The Deep Mycoses (Essentially or Potentially Systemic) 1ST 



ol the tissues lias taken place, a satisfactory result may be expected. 



(d) Treatment.— The internal administration ol iodides and roentgen 

 therapy in filtered dosage comprise the treatment usually employed. Sul- 

 fonamide therapy may be effective when the causal micro-organism is a 

 species of Actinomyces. With severe destruction of the tissues, surgical 

 amputation has been necessary. 



BIBLIOGRAPHY 



Hi rns, E. 1..: Moss. E. S., wn Brueck, J. \V.: Mycetoma pedis in United Slates and Canada 

 with report of three cases originating in Louisiana, Am. ]. Clin. Path. 15:35, 1945. 



Gammel, |. A.: Etiology of maduromycosis, Arch. Dermat. & Syph. 15:241, 1927. 



II \\\x. E. B., and Zurett, S. : \cw species of Madurella, Arch. Dermat. & Syph. 37:947, 

 1938. 



Lewis, G. M., and Sachs, W.: Mycetoma, Arch. Dermat. & Syph. 42:160, 1940. 



Shaw, H. M.. wn MacGregor, J. W.: Maduromycosis, with report of case due to Monosporium 

 apiospermum, Canad. M. A. J. 33:23, 1935. 



lHOMPSON, II. L.: Present status ol mycetoma, Arch. Surg. 16:774, 1928. 



3. NOCARDIOSIS (ACTINOMYCOSIS WITHOUT GRANULES) 



There are several reported cases of infections of the skin, of the sub- 

 cutaneous tissues and of the lungs in which Nocardia ( a species of Actino- 

 mycetaceae which is a common saprophyte of soil) was considered the 

 cause. 



Guy summarized the literature and reported a case in which the lesions 

 led to a clinical diagnosis of sporotrichosis. The clinical course and the rapid 

 response to iodide therapy also suggested this diagnosis. The evidence 

 (which included isolation of the fungus in culture and detection of a fine 

 mycelium in histologic section) is not entirely conclusive that the organ- 

 ism isolated ( Nocardia ) was more than a contaminant. Guy and Helmbold 

 reported a case in which gangrenous sloughing ulcers (clinically suggest- 

 ing pyoderma gangrenosum) successively developed, and there was asso- 

 ciated bloody diarrhea with ulceration of the rectum and sigmoid. In this 

 instance a species of Nocardia was isolated both from the lesions and from 

 the blood stream during a chill. Mycelium was noted in histologic section. 

 Cure followed blood transfusion and intensive iodide therapy. Gammel 

 reported that in a case in which death occurred the causative agent was 

 a species of Actinomyces. Granules were not present. In this case the first 

 lesions were situated in the skin and metastatic lesions in the skin and brain. 

 The micro-organism was repeatedly isolated from open and closed (deep) 

 lesions in the skin. Mycelium was found in the spinal fluid, but the organ- 

 ism did not grow on culture. Lamb observed a man with multiple nodular 

 fistulous lesions of the neck of 15 years' duration. The clinical diagnosis 



