SPOROTRICHOSIS 545 



Sporotrichosis. 



In 1898, Schenk, in America, described a case of chronic sub- 

 cutaneous abscesses associated with a fungus belonging to the 

 sporotricha, and during recent years the organism has been 

 isolated from a great many granulomatous conditions occurring 

 in various parts of the world. Most of the cases have been 

 characterised by somewhat heteromorphic and indolent granulo- 

 matous lesions in the skin, resembling those of tuberculosis and 

 syphilis. The initial lesion is at the site of some slight abrasion, 

 and it is followed by a succession of, usually small, granulomata, 

 whose distribution indicates a lymphatic spread. There is little 

 tendency to spontaneous cure. Apart from the skin, cases have 

 been recorded of lesions in the pharynx, larynx, muscle, bone, 

 and synovial membrane, and both in man and in animals (dogs, 

 rats) generalised infections of the serous cavities and solid organs 

 have been observed. The lesions are of a diffuse granulomatous 

 character, and at first consist of young connective-tissue elements 

 and plasma cells with little leucocytic exudation. Later, many 

 fibroblasts develop, embedded in a fibrinous-like exudate. Diffuse 

 degeneration and Heterosis occur and also leucocytic emigration 

 with the formation of abscesses, at first of microscopic size. When 

 the skin is involved, ulceration results. In certain cases abscess 

 formation is more marked. 



Direct examination of the pus may reveal the presence of oval, 

 highly refractile spores, 3-4 p long and l - 6-3 p broad, and 

 these may be demonstrated both free and in the granulomatous 

 cells, in films and sections stained by ordinary aniline dyes ; they 

 are Gram-positive. Mycelial formation does not occur in the 

 tissues, except occasionally in the most superficial parts of an 

 ulcerating lesion. If a drop of pus be placed on the glass of an 

 agar slope just above the condensation water, the sprouting of 

 a mycelium from the spores may be directly observed with the 

 microscope. The organism, which is generally known as the 

 Sporotrichon beivrmanni, grows readily on any ordinary medium 

 (gelatin, agar, potato), but is best studied on Sabouraud's 

 medium. Two sets of media should be inoculated — one in- 

 cubated at 37° C. and the other at room temperature. On the 

 latter, after about forty-eight hours, somewhat fluffy, snowflake- 

 like, white points appear which gradually become brown, and 

 when growing in mass present a heaped-up convoluted growth. 

 The morphology of the organism is best studied in hanging-drop 

 preparations made with agar. From a spore a mycelial thread 

 about 1 n in thickness, irregularly septate, and often containing 



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