Pathogenesis and Clinical Management of Rhinosporidiosis

Rhinosporidiosis is a chronic granulomatous disease caused by the protistan parasite Rhinosporidium seeberi. Infection follows contact with contaminated water or soil, enabling endospores to invade mucosal surfaces of the nasal cavity, conjunctiva or, more rarely, the tracheobronchial tree. At the site of attachment, the organism develops large sporangia that mature and release numerous endospores, provoking a persistent granulomatous inflammatory response. Clinically, this manifests as friable, polypoid masses prone to bleeding and local obstruction. Definitive diagnosis relies on histopathological examination of excised tissue, which reveals characteristic thick-walled sporangia containing endospores, often highlighted by special stains. Molecular techniques such as polymerase chain reaction have increased diagnostic sensitivity in atypical presentations. Surgical excision with electrocautery or laser-assisted removal of the lesion’s base remains the mainstay of treatment, yet recurrence rates remain high. Adjunctive medical therapy, most notably dapsone, is deployed to arrest sporangial maturation and reduce relapse risk. Novel endoscopic and adjunctive pharmacological strategies are under evaluation to improve outcomes. Given its tropical and subtropical epidemiology, rhinosporidiosis poses global health challenges through travel and migration, and recognition of unusual sites of involvement is essential for timely management.

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Pathogenesis and Clinical Management of Rhinosporidiosis publication trend

The graph below shows the total number of articles in pathogenesis and clinical management of rhinosporidiosis across all publications each year (not limited to Nature Index journals).

Technical terms

Granulomatous inflammation: A chronic immune response characterised by aggregates of activated macrophages (epithelioid cells) often with multinucleate giant cells, surrounding persistent organisms or foreign material.

Sporangia: Thick-walled structures formed by Rhinosporidium seeberi in host tissue, each containing numerous endospores.

Endospores: Reproductive spores released from mature sporangia that propagate infection within host tissues.

Cauterisation: The application of heat or cautery to destroy residual infected tissue and minimise risk of recurrence following surgical excision.

Dapsone: A sulfone antimicrobial agent that inhibits sporangial maturation and has been used adjunctively to lower relapse rates in rhinosporidiosis.

References

1. Case Report of Nasal Rhinosporidiosis in South Africa - Volume 30, Number 4—April 2024 - Emerging Infectious Diseases journal - CDC. Emerging Infectious Diseases (2024).
2. Detection and Identification of Previously Unrecognized Microbial Pathogens - Volume 4, Number 3—September 1998 - Emerging Infectious Diseases journal - CDC. Emerging Infectious Diseases (1998).
3. Tracheobronchial rhinosporidiosis: an uncommon life‐threatening benign cause of airway obstruction. Respirology Case Reports (2020).
4. A new technique to resolve Nasal Rhinosporidiosis: A case report with review of literature. International Journal of Surgery Case Reports (2022).