312 PATHOCxENIC YEAST-LIKE FUNGI 



elbows, and particularly between the fingers and toes. In several 

 such cases loss of hair was a striking feature, although actual in- 

 fection of the scalp could not be demonstrated. In these cases the 

 organism could be regularly isolated from the feces in considerable 

 numbers. These cases usually terminate fatally. The generalized 

 cutaneous eruptions suggest that the condition is similar to that 

 designated "trichophytide" in the ringworms, either an allergic mani- 

 festation or a blood-borne distribution in which for some reason the 

 organism localizes in the skin only." It is quite possible, however, 

 that the fungus is in the alimentary tract and is carried from the 

 mouth or the anus to the skin surfaces. 



In a small number of cases (seven collected by Plant) generalized 

 infection by way of the blood stream with metastatic abscess in 

 internal organs have occurred. 



The diagnosis of thrush is established by microscopic examination 

 of the membrane. This is best done by the use of unstained wet 

 preparations. One finds a tangled mass of branched filaments of 

 segmented mycelium, and scattered irregularly through them a num- 

 ber of yeast-like cells showing budding, together with leucocytes and 

 desquamated epithelial cells. The fungus is easily isolated in pure 

 culture on Sabouraud agar. It can be differentiated from similar 

 fungi by the production on corn meal agar of hyphae bearing clusters 

 of buds and chlamydospores, by its fermentation reactions, and by 

 its pathogenicity for rabbits. 



Fresh isolated strains are pathogenic for rabbits, producing local- 

 ized abscesses in the kidneys and heart muscle, and occasionally 

 generalized infection. When the fungus is injected intravenously the 

 miliary abscesses in the cortex of the kidneys resemble closely those 

 produced by Aspergillus fumigatus. In these lesions both mycelium 

 and yeast cells may be found. Mice are very susceptible. 



C. albicans {Monilia psilosis) is commonly present in the feces in 

 tropical sprue, but is no longer thought to be of etiological importance 

 in this disease. 



Dermatomoniliasis. In addition to the cutaneous lesions observed 

 in cases of thrush, Candida albicans has been isolated from various 

 skin infections not associated with lesions of the mucous membranes. 

 These have been for the most part conditions of an eczematoid 

 nature in moist skin surfaces or in skin folds. They have been noted 

 especially frequently in the webs of the fingers in washerwomen and 

 housewives. The disease is known as erosio interdigitalis. An in- 

 fection about the finger nails which occurs in workers in fruit can- 



