1 66 MEDICAL BACTERIOLOGY 



brane in oidiomycosis, or made from the serum or pus expressed from skin 

 lesions in bias tomyce tic dermatitis, or from the sputum in pulmonary blasto- 

 mycosis, or pus of abscesses, readily discloses the nature of the infection, the 

 large, round and oval, budding cells with a distinct wall being characteristic. 



Sections of involved tissue present numerous identical cells. 



Saccharomyces Neoformans, a yeast frequently found in fermented fruit and 

 advanced as the cause of cancer by Sanfelice, probably is not pathogenic and 

 has been rejected as the cause of carcinoma. 



COCCIDIOIDES IMMITIS 



Coccidioides Immitis is the cause of a disease in man Coccidiosis which 

 begins as a papular eruption, the papules- later coalescing, become pustules, 

 which in turn are followed by ulceration and a purulent discharge. 



The infection may remain localized in the skin for months, being confined 

 to the integument of one extremity or involving a larger area. Eventually in 

 most cases the lymphatic glands are attacked and general disseminated infec- 

 tion with clinical signs and pathological changes resembling miliary tubercu- 

 losis mark the last stage of its fatal course. 



Morphology. Coccidioides Immitis, in the purulent discharge from lesions, 

 in the giant cells of tubercles found in affected tissue and in material taken from 

 buboes, appears as round, thick- walled, yeast-like cells, 20 /z to 40 /i in diameter, 

 some of which contain spores. 



In spreads made from cultures organisms identical to those found. in tissue 

 are observed and in addition some show budding and mycelia. 



Growth. Occurs aerobically at room and body temperature on agar, 

 glycerin agar and glucose agar, neutral or acid in reaction. 



Pathogenesis. Subcutaneous inoculation of pus or fluid from lesions and 

 of cultures produces disease in guinea-pigs, rabbits and monkeys similar to 

 that observed in man. 



Diagnosis. Make smears for microscopic examination and cultures on 

 Sabouraud's agar of purulent discharge from skin lesion, or, if the disease has 

 not progressed beyond the papular stage, excise a papule, fix, section, stain and 

 examine serial sections. 



When buboes exist, if organisms have not been found in superficial lesions, 

 massage an enlarged gland, aspirate as much as possible of its contents with a 

 syringe and needle and examine the same as pus. 



For a detailed description of systemic blastomycosis see Stober, A. M., 

 Archives Int. Med., xiii, No. 4, April, 1914. 



