764 Sporotrichosis 



1. Disseminated Gummatous Sporotrichosis. — The onset is insidious. An 

 accident usually leads to the discovery of the first gummata. The number of 

 gummata may vary up to 100. The first takes origin from any point in the sub- 

 cutaneous tissue. Others disseminate themselves over the whole body. Each 

 gumma has an autonomous evolution which is the same for aU. At first it is a 

 little rounded mass, hard, elastic, painless and invariably in the subcutaneous 

 tissue. The mass evolves rapidly in the direction of softening and in four or 

 six weeks terminates in a characteristic cold abscess. When it undergoes lique- 

 faction, it contains a fluid which is at first transparent, viscid, gummy, and with 

 purulent streaks and later becomes opaque, thick and purulent. It does not 

 undergo complete softening, and when it becomes fluctuating we find a central 

 cup-shaped depression surrounded by a firm and resisting zone, and when its 

 contents are evacuated, there remains round the empty pocket a persistent and 

 indurated ring. 



2. Disseminated Subcutaneous, Gtmunatous Sporotrichosis with Ulceration. 

 ■ — In this variety, the subcutaneous gummata after having passed through the 

 phases described above, become hypodermo-dermic and destroy the skin by 

 ulceration more or less rapidly, sometimes in twenty days, sometimes in two or 

 three months. As a rule the ulcers are tuberculous in appearance. Frequently 

 the ulceration is at first no more than a narrow fistula from which oozes a viscid, 

 colorless and sometimes reddish pus or a yellowish serous fluid. 



3. Mixed forms are frequent. When the disease has existed for a long 

 time it presents a complete clinical picture. Side by side are lesions of different 

 age with different tendencies and different appearances; tuberculous looking, 

 syphilitic looking, ecthymous, rupial and furuncular. There may be associated 

 lesions of thelymphatics, and lesions of the dermis, epidermis, mucous membranes, 

 muscles, osseous tissues, synovial membranes, eyes, epididymis, etc. 



4. Localized Sporotrichosis. — The sporotrichum penetrates by a cutaneous 

 lesion at the site of which it produces an initial lesion, which may be called the 

 " sporotrichotic chancre." Then it gradually invades the lymphatics and a hard 

 lymphatic cord studded with gummata — centripetal gummatous sporotrichosis — 

 makes its appearance. Sometimes the lymph-nodes of the region react, but this 

 is not constant. The disease remains localized to the region primarily affected. 



Sporotrichosis of the mucous membranes, of the muscles, of the bones and 

 joints, of the synovial membranes, of the eye, of the epididymis, of the kidney, 

 and of the lung are described by de Beurmann. * 



Bacteriologic Diagnosis. — Diagnosis by immediate and direct 

 examination of the pus either stained or unstained is difficult be- 

 cause the parasites are few in number, and are present in the bacil- 

 lary form that is so difficult to recognize. 



The approved method is to carefully cleanse the skin over one 

 of the closed lesions, disinfect it with iodine, and then puncture the 

 abscess with a hollow needle. The pus obtained is spread plenti- 

 fully over the surface of culture-media in a number of tubes and stood 

 in the incubating oven. The characteristic colonies should appear in 

 from four to twelve days. 



Should cultures be on hand in the laboratory at the time a case 

 presents itself for diagnosis, two other methods may be employed. 



1 . The Agglutination. Test. — A suspension of the spores from cul- 

 tures of the sporotrichum will be agglutinated by the patient's 

 serum in dilutions of 1-400 to 1-500 on the average. 



2. The Complement-fixation Test. — The entire culture is used as 

 an antigen, the serum of the patient and guinea-pig complement em- 

 ployed as usual. As, however, oidium, actinomyces, discomyces 



* "Brit. Med. Jour.," 1912, 11, 293. 



