568 MEDICAL MYCOLOGY 



may be manifest as a mild, pleurisv-like, respiratory infection, 

 with chills, night sweats, and headache. After 2 or 3 weeks papil- 

 lomatous eruptions appear on the arms, thighs, and scalp, and 

 occasionally the knee and ankle joints are arthritic. Examination 

 by X-ray may reveal pulmonary nodules resembling primary 

 tuberculosis. The sputum is mucopurulent and may contain 

 blood. 



Ulcerative lesions on the face and neck may characterize an- 

 other form of the disease. Such lesions slowly become subcu- 

 taneous and may spread to the meninges and spinal cord. If the 

 miliary type of involvement develops, the fever is high, prostra- 

 tion is marked, and death occurs after a few weeks. 



When present in the tissues, Coccidioides 'nmriith, described by 

 Stiles in a report by Rixford and Gilchrist (1896), consists of 

 large, thick-walled, spherical cells that may reach a diameter of 

 50 to 70 /*. At maturity these cells function as sporangia, although 

 they have been misinterpreted by some to be asci. By cleavage 

 their content gives rise to a large number of spores, which escape 

 by rupture of the sporangial wall. From a comparative study of 

 15 strains by Baker, Alrak, and Smith (1943) it has been con- 

 cluded that the organism is a Phycomycete. 



This fungus in cultures on semisolid media forms creamy white, 

 cottony mycelium. By fragmentation chlamydospore-like oidia 

 are produced. Sporangia and sporangiospores are developed, how- 

 ever, if cultured under reduced oxygen tension in the presence of 

 tcrcf albumen or serum. 



The acute type of the disease probably enters through the pul- 

 monary route. The pathogen has been isolated from the soil, but 

 soil may not constitute its natural habitat. In patients who re- 

 cover spontaneously, and among residents of the San Joaquin 

 Valley generally, intradermal injection of killed cultures of the 

 fungus results in rather severe skin reactions. 



CRYPTOCOCCUS HISTOLYT1CUS 



Approximately 30 species of Cryptococcus are reported to be 

 pathogenic to man, Cryptococcus histolyticus, a cause of blasto- 

 mycosis, being perhaps the best known. Reports of blastomy- 

 cosis include a disease which in the United States manifests itself 

 by a disturbance of the central nervous system, clinically like 



