310 An Introduction to Medical Mycology 



(e) Culture mount.— Club-shaped fuseaux with blunt ends in groups 

 resembling bunches of bananas are frequently found in specimens from 

 the growth with a fluffy surface. Chlamydospores are abundant in the sub- 

 surface part of the colony. Racquet mycelium is often seen, but other vege- 

 tative and reproductive forms are infrequent. 



(f ) Filtered ultraviolet rays.— In about two weeks the colony is clear, 

 dull and dark olive. 



(g) Animal inoculation.— Animal inoculation is not successful. 



(h) Differential diagnosis.— In a direct mount, if the filaments are 

 numerous, infection with E. inguinale may be surmised. The cultural growth 

 can hardly be confused. The finding of clusters of fuseaux with blunt ends 

 in a culture mount is characteristic. 



13. MONILIA (CANDIDA) ALBICANS 



This is a pathogenic yeastlike micro-organism of considerable importance. 



(a) Clinical characteristics.— The manifestations of this organism may 

 be cutaneous (localized, generalized) or systemic. The localized eruptions 

 include perleche, erosio interdigitalis blastomycetica, paronychia and 

 onychia and intertrigo of the toes and of the inframammary, axillary, in- 

 guinal, intergluteal, anal and umbilical regions, as well as eczematous 

 patches on the smooth skin. The generalized types include any or all of the 

 manifestations just mentioned, with additional involvement of the scalp, 

 eyelids or other areas of skin. The intestinal tract of a patient with 

 cutaneous moniliasis, as well as that of a patient with no cutaneous mani- 

 festations, frequently harbors the organism. The percentage of patients 

 with stool cultures yielding M. albicans increases with the age of the 

 patients. Thrush, smooth tongue and other intraoral conditions are caused 

 by this yeast. Monilia albicans probably causes fermentation in the intes- 

 tinal tract with production of gas in many otherwise normal persons. This 

 organism has also been considered capable of causing a vaginal discharge, 

 and very occasionally an infection of the lungs and bronchi simulating 

 atypical tuberculosis. 



(b) Immunologic reaction.— In only 57 per cent of patients with the 

 localized form of cutaneous moniliasis and in only 52 per cent of patients 

 harboring the organism in a lesion of the skin or of the gastrointestinal 

 tract is there a positive response to the intracutaneous test with a com- 

 mercial extract of M. albicans. Of patients without any obvious infection, 

 from 46 to 54 per cent have a similar positive reaction. For this reason the 

 lest appears to be of limited diagnostic value. With increasing age, the 

 percentage of reactions to the test increases: thus in the decade between 



