HANOBUCH DER SPEZIELLEN PATHOLOGISCHEN ANATOMIE UNO HISTOLOGIE

BEGRONDET VON

O. LUBARSCH UNO F. HENKE

FORTGEFOHRT VON

R. ROSSLE

HERAUSGEGEBEN VON

E. UEHLINGER ZORICH

DRITTER BAND

ATMUNGSWEGE UNO LUNGEN

HERAUSGEGEBEN VON

E. UEHLINGER ZORICH

FUN FTER TEll

SPRINGER-VERLAG

BERLIN· HEIDELBERG · NEW YORK

1971

THE PATHOLOGIC ANATOMY OF MYCOSES

HUMAN INFECTION· WITH FUNGI ACTINOMYCETES AND ALGAE

BY

ROGER DENIO BAKER

AND

A. ANGULO O .. C. BARROSO-TOBILA . L. M. CARBONELL

R. CESPEDES F. . E. W . CHICK . B. M. CLARK· O. DUQUE

G. M. EDINGTON · B. F. FETTER· J. H. GRA HAM · D. J. GUIDRY

R. W. HUNTINGTON, JR . . H. ICHINOSE . G. K. KLINTWORTH

H.1. LURIE· L. N. MOHAPAT!A . J. MORENZ . H. S. NIELSEN, JR.

J. C. PARKER, JR . . C. E. PENA . P. PIZZOLATO · L. POLLAK

K. SALFELDER . ]. SCHWARZ· ]. P. WIERSEMA

H.1. WINNER · D. ]. WINSLOW

WITH 796 FIGURES 2 IN COLOR

SPRINGER-VERLAG

BERLIN· HEIDELBERG · NEW YORK

1971

ISBN-13: 978-3-642-80572-1 e-ISBN-13: 978-3-642-80570-7 DOl: 10.1007/978-3-642-80570-7

A special US·edition is available under the title: BAKER. Human Infection with Fungi, Acti­nomycetes and Algae

This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, re-use of illustrations, broadcasting, reproduction

by photocopying machine or similar means, and storage in data banks.

Under § 54 of the German Copyright Law where copies are made for other than private use, a fee is payable to the publisher, the amount of the fee to be determined by agreement with the publisher.

© by Springer Verlag, Berlin-Heidelberg 1971. Library of Congress Catalog Card Number 25-11247.

Soflcovcr reprint of the hardcover 1st edition 1971

The use of general descriptive names, trade names, trade marks, etc. in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as nnderstood by the Trade

Marks and Merchandise Marks act, may accordingly be nsed freely by anyone.

HUMAN INFECTION WITH

FUNGI, ACTINOMYCETES

AND ALGAE

BY

ROGER DENIO BAKER

AND

A. ANGULO O .. C. BARROSO-TOBILA . L.M.CARBONELL

R. CESPEDES F. . E. W. CHICK· B. M. CLARK· O. DUQUE

G. M. EDINGTON· B. F. FETTER· J. H. GRAHAM· D. J. GUIDRY R. W. HUNTINGTON, JR .. H. ICHINOSE . G. K. KLINTWORTH

H. I. LURIE· L. N. MOHAPAT~A . ]. MORENZ . H. S. NIELSEN, JR. J. C. PARKER, JR .. C. E. PENA . P. PIZZOLATO· L. POLLAK

K. SALFELDER . J. SCHWARZ· J. P. WIERSEMA H. I. WINNER· D.]. WINSLOW

SPECIAL EDITION OF

HANDBUCH DER SPEZIELLEN PATHOLOGISCHEN

ANATOMIE UND HISTOLOGIE 11115

WITH 796 FIGURES

2 IN COLOR

SPRINGER -VERLAG

NEW YORK· HEIDELBERG· BERLIN

1971

TSBN-13: 978-3-642-80572-1 e-ISBN-13: 978-3-642-80570-7 DOT: 10.1007/978-3-642-80570-7

Special edition of Handbuch der speziellen pathologischen Anatomie und Histologie, Band III/5

This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, re-Ilse of illustrations, broadcasting, reproduction

by photocopying machine or similar means, and storage in data banks.

Under § 54 of the German Copyright Law where copies are made for other than private use, a fee is payable to the publisher, the amount of the fee to he determined by agreement with the publisher_

© by Springer-Verlag, Berlin-Heidelberg 1971 . Library of Congress Catalog Card Number 72 - 160 588.

Softcover reprint of the hardcover 1 st edition 1971

The use ofgenerai descriptive names, trade names, trade marks, etc. in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as nnderstood by the Trade

Marks and Merchandise Marks act, may accordingly be used freely by anyone.

