152 An Introduction to Medical Mycology 



(3) Generalized cutaneous forms.— A fortunately uncommon manifesta- 

 tion seen in children is the type in which the hair of the scalp is sparse and 

 the scalp partially inflamed, with perleche and glossitis present as well as 

 other types of localized infection. The patient also may exhibit widespread 

 eruptions of the glabrous skin. Characteristic flat pustules may be observed 

 in some part of the eruption. The infection may last for many years and 

 be extremely resistant to therapy, and in some instances the outcome may be 

 fatal. 



(4) Systemic forms.— Greenwood and Rockwood and others have re- 

 ported instances of fatal systemic infection. This may be superimposed 

 on the type just discussed. Involvement of the meninges has been de- 

 scribed. In some instances bronchitis has also been considered to have 

 a monilial source. The finding of Monilia in the sputum in cases of suspected 

 bronchial moniliasis is not sufficient to establish a definite diagnosis, since 

 the organism is often present in the mouth and in the gastrointestinal tract. 

 In a patient with symptoms referable to the lungs, when repeated tests for 

 the tubercle bacillus have been fruitless, a mycotic disorder may be sus- 

 pected. The roentgenogram showing a mycotic disease of the lungs may 

 reveal shadows and densities of varying degree, often confined to the base. 

 Since the exact diagnosis is not a purely theoretic problem, in case of doubt 

 specimens should be obtained after bronchoscope study. It should also be 

 remembered that yeastlike fungi are notorious secondary invaders; their 

 presence in diseased tissue does not always mean that they are responsible 

 for the disease. The presence of M. albicans in diseased tissue is not always 

 sufficient evidence of its pathogenicity, and in some cases the cause of the 

 condition is difficult to ascertain. It is often necessary to study a patient 

 for some time before a definite diagnosis can be made. Castellani de- 

 scribed monilial bronchitis affecting tea-tasters of Ceylon. This is a rela- 

 tively banal infection with periodic flare-ups of a productive cough lasting 

 for years but finally disappearing spontaneously. More severe infections of 

 bronchopneumonic type are uncommon. A presumptive diagnosis is in 

 order after repeated examinations (including gastric washings) have been 

 negative for tubercle bacilli if massive amounts of the fungus are observed 

 in the sputum on several occasions. Joachim and Polayes reported the case 

 of a white man, 48, who had been addicted to the use of morphine and 

 heroin for 20 years. For 18 months he injected the drug intravenously. 

 Systemic manifestations developed and he finally died of subacute endo- 

 carditis. A species of Monilia was obtained in blood cultures and from 

 vegetations on the heart valves. Wikler and his associates also reported the 

 case of a drug addict who died of mycotic endocarditis, the organism being 

 M. parapsilosis. 



