988 THE HIGHER BACTERIA, MOLDS AND FUNGI 



Their case presented numerous pea sized cutaneous tumors and 

 clinically resembled mycosis fungoides. In the lesions they dis- 

 covered intracellular spherical hyalin bodies which they thought to 

 be protozoan cysts. These cysts were surrounded by hyalin capsules 

 and some of the larger forms contained a great number of the 

 daughter cysts. Later Rixford and Gilchrist 16 reported a similar 

 case and since then a number of other cases have been reported, 

 most of them from the San Joaquin Valley, California. 



Ophuls described three clinical types: (1) with primary cutane- 

 ous lesions, and later generalization; (2) with primary pulmonary 

 lesions and later generalization but no skin lesions; (3) with primary 

 pulmonary lesions and secondary subcutaneous lesions. 



The disease runs a more acute and severe course than blastomy- 

 cosis and of twenty-four cases collected by MacNeal and Taylor, 

 but two recovered. The cutaneous lesions consist of large rather 

 painless granulomatous abscesses; there is usually marked lympha- 

 denitis and the lungs, bones, liver, kidney, and meninges have been 

 found to be involved. Histologically, the lesions both in man and 

 in experimentally infected animals very closely resemble those of 

 tuberculosis. 



COCCIDIOIDES IMMITIS 

 (Oidium coccidioides, Ophuls ; Mycoderma Immite, Brumpt) 



The distinction between this parasite and that of blastomyces 

 is recognized by Ophuls, 17 Wolbach 18 and MacNeal, 19 but no typical 

 cases have been described by Europeans. The parasite seen in the 

 tissues resembles the blastomyces, but does not show buds and repro- 

 duces by the formation of endopores. These appear as a mass of 

 minute round bodies each of which may be capsulated within the 

 membrane of the parent cell. The parasites vary greatly in size and 

 some are much larger than those usually found in blastomycosis, 

 reaching 50 microns in diameter. 



Cultures. The colonies appear in surface plants in from two 

 to seven days as small slightly raised disks distinctly penetrating 

 the media. Older cultures become covered with a dusty white layer 



"Bixford and Gilchrist, Johns Hopkins Hosp. Reports, 1896, I. 



"Ophuls, W., J. Exper. M., 1905, vi, 443. 



18 Wolbach, J. M. Res., 1904, N. S. viii, 53. 



"MacNeal, W. J., and Taylor, E. M., J. M. Res., 1914, xxv, 261. 



