The Deep Mycoses (Essentially or Potentially Systemic) 205 



Peterson agreed with this opinion. They found the histoplasmin test posi- 

 tive in KS1 children From middle Tennessee who had pulmonary calcifi- 

 cation. The) cited a possible example of a nonfatal infection with II. 

 capsulatuni. 



(d) Pathology.— Gray or white nodules may be noted in the spleen, 

 liver, lungs and intestines as well as other tissues and organs. The niesen- 



Fig. 65. Histoplasmosis. 



teric lymph nodes are usually involved. The lesions are necrotic, simulating 

 tuberculosis. In the spleen and liver the fungus is found in the fixed reticulo- 

 endothelial cells. In other parts of the body it may be found in various 

 phagocytic cells. 



(e) Differential diagnosis.— In the classic cases, leishmaniasis may be 

 simulated. When lymph node enlargement predominates, Hodgkin's dis- 

 ease, leukemia or lymphosarcoma may be considered. Pulmonary tuber- 

 culosis or a chronic ulcer of the skin may be difficult to rule out in other 

 cases. In all instances, the diagnosis is made by demonstration of the caus- 

 ative fungus in smear, culture or biopsy section. 



(f) Prognosis.— In the well advanced ease the outlook is hopeless, and 

 no therapy has yet been developed which has influenced the fatal outcome. 



(g) Treatment.— Since the diagnosis is usually made after death or late 

 in the course of the disease, no specific therapy has had a fair trial. Meleney 



