232 An Introduction to Medical Mycology 



tageous not only for obtaining a satisfactory specimen from the exposed 

 base but is also important in therapy (see under treatment of onychomy- 

 cosis, pp. 135 ff. ). For direct examination, a small portion of material from 

 the nail bed is more desirable than large clippings or even the entire nail. 

 When there is little horny (scaly) material, it is impracticable to attempt 

 to identify the fungus by direct examination. In this case one must rely on 

 cultural methods. With the lesions under treatment, the amount of material 

 to be obtained may be reduced, and cultural methods alone will be effec- 

 tive in demonstrating the continued presence of a pathogen. It may be 

 mentioned here that fungi are frequently to be found at the sites of appar- 

 ently cured lesions; in such a case, unless treatment is continued, the infec- 

 tion may recur. 



If mycosis of the lungs is suspected, a specimen of sputum or a fragment 

 of tissue should be obtained bronchoscopically. Thus one may determine 

 whether Monilias, Actinomycetes or other organisms noted in a direct 

 smear or in culture from a casual specimen of sputum are actually invading 

 the lung or are merely present in the mouth as saprophytes. If the fungous 

 material is found in large amounts or if the same species of micro-organism 

 is repeatedly isolated in the presence of negative results of studies for 

 tuberculosis, carcinoma and other pulmonary diseases, primary fungous 

 disease may be considered probable. 



While it is often customary to collect a pathologic specimen from a 

 patient and place it on a sterile slide or in a sterile container for inoculation 

 of mediums and examination at a later time, we prefer to transfer material 

 directly from the patient to the culture medium. This makes possible the 

 selection of tissue most favorable for culture and also cuts down the inci- 

 dence of contaminants. 



