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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 4  |  Issue : 1  |  Page : 72-74

Conjunctival oculosporidiosis: A case report from a nonendemic zone in India


1 Department of Microbiology, College of Medicine and Sagore Dutta Hospital, Kamarhati, India
2 Department of Pathology, Vivekananda Institute of Medical Science, Kolkata, India
3 Department of Cardiology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India

Date of Web Publication2-Jun-2016

Correspondence Address:
Nandita Pal
Department of Microbiology, College of Medicine and Sagore Dutta Hospital, Kamarhati, Kolkata - 700 058, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-4848.183373

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  Abstract 

Oculosporidiosis or rhinosporidial infection of eye, a rarely encountered disease outside the endemic coastal areas of South India, is caused by Rhinosporidium seeberi. A 12-year-old patient presented with polypoidal conjunctival lesion of the right eye in a tertiary care hospital at West Bengal, India. Excision of the lesion followed by microbiological and histopathological examination confirmed the unique infectious etiology of the lesion. Oculosporidiosis should be included in the differential diagnosis of conjunctival polypoidal lesions even in nonendemic areas because misdiagnosis and improper management may lead to increased incidence in the same zones.

Keywords: Conjunctival oculosporidiosis, palpebral conjunctiva, rhinosporidiosis


How to cite this article:
Pal N, Adhikary M, Chatterjee RN, Majhi B. Conjunctival oculosporidiosis: A case report from a nonendemic zone in India. Arch Med Health Sci 2016;4:72-4

How to cite this URL:
Pal N, Adhikary M, Chatterjee RN, Majhi B. Conjunctival oculosporidiosis: A case report from a nonendemic zone in India. Arch Med Health Sci [serial online] 2016 [cited 2019 Aug 25];4:72-4. Available from: http://www.amhsjournal.org/text.asp?2016/4/1/72/183373


  Introduction Top


Rhinosporidiosis is a chronic and localized infection of mucus membrane caused by Rhinosporidium seeberi , which presents as polypoidal and vascular nasal mass. Oculosporidiosis i.e., rhinosporidiosis of eye, accounts for 15% of cases and is the 2nd most common endemic site primarily involves bulbar and palpebral conjunctiva; others are lacrimal sac, conjunctiva, and sclera with a typical monocular involvement.[1],[2] In India, oculosporidiosis is endemic in the states of Kerala, Tamil Nadu, Pondicherry, and Chhattisgarh.[3],[4] Until now, only four cases of conjunctival oculosporidiosis have been reported from West Bengal.[5],[6],[7] This is usually an incidental diagnosis in histological section of an excised conjunctival mass.[6] We report this rare case in a 12-year-old boy.


  Case Report Top


A 12-year-male child presented with a painless, red polypoidal mass in the lower part of his right eye, gradually enlarging over 5 months at the Ophthalmology outpatient department in a tertiary care hospital in Kolkata, West Bengal, India. Patient had also complained of mild irritation and watering from the right eye. There was no history of any traveling, ocular trauma, or contact with animals. The patient was a pond bather.

The right eye showed a solitary red colored lesion in the inferonasal quadrant, partially overriding the lower lid margin. On close examination, the polypoidal mass was found to be originating from the inferior palpebral conjunctiva. Its surface was studded with multiple white dots. Lesion did not bleed to touch. Visual acuity and the rest of the ocular, otolaryngological, and systemic examination were within the normal limits. Left eye did not show any abnormality. His routine blood examination was unremarkable. The case was suspected to be a conjunctival papilloma of the right eye. Excision biopsy was performed under local anesthesia, and the base of the mass was cauterized. Excised mass was sent for microbiological and pathological analysis.

The Gram's stain of crushed smear made from the biopsy specimen showed multiple bunched-up Gram-positive spore-like structures. There was no growth on routine bacteriological and fungal culture media even after prolonged incubation. Histopathological examination of the biopsied mass revealed thick-walled (chitinous) capsules filled with rounded periodic acid-Schiff (PAS)-positive, refractile spore-like bodies in a fibromyxomatous stroma, consistent with R. seeberi infection [Figure 1] and [Figure 2]. Surrounding tissue showed diffuse lymphoplasmacytic cell infiltrate admixed with eosinophils and occasional neutrophils. Stromal hyperplasia was noted focally. A diagnosis of oculosporidiosis was confirmed.
Figure 1: Periodic acid-Schiff stain (×10) multiple sporangia

