192 An Introduction to Medical Mycology 



shaped ulcer with a firm indurated border. In the untreated patient, new 

 lesions may continue to appear indefinitely. 



(3) Disseminated ulcerating type.— Although similar to the preceding 

 type, this form is distinguished by a tendency to early spontaneous ulcer- 

 ation of the lesions. The ulcerations vary greatly in size and character. At 

 times large crateriform ulcers develop, simulating the lesions of tuberculosis 

 or tertiary syphilis. There is little if any tendency to spontaneous cure. In 

 the untreated patient the general health may become impaired, with the 

 appearance of symptoms of toxemia. Moore and Kile reported an instance 

 of generalized subcutaneous gummous ulcerating sporotrichosis with pos- 

 sible involvement of the lungs. There was a favorable response to treatment. 

 In a case of disseminated cutaneous and visceral infection reported by 

 Collins, death occurred two months after onset. 



(4) Epidermal type— The primary lesion in sporotrichosis is nearly 

 always subcutaneous. In some instances the epidermis at adjacent or 

 remote sites becomes secondarily infected, with development of papules, 

 pustules and small ulcers. Rare cases have been described in which the 

 disease is limited to the skin, and in such instances tuberculosis is differ- 

 entiated with difficulty. The mucous membranes may also become sec- 

 ondarily infected in cases of the disseminated or ulcerating varieties. The 

 organism is said to be capable of remaining as a saprophyte on mucous sur- 

 faces after apparent cure, rendering the patient a possible carrier. 



(5) Verrucous dermatitis— Perhaps a variant of the preceding type has 

 been described by Smith and Garrett. There was considerable resemblance 

 in their case to blastomycosis with outlying satellite pustules. No lym- 

 phangitis developed. 



(6) Systemic type.— At times S. schencki invades the deeper tissues and 

 organs. In the majority of instances this occurs in the disseminated varieties 

 of infection when treatment is not promptly instituted. The differential 

 diagnosis must exclude cancer, syphilis, tuberculosis and other infections. 

 The bones or joints may be affected, the tibia being the most common site 

 of involvement. Invasion of the muscles and glandular structures may 

 occur, and a number of instances of pulmonary involvement have been 

 reported. Although a common site of involvement in laboratory animals, 

 the epididymis is rarely affected in human beings. Gastrointestinal or cere- 

 brospinal involvement is said to be extremely uncommon. In a case of 

 meningitis studied by Hyslop, Neal, Kraus and Hillman, repeated attempts 

 to culture spinal fluid were fruitless and iodide therapy was of no avail. 

 The diagnosis rested on the observation of sporelike bodies ami mycelium 

 in the centrifugated sediment of spinal fluid. There appears to be some 

 doubt as to the exact diagnosis. 





