence of sporangia within the lumen of a blood vessel. Systemic rhinosporidiosis is an extremely rare condition.

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 presenting as urethral polyp.

Rhinosporidiosis is a very common disease endemic in India, Ceylon, East Africa and part of America. Extremely rare in Europe. Nose, naso-pharynx, nasal sinuses, larynx are the common sites of affection, but urethral lesion is very rare. Reports from India so far as our knowledge goes are not available. Symmers may be the only case report available so far. For the rarity of site of affection, the case is reported.

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.

[Nasal rhinosporidiosis]. / Rinosporidiosis nasal.

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.