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Fig. 6.65 A, B. Candidiasis of the stomach. A Barium contrast study showed decreased peristalsis in the stomach, with rigidity and narrowing of the body and pylorus. The mucosal folds are lost: the barium coats the fungal membranes in the stomach and the appearance suggests that there are food particles and even gastric ulcers. This patient was a severe diabetic who had not taken anything by mouth for weeks. Endoscopy showed a membrane in the stomach and multiple small ulcers. B The patient after 2 weeks of treatment: the peristalsis has returned and the gastric mucosa is normal. It may take some weeks before recovery is complete.

Fig. 6.66 A-C Candidiasis of the urinary tract. A A contrast urogram of a 17-year-old male shows multiple negative filling defects in the renal collecting system due to a mass of hyphae and yeast forms. AFIP 229498-246. B,C A contrast urogram of an elderly female who complained of "endless" urinary infections. She was a severe, poorly controlled diabetic. There was poor function of the left kidney and a large fungus ball has filled the bladder. Culture confirmed Candida albicans. AFIP 229498-247

 

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Rhinosporidiosis

Rhinosporidium seeberi is included with the fungi although it has not been successfully cultured in artificial culture medium and the taxonomic position is uncertain.

This organism was originally thought to occur in the nostrils (hence its name) but has now been found in the ears, eyes, mouth, and larynx, as well as the urethra. Dissemination has occurred, with multiple skin and subcutaneous infections, as well as in the liver, spleen, lung, and kidneys. Bone infections in the hands and feet serve to emphasize that rhinosporidiosis is not restricted to the nostrils.

Definition

Rhinosporidiosis is infection with Rhinosporidium seeberi (Coccidium seeberi).

Geographic Distribution

The infection is found worldwide but is particularly common in Sri Lanka and in some areas of India. It is common in Madras (in southern India), rare in Central India. The next highest prevalence is in South America, where there are endemic foci, and in Africa; it has been reported from the United States. It is much less common in Europe and more temperate climates.

Epidemiology and Pathology

The organism has not been cultured, except in association with living cells, nor has it been identified other than in humans and some animals, particularly dogs and horses. Its natural habitat and the routes of infection and transmission are still unknown, although trauma is thought by some to be essential before the infection can start. Human eye infection has been linked to bathing in stagnant water or working in paddy fields. Nasal infection seem to be more common where there are storms or in those who work in sandy river beds. Not surprisingly, it is therefore more common in males from 20 to 40 years old.

Transmission from human to human is unknown. Although infections have been recognized in the female genital tract and rectum, sexual transmission has not been documented. Mucocutaneous lesions usually occur in the nose or eye. Thus, although the epidemiology is well documented, the source and ways of transmission remain a mystery.

The tissue reaction is a chronic inflammation with occasional foreign body giant cells. Hyperplastic growth of overlying epithelium gives rise to friable polyps and the spherical fungi (sporangia) may be clinically visible as white spots (Figs. 6.67, 6.68 A). The thick-walled sporangium contains hundreds of endospores developing at different rates. The underlying fibromyxomatous connective tissue may be hyperemic. Regional lymph nodes are not usually affected.

The diagnosis is made by recognition of the fungus, either from the surface of the polyp or by histopathology. The sporangia of R. seeberi are much larger than and thus easily differentiated from the spherules of Coccidioides immitis. Serology and animal inoculation are not helpful.


 

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