CHAPTER XXXVII 

 BLASTOMYCOSIS 



Blastomyces Dermatitidis (Gilchrist and Stokes) 



The first case in which yeasts or blastomycetes were definitely 

 connected with disease seems to have been pubUshed by Busse.* 

 He observed a case of tibial abscess in a woman thirty-one years of 

 age, who died about a year after coming under observation. Post- 

 mortem examination showed numbers of broken-down nodular for- 

 mations upon the bones, and in the spleen, kidneys, and lungs. In 

 all of these lesions he found, and from them he cultivated, an yeast, 

 which, when introduced in pure culture into animals — 'mice and 

 rats — proved infective for them. He called the organism Saccharo- 

 myces hominis, and the affection in which it was found "Saccharo- 

 mycosis hominis." 



In May, 1904, three months before the appearance of Busse's 

 paper, GUchrist exhibited to the American Dermatological Associa- 

 tion in Washington, microscopic sections from a case of cutaneous 

 disease, in which peculiar bodies, recognized as plant forms, were 

 found. After the appearance of Busse's papers, Gilchristf more 

 fully described and illustrated his findings, calling the lesions 

 "blastomycetic dermatitis." Though much work upon pathogenic 

 blastomycetes has been published and pathogenic forms of these 

 micro-organisms have been described by Sanfelice.f Rabinowitsch,§ 

 and others, the chief and almost the sole form in which these infec- 

 tions make their appearance is a dermal infection known as 

 "blastomycetic dermatitis." 



The infection usually begins with the formation of a papule upon 

 the tace or one of the extremities, which suppurates and evacuates 

 minute quantities of viscid pus. The lesion crusts and begins to 

 heal, but at the periphery new and usually minute foci of suppuration 

 occur, so that while the original lesion tends to heal very slowly, 

 with much cicatricial formation, it is always spreading. The 

 progress is usually slow, and Gilchrist's first case spread only 2 

 inches in four years. 



Though the progress is slow, it is sure, and there is no tendency 

 to spontaneous recovery in most cases, nor is the condition modified 

 by treatment. The patients may die from intercurrent disease or 



* "Centralbl. f. Bakt. u. Parasitenk.," 1894, xvi, 175. 

 t "Johns Hopkins Hospital Reports," i, 269, 291. 



t "Centralbl. f. Bakt. u. Parasitenk.," 1895, xvii, 113, 625; xviii, 521; xx, 219 

 § "Zeitschrift fur Hygiene," etc., 1896, xxi, ii. 



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