The Superficial Mycoses 153 



(d) Histology.— It is advisable to scrape the biopsy material For cult inc. 

 Mycelium is sometimes demonstrable in section but a diagnosis on tin's 

 alone is impossible. The findings arc usually those of a chronic inflammation 



with round cells and occasional giant, cells. 



(e) Differentia] diagnosis.— Usually, little difficulty is encountered in 

 recognizing tlic localized forms of moniliasis and distinguishing them from 

 similar disorders. Intertrigo of the feet may occasionally be puzzling, and 

 areas ol widespread involvement, especially if they have been overtreated, 

 ina\ be difficult to recognize at first. Pyodennic infection and tinea due 

 to Trichophyton are easily' distinguished by the acute painful paronychia 

 associated with the former and by the lack of paronychia and the presence 

 of a yellow triable nail with the latter. The moniliids are not as definite an 

 entity as one would desire, and the diagnosis must frequently be ascer- 

 tained by the exclusion of other diseases. Severe generalized involvement 

 should not be confused with any other disorder, although in some instances 

 it is mistaken for seborrheic eczema, and there may be slight resemblance 

 to disseminated neurodermatitis (atopic eczema). The greasy scales of the 

 former and the hchenification present in some areas of the latter, together 

 with the lack of flaccid vesicopustules and negative results of cultural 

 studies should be sufficient to distinguish these diseases. The oidiomycin 

 test is of no value in differential diagnosis. Demonstration of the organ- 

 isms in culture from lesions of moniliasis is usually readily accomplished. 

 As mentioned previously, tuberculosis must be distinguished from mondial 

 bronchomycosis. 



(f) Prognosis.— Patients with any form of moniliasis should be con- 

 sidered potentially diabetic. The infection may be the first manifestation 

 of diabetes. The local varieties usually respond to treatment, but relapse 

 may occur. It is difficult to eradicate the micro-organism from the gastro- 

 intestinal tract. Generalized involvement and moniliids are resistant to 

 therapy, and cure may require months or years. When infection is general- 

 ized, the prognosis should be reserved; in cases of systemic involvement 

 the outcome is often fatal. 



(g) Treatment. 



(I) General instructions.— If it is to be comprehensive and permanently 

 effective, therapy should be directed toward the eradication of all foci, 

 both in the skin and in the gastrointestinal tract. Unfortunately, treatment 

 of the latter is not highly effective. Infection caused by M. albicans calls 

 for urinalysis, to determine whether an otherwise asymptomatic glycosuria 

 is present. 



The treatment of infections of the skin caused by M. albicans depends 

 partly on the site of the disorder and partly on the individual patient. 