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Figure 2: Periodic acid-Schiff stain (×100) multiple periodic acid-Schiff-positive, refractile spores within capsule

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  Discussion Top


R. seeberi is now considered an aquatic protistan parasite belonging to a novel group of fish parasites that infect fish and amphibians, located phylogenetically between the fungal animal divergence on basis of molecular biological analysis of the organism's ribosomal DNA.[1],[8] Attempts to culture this unique organism have not been successful.[3] The presentation in the eye can be in the form of a swelling in the lacrimal region, a polypoidal conjunctival mass, a lid mass and rarely as a scleral mass which can cause scleral melting.[2],[9] Recurrence rate is low.[3] It thrives in hot, tropical climates. In India, oculosporidiosis is endemic in Kerala, Tamil Nadu, Pondicherry, and Chhattisgarh and occurs sporadically in Maharashtra, Madhya-Pradesh, West Bengal, Bihar, and Orissa.[4],[8]

The physical appearance of the polypoidal lesion and also the unusual site of the lesion and rare occurrence in this part of the country aroused diagnostic dilemma in the present case. However, clinical finding of multiple white dots on the surface of the mass which represented as developing sporangia in histopathological examination, confirmed the unique infection. Similar incidences had been reported previously.[2],[7],[10]

This patient did not provide any history of trauma and also was a regular pond bather. The modes of infection and transmission are not known definitely and may include trauma and water or dust exposure. According to David and Sivaramasubrahmanyan, the preponderance of infection in the lower palpebral conjunctiva may be due to the fact that the lower palpebral conjunctiva may be easily everted and exposed to dust and water. The downward flow of the lacrimal fluid may also aid the spores to settle down in the lower palpebral conjunctiva.[9]

Until date, only four cases have been reported from India, two cases by Sengupta et al ., one case by Parthasarathi et al ., and one case by Ghosh et al .[5],[6],[7]


  Conclusion Top


A proper diagnosis is essential to update the epidemiology of this unique infection. Occurrence of primary oculosporidiosis in a nonendemic region though rare until date, owing to the lack of documentation or otherwise, predicts the necessity of awareness regarding such incidence.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Chander J. Rhinosporidiosis. Textbook of Medical Microbiology. 3rd ed. India: Mehta Publishers; 2009. p. 462-73.  Back to cited text no. 1
    
2.
Arora R, Ramachandran V, Raina U, Mehta DK. Oculosporidiosis in Northern India. Indian Pediatr 2001; 38:540-3.  Back to cited text no. 2
    
3.
Hafeez MA, Tandon PL. Rhinosporidiosis of the conjunctiva. Indian J Ophthalmol 1965;13:114-6.  Back to cited text no. 3
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4.
Chowdhury RK, Behera S, Bhuyan D, Das G. Oculosporidiosis in a tertiary care hospital of western Orissa, India: a case series. Indian J Ophthalmol 2007;55:299-301.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.
Sengupta M, Mitra BK, Sarkar PK. Rhinosporidiosis of the palpebral conjunctiva. Indian J Ophthalmol 1958;6:39-40.  Back to cited text no. 5
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6.
Parthasarathi R, Sen S, Khan M. Conjunctival rhinosporidiosis. J Indian Med Assoc 2003;101:667-8, 670.  Back to cited text no. 6
    
7.
Ghosh AK, De Sarkar A, Bhaduri G, Datta A, Das A, Bandyopadhyay A. Ocular rhinosporidiosis. J Indian Med Assoc 2004;102:732, 764.  Back to cited text no. 7
    
8.
Pandey N, Chandrakar AK, Garg ML, Patel SS. Oculosporidiosis. Indian J Ophthalmol 2008;56:81.  Back to cited text no. 8
[PUBMED]  Medknow Journal  
9.
David SS, Sivaramasubrahmanyan P. Ocular rhinosporidiosis – (A study of twenty one cases). Indian J Ophthalmol 1973;21:204-7.  Back to cited text no. 9
  Medknow Journal  
10.
Makannavar JH, Chavan SS. Rhinosporidiosis – A clinicopathological study of 34 cases. Indian J Pathol Microbiol 2001;44:17-21.  Back to cited text no. 10
[PUBMED]  Medknow Journal  


    Figures

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