Preface

Half a century ago our knowledge of mycoses, especially pulmonary mycoses, was rather fragmentary. It was limited to rare case reports as oddities. Accordingly, in the "Handbuch der speziellen pathologischen Anatomie und Histologie" the chapter on lung diseases caused by budding and spore-forming fungi by J. WATJEN (Halle) took up as little as 27 pages. Only ARNDT (G6ttingen) could report on several cases from which he made his observations on actinomycotic changes of the lungs and pleura.

Since then our knowledge of mycoses has deepened and expanded in an unpre­dictable manner. This progress was mainly due to research and publications in the USA and South America. In Central Europe the number of cases of mycoses has increased during the last two decades, being reported especially as a second disease in patients with spontaneous or iatrogenic destruction of the bone marrow after treatment of cancer with cytostatic agents.

The number of known types of pathogenic fungi has increased. The knowledge of their types and conditions of growth have given rise to a subspecialty. Therefore, a great need has arisen for a new edition of the chapter on mycoses in the Henke­Lubarsch-Roessle Handbook of Special Pathological Anatomy and Histology.

The publishers as well as the editors had the great fortune to find as author Prof. ROGER D. BAKER, who himself has contributed substantially to the know­ledge of human mycoses. It is thanks to Prof. Baker that a large number of eminent scientists could be won as co-authors. Today, under his guidance, a complete handbook on human infection with Fungi, Actinomycetes and Algae has been written. At the present time no other book exists which describes so extensively the fundamentals of human mycology, including taxonomy, clinical aspects, epidemiology, and pathological anatomy.

For all the great progress of the past decades we should not forget that 50 years ago MAX ASKANAZY wrote, for the textbook of General Pathology edited by LUDWIG ASCHOFF, a substantial and thoughtful chapter on fungi as germs. Among his illustrations there is a marvelous colorprint of an aspergilloma of the lungs. This, an early milestone, should not get lost among the abundance of genuine and supposed newer discoveries.

Zurich/Heidelberg 1971 Prof. Dr. E. UEHLINGER

Contents List of Authors Introduction. .

XV . XVII

General Chapters (Chapter I-III) Chapter I: The Scope and General Pathology of Human Infection with Fungi, Actinomy-

cetes, and Algae. R.D. BAKER, New Brunswick, New Jersey, USA The Causative Organisms . . . . . . . . . . . . . 1 Fungus Diseases . . . . . . . . . . . . . . . . . . . . . . . 2 The Distribution and Epidemiology of Fungus Diseases. . . . . . 2 How Pathogenic Fungi Infect Man. . . . . . . . . . . . . . . 3 Mycoses Associated with Lowered Host Resistance, and Caused by Fungi which are

usually Nonpathogenic and "Opportunistic" . 4 Fungi as Inflammatory Irritants . . . . . 4 Tissue Changes in Fungus Diseases. . . . . . 5 Morbidity and Mortality in Mycotic Disease . . 6 The Demonstration of Fungi in Tissues . . . . 6 Examination for Fungi at Postmortem Examination and in Surgical Specimens 9 Infection by Actinomycetes 10 Infection by Algae 10 References. . . . . . . . 10

Chapter II: Mycology of the Agents Producing Deep Mycoses. J. SCHWARZ, Cincinnati, Ohio, USA (With 21 Figures). . . . . . . . . . . . 12

Different Mechanisms of Conversion from M to Y Phase 12 Blastomyces Dermatitidis . . . . . . . . 13 Blastomyces (Paracoccidioides) Brasiliensis 17 Histoplasma Capsulatum . 19 Histoplasma Duboisii. . . 23 Sporotrichum Schenckii. . 24 Cryptococcus Neoformans . 27 Candida Albicans. . 29 Coccidioides Immitis 31 Dematiaceous Fungi 34 References. . . . . 36

Chapter III: Ultrastructure of Human Pathogenic Fungi and Their Mycoses. L. M. CARBONELL, Caracas, Venezuela (With 25 Figures) 38

Introduction. 38 Methods. . . . . 38 Cell Wall . . . . 39 The Cell Contents 45 Developmental Studies 50 Action of Drugs on Fine Structure of Pathogenic Fungi 54 Action of Ultrasound on Pathogenic Fungi 55 Fine Structure of Mycoses ...... 55 Actinomyces, Nocardia and Streptomyces 58 Concluding Remarks 63 References. . . . . . . . . . . . . . 64

Chapter IV: Definition . History ..

The Great Endemic Mycoses (Chapter IV-VII) Histoplasmosis. J. SCHWARZ, Cincinnati, Ohio, USA (With 35 Figures) . 67

66 66

Contents

Epidemiology . . . . . . . . . . . . . . . Geographic Pathology. . . . . . . . . . . . Mycology ................ . Staining of Histoplasma Capsulatum in Tissues. Pathogenesis . . . . . . . . The Primary Lesion in the Lung Histoplasmoma . . . . . Cavitary Histoplasmosis . "Epidemic" Histoplasmosis The Spleen ...... . The Liver ....... . Bone-Marrow, Bone and Joints Lymph Nodes . . . . . . . . Lymphoma and Histoplasmosis Heart and Mediastinum . . . . Interpretation of Indirect Diagnostic Methods Adrenals ......... . Mucocutaneous Histoplasmosis Larynx ....... . Gastrointestinal Tract Genitourinary System. . Brain, Meninges and Eye Associated Diseases. References. . .

