The Deep Mycoses (Essentially or Potentially Systemic) 197 



Schenck, B. R.: On refractor) subcutaneous abscesses caused !>> ;i fungus possibly related to 



Sporotricha, Bull, fohns Hopkins Hosp. 9:286, L898. 

 Shaffer, L \\ ., ind Zackheim, H. S.: Sporotrichosis, Arch. Dermat. & Syph. 56:244, 1947. 

 Smith, L. M., ind Garrett, II. I).: Verrucous sporotrichosis, Vrch. Dermat. <.\ Syph. 56:532, 



1947, 

 Tempi i pon, H. | . uro Lunsford, C. [.: Sporotrichosis on tin Pacific ('nasi. Northwest Med. 



80:132, L931. ' 



5. BLASTOMYCOSIS 



The North American form of blastomycosis is chiefly seen in the Middle 

 West, particularly in the region around Chicago, but the disease may appear 

 sporadically in any section of the country. There are only three proved in- 

 stances of the disease originating outside the United States, one each in 

 Canada. England and France. The case reported by Brody occurred in an 

 American soldier who was in France for 10 months before he showed 

 clinical signs of the disease. The presence of budding cells in the diseased 

 tissue was first demonstrated by Gilchrist, in 1896, and the organism 

 causing the disorder was later described in detail by Gilchrist and Stokes. 

 A number of articles and case reports have since appeared, and the nature 

 of the disease is now well known. 



(a) Period of incubation.— Although unknown, it is probably one to 

 two weeks. 



(b) Etiology.— Although Blastomyces dermatitidis is the organism caus- 

 ing American blastomycosis, other organisms are capable of producing 

 lesions which simulate this disorder. The European type of blastomycosis 

 (torulosis) is a distinct entity (Benham). Most of the patients are adults, 

 50 per cent being over 40 years of age and about the same proportion being 

 between 20 and 40. Most patients are men. The organism may have a 

 saprophytic existence on plants, since numerous Blastomyces are wide- 

 spread in nature. Two instances of spontaneous blastomycosis in dogs have 

 been reported. Trauma is usually necessary for development of the infec- 

 tion. Scratches, puncture wounds, bruises and the like have been reported 

 as predisposing factors. 



(c) Clinical characteristics.— The disease may be local or systemic. 

 In most cases the initial lesion appears on the skin. The chief sites are the 

 face, hands, wrists and forearms, although any part of the body may be 

 involved. In some instances the tongue and the lungs are the sites of the 

 first manifestations. On the skin, the first lesion is a papulopustule, which 

 soon becomes crusted. There is peripheral enlargement, and after several 

 weeks a plaque elevated above the surrounding skin is present. Crusting 

 may be of slight amount or may cover the entire lesion. Beneath the crust, 

 the surface shows irregular papilliform elevations and is covered with a 



