Tuesday, December 28, 2010

Rhinosporidiosis

It is a fungal granuloma caused by Rhinosporidium seeberi.
It is seen in India, Pakistan and Sri Lanka. In India, most
of the cases are seen in southern states though several
cases have also been reported from other parts of the
country.
Clinical features. The disease mostly affects nose and
nasopharynx; other sites such as lip, palate, conjunctiva,
epiglottis, larynx, trachea, bronchi, skin, vulva, vagina may
also be affected.
The disease is acquired through contaminated water
of ponds also frequented by animals. In the nose, the disease
presents as a leafy, polypoidal mass, pink to purple in
colour and attached to nasal septum or lateral wall.
Sometimes, it extends into the nasopharynx and may
hang behind the soft palate. The mass is very vascular
and bleeds easily on touch. Its surface is studded with
white dots representing the sporangia of fungus.
In early stages, the patient may complain of nasal discharge
which is often blood-tinged, or nasal stuffiness.
Sometimes, frank epistaxis is the only presenting complaint.
Diagnosis is made on biopsy. It shows several sporangia,
oval or round in shape and filled with spores which may be
seen bursting through its chitinous wall. It has not been
possible to culture the organism or transfer the disease to
experimental animals.
Treatment is complete excision of the mass with
diathermy knife and cauterisation of its base. Recurrence
may occur after surgical excision. Not many drugs are
effective against the disease. Dapsone has been tried with
some success.

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