LITERATURE 383 



ency for the organisms to become distributed through the blood with 

 the formation of abscesses in other viscera, especially the brain. A 

 rather large proportion of the reported cases have died from brain 

 abscesses, and in some of these the pulmonary lesions were not dis- 

 covered until after death. There were two cases of primary peri- 

 tonitis following a simple surgical exploration of the abdomen. 



Infections with the acidfast actinomycetes are to be differentiated 

 from tuberculosis. In pronounced pulmonary cases this is not easily 

 done, and undoubtedly these infections have been mistakenly diag- 

 nosed as tuberculosis a number of times. In the sputum the organism 

 readily undergoes fragmentation and, being acidfast, the fragments 

 resemble tubercle bacilli very closely. They are more variable in 

 length, and sooner or later long branched filaments will be found. 



Although these forms grow readily on ordinary culture media, they 

 grow more slowly than bacteria, and isolation from sputum by plating 

 is difficult. By guinea pig inoculations pure cultures may be readily 

 obtained. This would seem to be the procedure of choice for estab- 

 lishing the diagnosis. If inoculated intraperitoneally the animals 

 generally die in less than a week, with very characteristic miliary 

 white nodules over the peritoneal surfaces, especially in the omentum. 

 The cultures retain their virulence for surprisingly long periods. 

 Thus Musgrave and Clegg found subcultures of Eppinger's strain of 

 N. asteroides fully virulent after twenty years. 



iV. asteroides undoubtedly is common in soils. Gordon and 

 Hagan ^^ isolated acidfast strains, some of which closely resembled 

 that species and are without doubt identical with it, by placing 

 paraffin-dipped rods in a soil suspension. The ability of this and 

 related fungi to utilize paraffin makes this a highly selective method. 

 Emmons isolated strains from soil by injecting a soil suspension 

 intraperitoneally into guinea pigs. 



LITERATURE 



1. Alpers, B. J., Abscess of the brain, Arch. Otolaryngol, 29, 199 (1939). 



2. Bollinger, 0., Ueber eine neue Pilzkrankheit beim Rinde, Centr. med. 



Wisse7i., 15, 481 (1877). 



3. CoLEBROOK, L. A., A report upon 25 cases of actinomycosis, with especial 



reference to vaccine therapy, Lancet, 200, 893 (1921). 



4. Cornell, A., and H. B. Shookhoff, Actinomycosis of the heart simulating 



rheumatic fever, Arch. Internal Med., 74, 11 (1944). 



5. Cornell, V. H., Actinomycosis of tubes and ovaries, Am. J. Path., 10, 519 



(1934). 



6. Drake, C. H., and A. T. Henrici, Nocardia asteroides; its pathogenicity and 



fillergic properties, Am, Rev. Tuherc, 48, 184 (1943). 



