218 An Introduction to Medical Mycology 



(a) Etiology.— Almost all humans affected are children and young men. 

 Horses, cattle and mules have been found infected. Trauma has been con- 

 sidered a factor. There is no evidence that the fungus causing the disease 

 ( Rhinosporidium seeberi) is air-borne. Stagnant water is suspected as a 

 source. 



(b) Clinical characteristics.— In a predominant number of cases, the 

 disease is confined to the anterior nares. Occasionally it spreads to other 

 sites on the face or to the posterior nares. At first there is a mucoid discharge 

 and pruritus is troublesome. The lesions develop slowly, are sessile but later 

 tend to become pedunculated and may eventually weigh up to 20 Gm. The 

 tumor mass is red, soft, moist, friable and lobulated. Older lesions become 

 verrucous and may resemble a cauliflower. When the disorder is neglected, 

 the pharynx and larynx are not uncommon sites for extension, and obstruc- 

 tion is produced. The conjunctiva may be involved; the lesions are red, 

 polvpoid and speckled, and bleed readily. 



(c) Histology.— There is downgrowth of the epithelium, which is some- 

 what acanthotic. The connective tissue proliferates, and new blood vessels 

 are present in large numbers. Chronic granulation tissue is present in the 

 cutis. The predominant inflammatory cell is the plasma cell. Fungi sur- 

 rounded by leukocytes may be present in clumps in the upper cutis, de- 

 tectable clinically as white or yellow specks. 



(d) Differential diagnosis.— The site of the lesion, the readiness to 

 hemorrhage and the mottled appearance of the lesion are suggestive points, 

 and a definite diagnosis can usually be established by direct examination 

 of material from the lesion or from the nasal secretion. The lesions of blas- 

 tomycosis and of paracoccidioidal granuloma are not vascular but are 

 firm, papillomatous and crusted. Tuberculosis affecting the anterior nares 

 would be present only if the patient had pulmonary involvement. Car- 

 cinoma is rarely seen in this site and usually shows a rolled edge. Granu- 

 loma pyogenicum bleeds easily but is a firmer, more rapidly growing tumor. 



(e) Prognosis.— The lesions are usually only of local significance. Unless 

 thoroughly destroyed, they tend to recur. 



(f) Treatment.— Some form of local destructive treatment, such as 

 electrodesiccation, is indicated. 



BIBLIOGRAPHY 



Allen, F., and Dave, M. L.: Treatment of rhinosporidiosis in man based on study of 60 cases, 



Indian M. Gaz. 71:376, 1936. 

 Ashworth, J. H., and Turner, A. L.: Case of rhinosporidiosis, Edinburgh M. J. 30:337, 1923. 

 Barnshaw, H. I., and Read, W. T., Jr.: Rhinosporidiosis of conjunctiva. Arch. Ophth. 



24:357, 1940. 

 Karunaratne, W. A. E.: Rhinosporidiosis in Man (Ceylon: Columbo Catholic Press, 1939). 



