APPEARANCE IN CULTURE 187 



and mucous membrane lesions and systemic involvement in which 

 budding cells were observed in the pus. Splendore in 1912 named 

 the fungus Zymonema brasiliense. In many of the early studies the 

 disease was confused with coccidioidomycosis; Almeida^ in 1929 

 summarized the characteristics of the two mycoses and clearly pointed 

 out their clinical differences, the fundamental morphological differ- 

 ences between the fungi, and the lower virulence of this fungus for 

 experimentally infected guinea pigs. 



Clinical. Unlike coccidioidomycosis, the primary lesions are most 

 often in the mucous membranes of the mouth and nostrils and in- 

 volvement of the gastrointestinal tract is usual. The lesions are 

 ulcers which increase in size by peripheral spread and by the coales- 

 cence of satellite lesions. They cause a rapid and extensive destruc- 

 tion of the tissues. Skin lesions are crusted or nodular and resemble 

 those of American blastomycosis. The regional lymph nodes become 

 enlarged, break down, and drain through sinuses which penetrate 

 the skin. Hematogenous spread of the organism follows. In some 

 cases the first evidence of infection is enlargement of the lymph 

 nodes in the neck. 



Primary lesions may appear in the gastrointestinal tract in the 

 region of the cecum or appendix, where ulcers develop. The infec- 

 tion spreads by peripheral enlargement of the lesions and by way of 

 the blood stream. The lungs, spleen, liver, and other organs are in- 

 volved when the disease becomes generalized. 



Diagnosis. The clinical aspects of the disease and the location and 

 appearance of the lesions are fairly distinctive. In the laboratory 

 diagnosis the fungus should be demonstrated in the lesions or a cul- 

 ture should be obtained. 



Treatment and Prognosis. The disease does not yield to iodides 

 and other antimycotic treatment and is almost invariably fatal in 

 the diagnosed cases. 



Appearance of the Fungus in Tissues. The fungus is found in pus 

 and in the tissues as a spherical cell 10 to 60 microns in diameter. It 

 reproduces by budding. Some cells produce one or a few buds and 

 resemble Blastomyces dermatitidis. Cells considered typical of this 

 fungus produce many small buds. In optical section these appear as 

 a crown of small (1 to 4 microns) spherical or elongated projections 

 from the cell wall. 



Appearance in Culture. The fungus grows slowly. When cultures 

 are incubated at 37° C. the fungus reproduces by a process of multiple 

 budding similar to that seen in tissues. At room temperature it pro- 

 duces hyphae which bear conidia similar to those seen in Blastomyces 



