Understanding Rhinosporidiosis and Rhinoscleroma

There are some conditions like inflammatory diseases, infectious diseases, neoplasms, trauma, and cocaine abuse that can cause granulomatous conditions in the nose. Some infections such as invasive fungal rhinosinusitis and rhinoscleroma have a chronic course, therefore they need regular checkups, pharmacological treatment, and sometimes surgical management.

Rhinoscleroma

• It is a bacterial infection and it has a granulomatous course of disease.
• Gram-negative bacillus like Klebsiella rhinoscleromatis is the causative agent of this disease.
• Rhinoscleroma is endemic in northern parts of India as compared to southern parts.
• The mode of transmission is through air droplet infection.

• The clinical features are divided into various stages:

1. Stage 1: Atrophic stage
   • In this stage, the bacteria destroy the mucin-producing cells. The immunoglobulins are present in these cells and due to the destruction of these cells immunoglobulins will be absent which will help the bacteria to grow at the site and hence there will be no mucus present.
   • This leads to dryness of the nose which results in foul-smelling purulent nasal discharge and crust.
2. Stage 2: Granulomatous stage
   • In this stage, the body's immune system starts fighting against the bacteria and it forms the granuloma.
   • Nodules in the nose give rise to a woody feel.
   • This leads to the production of a woody Hard nodule that results in deformity of the nose, it is also known as a Hebra nose.
   • The nodules are seen in the lower part of the external nose and lip.
   • Sometimes the nodules are painless and nonulcerative.
3. Stage 3: Cicatrizing stage or stage of healing- It is the third stage of rhinoscleroma and it is also called as stage of the healing period.
   • This stage results in stenosis of the nears and nasopharynx. It is also called a Tapir nose deformity.
   • The disease starts in the nose and spreads to the pharynx, larynx, trachea, and bronchus. 
   • In the Laryngeal scleroma, the most affected site is the subglottic larynx

Also Read: Nasal Septal Deviation: Causes, Types, Clinical Features and Treatment

Diagnosis of Rhinoscleroma

• Own biopsy or histopathological examination there are two types of cells present. These are:
  • Mikulicz cells- These are vacuolated histiocytes.
  • Russell bodies- These are eosinophilic inclusions in the plasma cells.
• The culture medium used is MacConkey’s agar medium.

Also Read: Tumors of Nose and Sinuses Types

Treatment of Rhinoscleroma

• The medical therapy is the first line of treatment in less severe disease.
  • Streptomycin and Tetracycline for a minimum period of 4-6 weeks.
  • After four to six weeks of treatment, the culture samples are repeated and examined.
  • If the culture is positive, then continue the treatment but if the culture is negative, we have to take another repeat culture after one week. If after one week the culture is still negative, then stop the treatment.
• Steroids are given to decrease fibrosis in the cicatrization stage.
• Acriflavine is given to treat the skin inflammation. It is a topical therapy for the nodules.
• In case of severe presence of necrotic tissue, surgery is preferred to debride the dead tissue.
• In rare cases, irradiation can be used.

Also Read: Nasal Polyposis: Clinical Types, Pathogenesis and Management

Rhinosporidiosis

• It is not a bacterial, viral or fungal infection. This infection is caused by an aquatic protozoa known as Rhinosporidium Seeberi.
• It is a waterborne disease.
• It is prevalent in South Asian countries like India, Pakistan, and Sri Lanka.

Pathogenesis of Rhinosporidiosis

• These protozoa multiply in layers of the epidermis of the nasal cavity and they form a red polypoidal mass.
• The mass is highly vascular and contains spores which appear as whitish dots.
• This red polypoidal mass with whitish dots resembles a strawberry-like mass in the nasal cavity.

On histopathological examination:

• The sporangia with the spores will be found.
• Diagnosis cannot be established on culture.
• It is mainly established by history, clinical examination, and histopathological examination.

Also Read: EPISTAXIS- Anatomy, Classification and Management

Symptoms of Rhinosporidiosis

The bleeding from the nose is the primary manifestation of rhinosporidiosis.

• The patient will present with features of nasal obstruction and difficulty in breathing.
• External polypoidal nose results in cosmetic problems and the patient’s routine social life will be altered.

Treatment of Rhinosporidiosis

• Surgery followed by medical treatment is the intervention of choice.
• Complete excision of the mass with a diathermy knife and cauterization of its base is done.
• Recurrence is very common in rhinosporidiosis.
• Medical treatment is Dapsone. However, Dapsone is partially effective and can be given to reduce the recurrence.

Also Read: Olfactory Disorders – Pathway, Work up And Causes

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