306 PATHOGENIC YEAST-LIKE FUNGI 



since various wild yeasts have been found to produce abscesses in 

 lower animals when inoculated subcutaneously. 



CRYPTOCOCCOSIS 



(Torulosis, Torula Meningitis, European Blastomycosis) 



History. The presence of an encapsulated yeast-like fungus in 

 lesions and pathological material was reported by Busse in 1894 and 

 1895. '^ The patient was a woman who had a localized subperiosteal 

 lesion of the tibia and in whom other osseus and visceral lesions 

 subsequently developed. Busse called the disease saccharomycosis 

 hominis and referred to the fungus which he found in the lesions as 

 a yeast and as Saccharomyces, but he apparently did not use a 

 binomial or specific name. In 1894 Sanfelice had isolated from fruit 

 a fungus which was apparently like the one subsequently studied by 

 Busse. He found that it was pathogenic for animals and he named 

 it Saccharomyces neojormans}^ Vuillemin -^ pointed out that the 

 fungus differed from the true yeasts and transferred the species to 

 the emended genus Cryptococcus, using the binomial Cryptococcus 

 hominis. Another name, Torula histolytica, was added to the 

 synonymy by Stoddard and Cutler ^^ who, in reporting two cases of 

 meningeal infection, interpreted the capsular material which sur- 

 rounds the fungus cell as a space caused by a lytic action of the 

 fungus. This name has been used widely in the United States. 

 Other specific names and combinations of names have been used for 

 this fungus, but the correct name appears to be C, neojormans.^' ^^ 



Clinical. It is generally accepted, since the investigations of Ben- 

 ham - and of Lodder," that cryptococcosis in the United States and 

 in other parts of the world has a single common etiology, but that 

 the disease in Europe is usually generalized, with skin lesions being 

 a prominent feature, whereas in the United States it is primarily an 

 infection of the central nervous system. The similarity between the 

 fungi from the two types of lesions was noted in the first edition of 

 this book. As additional cases have been reported from the United 

 States it seems probable that this geographical differentiation has 

 been overemphasized. It is true that meningitis is a common aspect 

 of the disease as seen in the United States, but a review of the re- 

 ported cases shows that in many instances there was widespread 

 dissemination, and skin lesions are not uncommon. In many cases 

 where meningitis was the principal feature, lesions were found in 

 the lungs at autopsy and it is probable that in most cases the primary 

 lesion was in the lungs. 



