2o88 



TROPICAL DERMATOMYCOSES 



The fungi may also, apparently, live saprophytically in the oral 

 cavity and pharynx of certain individuals, who then become carriers. 



The rat, mouse, monkey, cat, and very young guinea-pigs, are all 

 more or less susceptible, and may be infected by subcutaneous or 

 intraperitoneal inoculation. The rat is the most susceptible 

 animal. In it Lutz and Splendore have described a spontaneous 

 sporotrichosis due to a Sporotrichum apparently identical with 

 S. beurmanni. Moore and Davis have described a case following 

 the bite of a field-mouse. The patient's blood agglutinated equally 

 well 5. schenki and 5. beurmanni. The affection has also been 

 observed to occur spontaneously in the dog (Gougerot and Caravan) 

 and in the mule (Fontoynont and Carougeau) in Madagascar. 



Histopathology. — The histopathology of the cases due to 5. 

 beurmanni has been investigated by De Beurmann and Gougerot; 

 that of the cases due to S. asteroides by Splendore; that of the 

 cases due to 5. indicum by ourselves. Whatever the causative 

 species of Sporotrichum, the histological lesions are apparently 

 the same, and correspond to the three principal types described 

 by De Beurmann and Gougerot — viz., (i) An epithelioid type, 

 with presence of giant cells — this corresponds to the tuberculoid 

 type of De Beurmann and Gougerot; (2) a lympho-connective 

 tissue or syphiloid reaction; (3) a polymorphonuclear or ecthy- 

 matiform type. 



Symptomatology. — In a well-marked case, several gummatous- 

 like swellings, situated in the subcutaneous tissue, are present on 

 various parts of the body — the arms, legs, and trunk. The size 

 varies from that of a small pea to that of an orange. On palpation, 

 they are hard, resistant at first; later they soften, the skin becomes 

 reddish or violaceous and after a time perforates. From the 

 fistulous opening a yellowish homogeneous pus is slowly evacuated, 

 or at times a thin serous discharge. In some cases the suppuration 

 ceases, granulation sets in, and a coarse cheloid-like scar remains. 

 In other cases the fistulous opening enlarges and a crateriform 

 ulcer, with often a fungating fundus, develops. The lymphatic 

 glands may occasionally become affected. The course of the disease 

 is very chronic. In some cases deep gummata develop under the 

 periosteum of various bones, and in the muscles. Large granulating 

 ulcerations may form in the buccopharynx and larynx. The general 

 health, as a rule, is not much affected. 



Clinical Varieties. — The commonest varieties met with are: — 



1. The localized type, with sporotrichic chancre and ascending 

 sporotrichic lymphangitis. 



2. The disseminated gummatous type. 



3. The disseminated ulcerative type, presenting often poly- 

 morphic lesions — viz., syphihtic-like, tubercular-like, ecthymatous, 

 rupial, furuncular. 



4. The extracutaneous type, with sporotrichic lesions of the 

 mucous membranes, the muscles, the articulations, the bones, the 

 organs of special sense, the internal organs— lungs, kidneys, etc. 



