2084 



TROPICA L DERMA TOM Y COSES 



Clinical Varieties. — Several varieties can be distinguished:— 



1. The common cutaneous type, or North American and 



Asiatic type. 



2. The oro-pharyngeal blastomycosis. 



3. The Coccidioides blastomycosis. 



4. The gluteal blastomycosis. 



1. Common Cutaneous Type. — The description we have given 

 of the disease refers to this type, which is quite common in Ceylon. 

 Southern India, Philippine Islands, Indo-China, Tonkin, and prob- 

 ably in many other parts of the tropics. A very frequent localization 

 in Ceylon is the upper lip (see Fig. 830), the disease extending 

 later occasionally to the nasal mucosa, and very rarely to the 

 oral mucosa. In several of our cases a monilia-like fungus was 

 grown. 



2. Oral Blastomycosis. — This variety has been investigated by 

 Lutz and Splendore in South America. Splendore considers the 

 fungus to be a Zymonema, and calls the disease zymonematosis. 

 As most authorities do not accept the gQmx'i> Zymonema, we place the 

 fungus in the genus Monilia (see p. 1079). The skin lesions 

 are identical with those found in the common type of the malady, 

 but the infection spreads to the oral mucosa, lips, gums, soft and 

 hard palate, giving rise to numerous small, verrucoid, papillomatous, 

 or framboesiform patches, which later may undergo deep ulceration. 

 The disease later invades the pharynx, nose, larynx, and bronchi, 

 and often terminates fatally. 



3. Blastomycosis Coccidioides (synonym, Protozoic disease) was 

 described by Wernike of Buenos Ayres in 1890, and later by Posadas ; 

 it was further investigated by Ophiils, Mofht, and others. It was 

 at first considered to be of protozoal origin. The lesions on the 

 skin are somewhat similar to those found in the more usual type of 

 blastomycosis — viz., verrucose patches with minute epidermal 

 abscesses — ^but are generally of larger size, and visceral complications 

 are the rule, the malady terminating almost always fatally. In the 

 affected tissues peculiar large structures are seen, some of which 

 may contain as many as 100 spore-like bodies (see p. 985). 



4. Gluteal Blastomycosis. — This condition was described by Kar- 

 tulis some years ago in Egypt. We have often observed it in 

 Ceylon. The skin of the gluteal region — one nate or both nates — 

 presents a diffuse induration, and is cribrated with the opening 

 of sinuses, from which a thin pus exudes. The sinuses may be 

 very deep and connected with each other, but in our cases did 

 not communicate with the intestine. The pus does not contain 

 grains, as is the case with actinomycosis. The patient may com- 

 plain of pain and discomfort on sitting down. The disease is chronic. 



Maxwell has reported from Formosa cases of a fistulous disease pf the 

 buttocks, which may be of the same nature. He is inclined, however, to 

 consider them to be of amoebic origin. 



