DIFFERENTIAL DIAGNOSIS 



1889 



On these media the growth, which is generally white with a smooth surface 

 when young, slightly crinkled when old, is composed practically of globular, 

 yeast-like cells, while in the water of condensation globular cells and mycelial 

 elements are found together. A little mycelium may, however, be found also 

 occasionally in the growth on the slope. On serum all the strains produce at 

 first a white growth, but some, later on, induce a peculiar brownish-black 

 discoloration of the medium round the growth. Most species do not liquefy 

 the medium. 



On gelatine all the species grow fairly well; a few, including Monilia 

 albicans, produce liquefaction of this medium. In milk some do not produce 

 either acid or clot, others produce a temporary or permanent acidity, others 

 clot the milk or peptonize it. The reactions in the various sugar broths are 

 important, and in association with the behaviour of the fungi on serum, 

 gelatine, and milk, give the data on which to differentiate the various species 

 [vide p. 1081). . 



Differential Diagnosis. — Primary bronchomoniliasis, as described 

 in this chapter, should be distinguished from the secondarybroncho- 

 moniliasis occasionally met with in cachectic patients suffering 

 from cancer, diabetes, tuberculosis; etc. In such cases there is 

 generally thrush of the oral mucosa, and the thrush Monilias spread 

 to the pharynx, larynx, and bronchial mucosa, while in primary 

 bronchomoniliasis the oral mucosa is not, as a rule, affected. 



From pulmonary tuberculosis the condition is distinguished by 

 the absence of the tubercle bacillus in the sputum and the negative 

 animal inoculations. Cases of mixed infection, however — tubercu- 

 losis and moniliasis — are occasionally met with, the sputum con- 

 taining both the tubercle bacillus and the Monilia fungi. 



From bronchospirochaetosis it is recognized by the absence of 

 spirochaetes, though occasionally cases of mixed infection occur ; from 

 endemic haemoptysis by the absence of the ova of Paragonimus 

 ringeri Cobbold. 



Prognosis. — ^The cases of a mild type may recover spontaneously 

 or under appropriate treatment. Those of the severe type usually 

 end fatally. 



Treatment. — Mild cases and those of medium gravity respond 

 often to potassium iodide (gr. x. to xx.) given well diluted in water 

 or milk three times daily. When potassium iodide causes severe 

 symptoms of iodism, saiodin in the same doses (in cachets) may be 

 administered. In the cases of the severe type we have seen no 

 improvement from the many different treatments administered. 

 Potassium iodide, however, should always be tried also in these 

 cases, as well as balsamics. The diet should be nourishing; hypo- 

 phosphites and glycerophosphates may be tried to keep up the 

 strength of the patient, as in phthisis. 



Broncho-Oidiosis. 



Synonyms. — Bronchial oidiomycosis, Broncho-endomycosis. 

 Historical. — Cases have been described by Blanchard, Chant emesse 

 and Vidal, Linossier, Pinoy, Castellani, and others. 

 Geographical Distribution. — The same as bronchomonihasis. 



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