146 An Introduction to Medical Mycology 



United States to report a case of generalized cutaneous thrush. Engman 

 in 1920 described a case of moniliasis localized to the upper parts of the 

 thighs, the vulva and the inframammary regions. The article by Shelmire 

 and that by Beeson and Church were also early contributions. 



(b) Etiology.— The causative micro-organism, M. albicans, is seldom 

 if ever found on the normal skin. Other yeastlike fungi should not be 

 confused. The organism is a common inhabitant of the gastrointestinal 

 tract, where it may produce no symptoms. While it was formerly consid- 

 ered, mainly through the investigations of Ashford, to be of etiologic 

 significance in sprue, later research does not appear to bear out such a 

 relationship. 



The incidence of infection increases with age. There is a more or less 

 corresponding increase with age in the involvement of the gastrointestinal 

 tract. Relapse of cutaneous lesions may take place when a systemic or de- 

 bilitating illness is experienced. The resistance of the patient to M. albi- 

 cans is decreased by diabetes, probably because the storing of sugar favors 

 the growth of the organism. We have noted that a large percentage oi 

 the patients with different types of cutaneous moniliasis are obese. The 

 organism is more apt to find suitable soil in persons whose skin is macer- 

 ated by frequent or prolonged immersion in water. Profuse sweating may 

 be followed by moniliasis. Housewives, bartenders, waiters and bakers 

 appear to be more prone to the condition because of their occupations. 

 The organism is probably of weak pathogenicity, but once the disease 

 state is established, through a letdown in the natural immune forces, the 

 condition is apt to persist indefinitely. The organism multiplies rapidly; 

 it may be isolated from such diseased tissues as those of carcinoma, and 

 it may be found in the sputum of a patient approaching death. In such 

 instances, one must be careful to differentiate between the saprophytic 

 and the pathogenic significance. It is probable that the virulence of M. 

 albicans may so increase that the fungus is capable of causing an infection 

 without any apparent predisposing factor. The series of cases of perleche of 

 children in an orphanage, as reported by Finnerud, mav be cited as a 

 possible example. 



(c) The clinical syndrome.— The manifestations of M. albicans may 

 be grouped as (1) localized, (2) of moniliid type, (3) generalized cu- 

 taneous and (4) systemic. 



(1) Localized forms. 



a. Onychia and paronychia. It is chiefly the fingers which are affected, 

 although we have observed instances of infection of the toenails. There 

 mav be involvement oi only owe digit, but multiple infections are more 

 frequently seen. The paronychia] tissues are usually the first to be involved, 



