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LETTER TO THE EDITOR
Year : 2008  |  Volume : 56  |  Issue : 2  |  Page : 165

Oculosporidiosis in a tertiary care hospital of Western Orissa, India


Department of Ophthalmology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal

Date of Web Publication16-Feb-2008

Correspondence Address:
Archana Sood
C-72, NDSE-2, New Delhi - 110 049, India

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.39130

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How to cite this article:
Sood A, Badhu B. Oculosporidiosis in a tertiary care hospital of Western Orissa, India. Indian J Ophthalmol 2008;56:165

How to cite this URL:
Sood A, Badhu B. Oculosporidiosis in a tertiary care hospital of Western Orissa, India. Indian J Ophthalmol [serial online] 2008 [cited 2019 Oct 17];56:165. Available from: http://www.ijo.in/text.asp?2008/56/2/165/39130

Dear Editor,

We read with interest the article on oculosporidiosis in Western Orissa by Chowdhary et al. [1] and would like to share our views and experiences regarding the management of this disease.

The authors have observed lacrimal sac involvement in three patients while the rest of the 49 patients had conjunctival polyps. Recurrence was seen in only two cases, both of which were lacrimal sac rhinosporidiosis with subcutaneous spread. The authors have mentioned that no special maneuver was used during surgery in these cases to ensure complete removal of spores.

Conjunctival disease did not recur in this series probably because of easier complete excision of the well-defined polyps. But since lacrimal sac involvement with subcutaneous spread is more ill-defined, we suggest a more aggressive approach to ensure complete eradication of the disease

This approach includes complete, meticulous surgical excision with electric cautery. [2] A suspicion of rhinosporidiosis in a patient belonging to an endemic area, with a boggy swelling of the sac should be managed with a complete excision of the sac, subcutaneous tissue and overlying skin, if involved, followed by electrocauterization of the healthy margins.

Copious irrigation for 5 min, with 5% betadine solution and 1 to 5 mg/ml amphotericin-B have also been tried by us with good results in similar patients who presented to us with an ill-defined swelling with lacrimal sac rhinosporidiosis. Use of 0.15% amphotericin-B has previously been reported with success in peripheral keratitis. [3]

The authors have not mentioned any specific postoperative therapy but postoperative dapsone therapy with 100 mg once/twice daily for three to six months has been found to prevent recurrence as it is known to arrest the maturation of spores and promote fibrosis in the stroma. [2] This drug should however be used after ruling out drug allergy and G6PD deficiency. [4]

The authors mention that this fungus thrives in a hot tropical climate and endemic zones are located in south India and Sri Lanka. We would like to mention that Rhinosporidium seeberi is not a classic fungus, but an aquatic protistan parasite belonging to a new clade, Mesomycetezoa. [4] This novel clade includes fish and amphibian pathogens in the former DRIP clade (Dermocystidium,the Rosette agent, Ichthyophonus and Psorospermium).

It is of interest that the histopathology of these fish and amphibian diseases closely resembles that of R. seeberi , which is the first known human pathogen from the DRIPs clade. This explains the positive history of bathing in stagnant pond water in most of the cases as was observed by the authors in 90% of their patients.

 
  References Top

1.
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. 1
[PUBMED]  Medknow Journal  
2.
Ghorpade A, Gurumurthy J, Banerjee PK, Bhalla M, Ravindranath M. Oculosporidiosis presenting as an under -eye swelling. Indian J Dermatol Venereol Leprol 2007;73:196-7.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Bhomaj S, Das JC, Chaudhari Z, Bansal RL, Sharma P. Rhinosporidiosis and peripheral keratitis. Ophthalmic Surg Lasers 2001:32:338-40.  Back to cited text no. 3
    
4.
Arseculeratne SN. Recent advances in rhinosporidiosis and rhinosporidium seeberi. Indian J Med Microbiol 2002:20:119-31.  Back to cited text no. 4
    




 

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