Oculosporidiosis in a tertiary care hospital of Western Orissa, India.

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.