CHAPTER X 



The Deep Myeoses (Essentially or 

 Potentially Systemic 



DURING a lifetime of work in private and hospital practice, a physician 

 may sec only a few patients with one of the deep fungous infections. 

 However, the prompt recognition of the disease is vitally important, since 

 delay in beginning treatment may result in a fatal outcome. Patients suffer- 

 ing from these rare yet potentially dangerous diseases may consult the gen- 

 eral practitioner, the internist, the surgeon, the gynecologist or some other 

 specialist as well as the dermatologist; thus consideration of a few essential 

 facts concerning the detection and management of these diseases appears 

 of general interest. As a rule, diagnosis of the deep mycoses is not difficult, 

 if they are kept in mind as possibilities. The following will be discussed: 



1. Actinomycosis (streptothricosis) 



2. Mycetoma (maduromycosis) 



3. Nocardiosis (actinomycosis without granules) 



4. Sporotrichosis 



5. Blastomycosis 



6. Histoplasmosis 



7. Coccidioidomycosis 



8. Granuloma Paracoccidioides 



9. Torulosis 



10. Rhinosporidiosis 



1 1. Aspergillosis 



12. Mycoses of the lungs 



1. ACTINOMYCOSIS (STREPTOTHRICOSIS) 



Ol all the rare, deep mycoses, tliis is probabl) the most widely distrib- 

 uted throughout the world. It may remain in a localized stage, in which 



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