A CASE OF NOCARDIASIS. 



BY 



A. PIJPER M. D. (Leyden). [Bethal, Transvaal), 



Patient is a white man, 36 years of age, born in S. Africa. 

 He complains of a chronic cough worrying him these last 

 eleven years. Only in the early morning he produces sputum. 

 There is no evidence of tuberculosis among his relations. He 

 gets out of breath fairly soon and he cannot sleep on his left 

 side because of a feeling of oppression overcoming him in that 

 position. His weight and appetite are good. Treatment with 

 various medicines brought no relief. Apparently there is no fever. 

 On inspection a considerable degree of emphysema is found. The 

 expiration is prolonged and the breath-sounds are harsh and 

 loud. The physical signs are those of chronic bronchitis, moist 

 rales are audible everywhere in varying intensity. The sputum 

 is white-yellowish and mucopurulent. On microscopic exami- 

 nation it is found to consist of mucus, puscells, a few chromo- 

 cytes, many cells from the lungs, and bacteria. The lungcells 

 often present a peculiar appearence, being filled up with masses 

 of bacteria, in the form of long and short bacilli, sometimes 

 forming longer threads, occasionally with a swollen end, and 

 sometimes broken up into coccuslike bodies. Similar gatherings 

 are found outside the cells. 



Attempts at culture (with all due precautions) were undertaken 

 twice, and on both occasions a growth was obtained which 

 could be recognised as belonging to the class of fungi which 

 CasTELLANI (1 ) calls Nocardia, LEHMANN and NEUMANN (2) 

 Actinomyces, and Petruschky (3) Trichomyceten. It proved 

 pathogenic for guinea-pigs. Further characteristics are : on agar 

 after 48 — 72 hours small whitish colonies become visible. These 

 increase very slowly and become yellowish crusts, hard like 

 cartilage, and very adherent to the medium. Their surface is 



