THE MADUROMYCOSES 



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C. The Asian White Maduromycosis. 



Brumpt's white maduromycosis, due to Indiella mansoni Brumpt, 

 1905, with very small and very hard white grains, found in India. 



The differentiation of the white maduromycoses may be effected 

 as follows: — 



A. Grains soft : — 



1. Sterigmatocystic heads found in grains and in cultures. Grains 



not like a ribbon rolled on itself — Nicolle and Pinoy's white 

 maduromycosis. 



2. No such heads to be found in the grains, which are like a ribbon 



rolled upon itself — Brumpt and Reynier's white maduromycosis. 



B . Grains hard : — 



1 . Grains small, yellowish, not reniform ; spore of the type of a coni- 



dium — Tarozzi and Radaeli's white maduromycosis. 



2, Grains small, whitish, reniform; spore of the type of an arthro- 



spore — Brumpt's white maduromycosis. 



III. THE RED MADUROMYCOSIS. 



Only one form is known Balfour and Archibald's red maduromycosis, which 

 was possibly due to an aspergillus, because aspergillar-like heads were found 

 in the grains. It occurred in the Anglo-Egyptian Sudan. 



Pathology. — ^The causal fungus is introduced into some part of 

 the body by a wound produced by a thorn, a splinter of bamboo or 

 other wood, by a sharp stone, knife, etc., but once introduced into 

 the subcutaneous tissues, it commences to grow, the original wound 

 in the meantime healing. Usually the growth is slow; but if 

 Kemper and Jamieson's case was true mycetoma, it may be rapid, 

 and, indeed, this is supported by Musgrave and Clegg's inoculation 

 of Nocardia aster oides into a monkey's feet, in which the swelling 

 developed in ten to sixteen days, and was quickly followed by sup- 

 purative lesions. As the fungus grows, it destroys the tissues of the 

 foot, and meets with but little reaction on the part of the body, 

 and no attempt is made to repair its ravages. The reaction on the 

 part of the body confines itself to alymphocytic infiltration around 

 the fungus, and later the formation of granulation tissue, with 

 epithelioid and giant cells at times; while, finally, fibrous tissue is 

 formed around the fungus and its surrounding cells, and the vessels 

 become blocked by an endarteritis and periarteritis. This appears 

 to be an attempt to encapsule and prevent the spread of the parasite, 

 as well as to damage it by cutting off its food-supply. 



At the same time the cellular exudate becomes a thin, oily, occa- 

 sionally stinking, pus, and works its way to the surface, forming 

 apertures, and carrying the parasite with it. This must be con- 

 sidered to be an attempt to rid the body of the fungus. 



In the meanwhile the parasite, if of certain species, forms special 

 club-shaped hyphae considered to be chlamydospores, which at first 

 serve for extracting nutrition from the surrounding leucocytes, but 



