The Deep Mycoses (Essentially or Potentially Systemic) 215 



BIBLIOGRAPHY 



pi \i \n m\. 1'.: Blastomycoses of Brazil, Ann. Fac. de med. de Sao Paulo v-A^K L933. 



Conant, V I'. ami Howell, A., Jr.: Similarity of fungi causing Smith American blastomy- 

 cosis (paracoccidioidal granuloma) and North American blastomycosis (Gilchrist's disease), 

 J. Invest. Dermat 5:353, 10 12. 



[ordon, |. \\ '.. wn Weidman, F. 1).: Coccidioidal granuloma: Comparison <>l the North 

 and South American diseases with special reference to Paracoccidioides brasiliensis, Arch. 

 Dermat. & Syph. 33:31, 1936. 



Moore, M.: Blastomycosis, coccidioidal granuloma and paracoccidioidal granuloma, Arch. 

 Dermat. & Syph. 38:163, 1938. 



9. TORULOSIS (EUROPEAN BLASTOMYCOSIS) 



This disease is due to a yeastlike organism with a predilection to in- 

 volvement of the central nervous system. In a recent monograph, Cox and 

 Tolhurst stated that more than 100 cases have been reported. In 1895 Busse 

 and Buschke described cutaneous lesions due to yeastlike organisms. In 

 1905 von Hansemann reported the first recognized case of infection of 

 the brain. In 1916 Stoddard and Cutler first described the clinical and 

 pathogenic characteristics of the disease, the cultural findings and results 

 of animal inoculation of the causal organism. Torulosis has been reported 

 from most parts of the world; in the United States the majority of cases 

 occur along the eastern seaboard or in the South. It is not uncommon in 

 South Australia. 



(a) Etiology.— The micro-organism, Cryptococcus hominis (Torula his- 

 tolytica), is commonly found as a saprophyte on the skin and also in the 

 throat and the gastrointestinal tract. It is to be found on many plants. It is 

 probable that some strains assume virulence. As a rule the exact portal 

 of entry is obscure, although it is thought that the upper part of the res- 

 piratory tract is the usual route. Men are affected twice as frequently as 

 women. Two thirds of the patients are between 30 and 60 years old (Levin). 

 In over 250 specimens of spinal fluid from patients with syphilis, furnished 

 us by Girsch Astrachan and by Bruce Webster, we found no evidence of 

 infection. 



(b) Symptoms.— The symptoms are usually referable to the central 

 nervous system. As a rule, the disease begins insidiously. A subacute upper 

 respiratory tract infection may be the first evidence of invasion. Persistent 

 s< \ ere headache, stiffness of the neck and vomiting are characteristic. Later, 

 dimness of vision or actual blindness may occur. Paralysis and convulsions 

 are not uncommon. The patient may be afebrile or may have intermittent 

 low grade fever. Stiffness of the neck, neuroretinitis, choked disks, diplopia, 

 nystagmus, strabismus and hyporeflexia may be found. Laboratory investi- 



