194 INFECTIONS CAUSED BY MOLDS 



have been primarily wound infections, but a few cases presenting a 

 generalized infection without any primary focus have been inter- 

 preted as an invasion through the mucous membrane of the intestinal 

 tract. Davis ^ * was thus able to produce a generalized infection in 

 rats by feeding the organism. A few cases have been reported in 

 which apparently a primary involvement of the lungs occurred. In 

 most of the cases the lesions will be seen in the skin and subcutaneous 

 tissues. Foerster ^ reports that 111 of 146 cases were primary on the 

 hands. 



The clinical picture of a typical case is so striking that, once seen, 

 the disease will always be readily recognized.^- ^' "• " There will be 



Fig. 9S. Sporotrichosis. 



seen extending in a line upon the surface of an extremity, a series 

 of hard, elevated, reddened lumps, the older lesions presenting a 

 fistula from which pus may be expressed. At first glance the lesions 

 look like boils but are not hot and tender, and there is practically no 

 constitutional reaction. The firmness of the nodules suggests a 

 syphilitic gumma. Between the lesions the course of the subcuta- 

 neous lymph vessels can frequently be traced as reddened lines. Al- 

 though in the majority of cases the infection spreads from the pri- 

 mary lesion by way of the lymph vessels, it seldom goes beyond the 

 regional lymph nodes. Cases of generalized infection by way of the 

 blood stream occur but are relatively rare. Metastatic lesions may 

 occur in the lungs, liver, and especially frequently in the testicles. 

 One gains the impression that such generalized cases are more fre- 

 quent in Europe than in America. In some cases the disease may be 

 transmitted from the arm to some other part of the skin surface by 

 contact. 



Diagnosis. The disease may present so close a resemblance to 

 tertiary syphilis that it has undoubtedly been frequently misdiag- 

 nosed for that disease. An incorrect diagnosis subjects the patient 

 needlessly to a prolonged course of treatment without any benefit 



♦Literature citations for this section will be found on page 199, 



