Rhinosporidiosis

seminar

1. RHINOSPORIDIOSIS By Dr Basavaraj Patil DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY INHS ASVINI

2. Introduction History Incidence Mode of spread Life cycle Cardinal features Clinical manifestations Investigations Treatment. DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY INHS ASVINI

3. Introduction Rhinosporidiosis is a chronic granulomatous infective disorder caused by Rhinosporidium seeberi , whose taxonomy is still debated DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY INHS ASVINI Sinha A, Phukan JP, Bandyopadhyay G, et al. Clinicopathological study of rhinosporidiosis with special reference to cytodiagnosis .  J Cytol . 2012;29(4):246–249. doi:10.4103/0970-9371.103943

4. History & Taxonomy 1892- regarded as a sporozoan by Malbran , its discoverer, in nasal polyp 1900- Protozoan by Guillermo Seeber who first published a description of the pathogen 1923- Phycomycete by Ashworth Herr et al classified the organism in a new clade - Mesomycetozoa , which includes fish and amphibian pathogens in the former DRIP clade ( Dermocystidium , the rossette agent, Ichthyophonus and Psorospermium ). 1953 - Demellow described the mode of its transmission DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY INHS ASVINI Indian Journal of Medical Microbiology, (2002) 20 (3):119-131

5. INCIDENCE AND GEOGRAPHICAL DISTRIBUTION India and Sri Lanka. DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY INHS ASVINI Sinha A, Phukan JP, Bandyopadhyay G, et al. Clinicopathological study of rhinosporidiosis with special reference to cytodiagnosis .  J Cytol . 2012;29(4):246–249. doi:10.4103/0970-9371.103943

6. Hypothesized Mode of Spread Theories Demellow's theory of direct transmission. Autoinoculation theory of Karunarathnae (responsible for satellite lesions). Haematogenous spread - to distant sites DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY INHS ASVINI Prakash M, Johnny JC. Rhinosporidiosis and the pond.  J Pharm Bioallied Sci . 2015;7( Suppl 1):S59–S62. doi:10.4103/0975-7406.155804

7. Classifications Nose and nasopharynx were the most commonly affected sites (74.6%), followed by eye (19%). Other rare sites accounted for (6.3%) Lips, Palate, Uvula, Maxillary Antrum, Epiglottis, Larynx, Trachea, Bronchus, Ear, Scalp, Vulva, Penis, Rectum and Skin DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY INHS ASVINI Sinha A, Phukan JP, Bandyopadhyay G, et al. Clinicopathological study of rhinosporidiosis with special reference to cytodiagnosis .  J Cytol . 2012;29(4):246–249. doi:10.4103/0970-9371.103943

8. Reasons for endemicity : Aquatic micro-organisms might also be relevant to a possible synergistic action in the establishment of natural rhinosporidiosis . * Blood group studies indicate that rhinosporidiosis is common in patient's with group O (70%), the next high incidence was in group AB.** Cultureal practice** Climatic conditions** Physiochemical properties of water** DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY INHS ASVINI *Indian Journal of Medical Microbiology, (2002) 20 (3): 119-131 ** Prakash M, Johnny JC. Rhinosporidiosis and the pond.  J Pharm Bioallied Sci . 2015;7( Suppl 1):S59–S62. doi:10.4103/0975-7406.155804

9. LIFE CYCLE DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY INHS ASVINI

10. Cardinal features The cardinal features of rhinosporidiosis are Chronicity Recurrence Dissemination DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY INHS ASVINI

11. REASONS FOR CHRONICITY Antigen sequestration Antigenic variation Immune suppression Immune distraction Binding of host immunoglobulins DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY INHS ASVINI

12. Clinical manifestations DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY INHS ASVINI Sinha A, Phukan JP, Bandyopadhyay G, et al. Clinicopathological study of rhinosporidiosis with special reference to cytodiagnosis .  J Cytol . 2012;29(4):246–249. doi:10.4103/0970-9371.103943

13. Karthikeyan P, Vijayasundaram S, Pulimoottil DT. A Retrospective Epidemiological Study of Rhinosporidiosis in a Rural Tertiary Care Centre in Pondicherry.  J Clin Diagn Res . 2016;10(5):MC04–MC8. doi:10.7860/JCDR/2016/17465.7788 DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY INHS ASVINI

14. Gross features DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY INHS ASVINI Sinha A, Phukan JP, Bandyopadhyay G, et al. Clinicopathological study of rhinosporidiosis with special reference to cytodiagnosis .  J Cytol . 2012;29(4):246–249. doi:10.4103/0970-9371.103943

15. HISTOLOGY DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY INHS ASVINI Sinha A, Phukan JP, Bandyopadhyay G, et al. Clinicopathological study of rhinosporidiosis with special reference to cytodiagnosis .  J Cytol . 2012;29(4):246–249. doi:10.4103/0970-9371.103943

16. Investigations Histology is the mainstay of diagnosis . A diagnosis of the disease can be made by simple aspiration cytology, the examination of aspirated material with Gomori methenamine silver and periodic acid–Schiff reaction, and the presence of the organism indifferent stages of maturation even in the absence of a histopathological study. It has to be differentiated from coccidiomycosis . Endospores of coccidiomycosis have sporangia of smaller size. DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY INHS ASVINI

17. TREATMENT SURGICAL – endoscopic excision and cauterization of the base -laser excision MEDICAL Dose of Dapsone - 100 mg once daily for 6 months to several years.Check LFT and blood counts every 2 weeks. DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY INHS ASVINI

18. Conclusion Rhinosporidiosis shows both long duration & tendency for recurrence. Recurrent seeding of circulation with spores from nose & nasopharynx may lead to involvement of non mucosal sites. Trans epithelial infection is also important for recurrence in sites & extension to nearby sites. Failure to remove all infected tissues at the time of surgery & implantation of spores in fresh areas of abrasions may cause recurrence. Removal of growth by snare without cauterisation was considered to result in dissemination & recurrence. Good result obtained with diathermy was explained on the basis that it avoids implantation of spores & destruction is deep. DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY INHS ASVINI

19. THANK YOU DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY INHS ASVINI