BLASTOMYCOSIS 



2085 



Diagnosis. — This is based, in the usual type of the malady, on 

 the presence of verrucose patches with micro-abscesses, in which the 

 fungi are found. The disease has been often confused with tubercu- 

 losis verrucosa, with a syphilide, with an epitheliomatous lesion, 

 and, in the tropics, with atypical framboesia and even ringworm. 

 The microscopical examination and cultivation of scrapings, or, 

 better, of the pus of the miliary abscesses present in the lesions, will 

 be necessary to clear the diagnosis. A droplet of the pus, or a 

 minute portion of teased tissue, is placed on a slide with a drop 

 of a 30 per cent, solution of potassium hydrate, and a cover-glass 

 is placed on the preparation; after about half an hour in a temperate 

 climate, and generally a few minutes only in |a tropical climate, the 

 tissue and pus cells are disinte- 

 grated by the potash solution, while 

 the organisms, being resistant, can 

 be easily seen. Cultures should 

 also be made from the pus. It 

 is important to note that yeast- 



Fig. 834.— Fungus foumd in Der- 

 matosis Hyphomycetica Indica. 

 (Broth Culture.) 



Fig. 835. — Dermatosis Hypho- 



MYCETICA IiNDICA (SCe. 



p. 2086). 



like organisms may be frequently found as saprophytes on |the 

 surface of various ulcerated skin lesions, which have nothing to do 

 with true blastomycosis. 



0ml blastomycosis may occasionally be confused with espundia, 

 from which it is differentiated by the absence of Leishmania and 

 presence of fungi. Blastomycosis coccidioides is easily diagnosed by 

 the presence of bodies containing numerous— as many as 100 — 

 endospores. Gluteal blastomycosis is distinguished from actino- 

 mycotic and mycetomatous conditions by the absence of the grains 

 and the characters of the fungi; from a syphilitic condition by 

 the ineffiaacy of a mercurial treatment; from tubercular fistulous 



