MONILIA AND SPRUE 145 



The cases caused by the black varieties are more rare and are characterized by the 

 presence in the discharge from the sinuses of black gunpowder-like grains. 



These hard, brittle, irregular grains are caused by various species of fungi of 

 which the best known is Carter's black mycetoma (Madurella mycetomi). This 

 species was cultured by Wright and first shows a grayish growth, later becoming 

 black. Other black varieties of mycetoma are due to various other fungi. Bouf- 

 fard's black variety is caused by Aspergillus bou/ardi. DeBeurmann's black myce- 

 toma has as cause Sporotrichum beurmanni. 



Besides the white and black varieties we also have a red variety of mycetoma. 

 The fungus grains are quite small and reddish in color. It is not an uncommon 

 infection in certain parts of Africa, as Senegal. The cause is Nocardia pelletieri. 

 Discomyces carougeani has been reported as the cause of juxta-articular nodes, 



but Breinl has been unable to verify the finding. 



M alassezia furfur. This is the fungus of tinea versicolor. It is common both in 

 temperate and in tropical climates. It is characterized by dirty yellow spots 

 about covered parts of the body. Scrapings shows a profusion of mycelial 

 threads and interspersed spores. It is very difficult to cultivate. The organism 

 usually termed the bottle bacillus is really a fungus having the characteristics 

 of the genus Malassezia. It is thought to be the cause of pityriasis of the 

 scalp. 



Microsporoides minutissimus. This is generally considered as the cause of Ery- 

 thrasma or dhobie itch, a very common intertrigo of the tropics. It is char- 

 acterized by its narrow mycelium and small spores. Various fungi are found 

 in this affection. Castellani considers the chief cause of dhobie itch to be a 

 trichophyton. Epidermo phyton cruris. 



Clinically this affection shows festooned areas of a bright red color which tend 

 to clear up in the center becoming fawn color. As a result of the intolerable itching 

 and scratching the affection tends to spread from its favorite sites the inner sur- 

 faces of the thighs and the scrotum. The spores and mycelium are abundant at 

 the onset but later, one may not find any evidence of the mould. In some of the 

 rapidly spreading cases I have found a symbiosis of fungus and coccus, the bacterial 

 elements lying packed in aggregations scattered through the mycelial ground work. 

 Culturally these cocci were S. pyogenes aureus. (See page 142.) 



Monilia albicans (Oidium albicans). Castellani separates Monilia 

 from Endomyces in that it does not show the asci and internal spores 

 of the latter. In cultures it gives budding yeast-like growths and 

 mycelial threads. On Sabouraud's medium it gives a whitish growth. 

 It slowly liquefies gelatin and blood-serum and, after acidifying, clots 

 milk. It is recognized as the organism of thrush. Bahr found this 

 fungus in the deep layers of the tongue as well as in the cesophageal 

 and intestinal coatings of sprue. 



Ashford is convinced that a species of Monilia which he is sure is distinct from 

 M . albicans, is the cause of sprue. He states that this fungus is common in the 

 bread of Porto Rico. He has recovered the organism from sprue lesions and has 



