ACLADIOSIS 



2091 



of the polymorphonuclear type; in this patient there was abundant 

 purulent secretion and serotine fever, which on some days reached 

 102° and 103° F. 



Diagnosis. — A positive diagnosis can be made with certainty only 

 by cultural methods. The microscopical examination alone is of 

 very little use, hyphomycetic elements being as a rule absent micro- 

 scopically in the scrapings from the ulcers and contents of nodules. 

 The material should be inoculated in glucose agar tubes. Four to 

 eight days after inoculation small, yellowish, amber-coloured colonies 

 appear ; they enlarge fairly rapidly, become hemispheric, and often 

 coalesce in a knotty mass. At times the colonies may not fuse 

 together ; each colony then remains separate, reaches a large size, and 

 occasionally presents peculiar radiating furrows as seen in certain 

 species of trichophytons. In many cases where the material has 

 been collected 'from ulcerated lesions, the fungus grows in symbiosis 

 with a coccus, and it' may be difficult to separate the two organisms. 



Fig. 839. — AcLADiosis of the Arm. 



The malady is often taken for a syphilitic condition. The history, 

 the negative examination of the lesions for spirochsetes, the failure 

 of mercury and salvarsan treatment, will exclude it . When the lesions 

 are covered by raised, thick, bright, yellow crusts the condition must 

 be differentiated from yaws: in acladiosis, on removing the crusts, 

 ulcers are found, while in yaws, the typical framboesiform nodules 

 will be seen; in scrapings from yaws lesions the treponema will be 

 found. Acladiosis can be differentiated from sporotrichosis and 

 other affections of hyphomycetic origin by cultural methods. 



Prognosis. — ^The course of the disease may be very long, and 

 there is very little or no tendency to spontaneous cure; but if a 

 proper treatment is carried out a cure can be obtained fairly rapidly 

 in the majority of cases. A few cases respond to treatment ex- 

 tremely slowly. 



Treatment. — Potassium iodide given in full doses (20 gr. ter diem) 

 acts satisfactorily. The drug appears to act at times more rapidly 

 if given according to Professor Pinoy's method — viz., in conjunction 



