Fig. 144.—Juxta-articular nodules. (After Steiner; from Mense.)
In those parts of Africa where the tumors due to Onchocerca volvulus are found there may be confusion in diagnosis but these filarial nodes are elastic. By aspirating the swelling microfilariae should be found in onchocerciasis.
The treatment of juxta-articular nodules is by excision should they give trouble.
Visceral Mycoses
The majority of cases of visceral mycoses reported from tropical regions have been considered as caused by species of Monilia, but not infrequently fungi of the genus Cryptococcus have been incriminated. As a rule the mycosis is reported as occurring in cases which had been regarded as pulmonary tuberculosis. In some of the cases there were cutaneous lesions, enlarged glands and even generalized conditions as well as lung involvement.
Among the fungi reported for the lungs we have: Rhizomucor parasiticum, Nocardia pseudotuberculosis, Aspergillus fumigatus, Penicillium crustaceum, Monilia tropicalis, Monilia candida, Cryptococcus gilchristi, Coccidioides immitis and various other species. A satisfactory study of the true nature of the causative fungi has been made in only certain instances and a scientific investigation of this phase of tropical pathology is desirable.
Bronchomoniliasis.—Castellani has used this designation for two types of cases in which various species of Monilia have been reported as causative. In one type the symptoms are mild with but slight impairment of health, there being only a cough with expectoration of muco-purulent sputum. No fever is present. In the severe type we have the symptomatology of pulmonary tuberculosis with abundant reddish-gray sputum. In both types the diagnosis is made by finding the fungi in perfectly fresh sputum. This should be cultured in a hanging-block culture using Sabouraud’s medium. The mycelium and budding forms can best be studied in such a preparation. Negative findings for tubercle bacilli are important in diagnosis. Potassium iodide is recommended in treatment.
Sporotrichosis.—The infection with various species of Sporotrichum usually gives rise to gummatous lesions along the lines of the lymphatics of the extremities. These tumor masses break down and discharge a yellowish-brown pus. Rarely the process generalizes, then often invading the lungs. Culturing of the pus or sputum is necessary for diagnosis. In cultures the sporothrix shows a narrow (2µ) mycelium with grape-like clusters of oval spores at the end of a filament. The treatment recommended is iodide of potash.
Blastomycosis.—The causative organism, Cryptococcus gilchristi, is found in the purulent discharge as oval to round, doubly contoured, budding yeast-like cells 10 to 16µ. In cultures we have formation of a mycelium resembling that of an oidium. The lesions may be solely cutaneous or generalized in which latter case the lungs are apt to be involved giving a condition resembling pulmonary tuberculosis.
Coccidioidal granuloma.—This is a very rare and fatal infection caused by Coccidioides immitis, a fungus somewhat similar in cultures to C. gilchristi but differing in tissues in that it gives rise to endogenous spore formation in the cells found in the granulomatous material. The spores are about 3µ in diameter and contained in a large cell (30-60µ) which does not bud. We may have skin lesions accompanying visceral involvement or the latter alone. When involving the lung the infection closely resembles pulmonary tuberculosis. The spores metastasize readily by way of the lymphatics involved and we may have a picture of pyaemia. Skin lesions, when present, are ragged and punched out. About 40 cases have been reported, chiefly from California.