Chapter V, Part 1: African Histoplasmosis. G.M. EDINGTON, Ibadan, Nigeria 1 Figure)

References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(With

Chapter V, Part 2: African Histoplasmosis. J. SCHWARZ, Cincinnati, Ohio, USA (With

VII

68 68 69 71 75 79 84 87 90 92 95 95 98

102 103 105 107 109 III 112 115 116 119 121

131

137

4 Figures) . . . . . . . . . . . . . . 139

Geography . . . . . . . . . . . . . . 139 The Organism H. Duboisii Vanbreuseghem 139 References. . . . . . . . . . . . . . . 145

Chapter VI: Coccidioidomycosis. R. W. HUNTINGTON, Jr., Bakersfield, California, USA (With 36 Figures) 147

I. Definition, Synonomy . . . . . 147

II. History . . . . . . . . . . . 150 a) Clinical and Pathologic Studies 150 b) Character and Ecology of the Organism 161

III. Biology . . . . 167 a) The Fungus . . . . 167 b) The Infection 170

IV. Geographical Pathology 172

V. Diagnosis . . . . 174 a) Skin Tests . . . 175 b) Serologic Studies 176 c) Wet Mounts. . 177 d) Cultures. . . . 178

VI. Pathologic Anatomy. 179 a) Basic Pathologic Processes 179 b) Sources of Material . . . . 181 c) Lesions in Fatal Coccidioidomycosis. 183

VII. Categories of Grave and Fatal Coccidioidomycosis 187

VIII. Demonstration of Coccidioides in Tissue Sections 199

Mycelial Phase - C. Immitis in Tissue 201 References. . . . . . . . . . . . . . . . . . . . 202

VIII Contents

Chapter VII: Dermal Pathology of Superficial Fungus Infections. J. H. GRAHAM, Irvine, California, USA, and C. BARRoso·ToBILA, Maracaibo, Venezuela (With 156 Figures) 211

Introduction. . . . . 211 Material and Methods. 212 Tinea Capitis 214

1. Introduction 214 2. Microsporum Audouinii and Microsporum Canis 215 3. Microsporum Gypseum . . . . . . . . . . . 230 4. Trichophyton Schoenleinii ......... 233 5. Trichophyton Mentagrophytes . . . . . . . . 239 6. Trichophyton Tonsurans and Trichophyton Sulfureum 243 7. Trichophyton Violaceum . . . . . . . . . . . . . 252 8. Summary and Conclusions . . . . . . . . . . . . 256

Tinea Barbae, Tinea Faciei, Tinea Corporis, Tinea Manuum, Tinea Cruris, Tinea Pedis and Tinea Unguium. . . . 257

1. Introduction .. . . . . . 257 2. Trichophyton Rubrum . . . 258 3. Trichophyton Mentagrophytes 292 4. Trichophyton Verrucosum. . 304 5. Trichophyton Violaceum . . 308 6. Trichophyton Concentricum . 310 7. Trichophyton Tonsurans and Trichophyton Sulfureum 313 8. Trichophyton Epilans. . . . . . . . . . . . 315 9. Microsporum Audouinii and Microsporum Canis 321

10. Microsporum Gypseum . . . 325 11. Epidermophyton Floccosum . 332

Cutaneous Candidiasis. . 335 Tinea Versicolor . . . . 342 Pityrosporum Folliculitis 347 Tinea Nigra 352 Piedra . . 359 Erythrasma 370 References. 377

Infections by Fungi That Are Commonly Primary Pathogens (Chapter VIII-XV)

Chapter VIII: Cryptococcosis. K. SALFELDER, Merida, Venezuela (With 68 Figures) 383 Definition . 383 History. . . . . . 384 Incidence . . . . . 385 Associated Diseases 388 Epidemiology 390 Mycology . . . . . 393 Pathogenesis 401 Pathology 405 Diagnosis and Differential Diagnosis 436 Clinical Aspects 439 Animals. . 441 References. . . 445

Chapter IX: North American Blastomycosis. E.W. CHICK, Lexington, Kentucky, USA (With 40 Figures) 465

Definition. . . . . . . . . . 465 Epidemiology . . . . . . . . 466

a) Geographical Distribution 466 a) Cases from North America (USA and Canada) 466 fi) Cases outside North America 466

b) Age Distribution . 466 c) Sex Distribution . 468 d) Racial Distribution 468 e) Occupation 468

Contents IX

f) Epidemics . . . . . . . . . . 469 g) Natural Occurrence of Organism 470

Mycology . . . . . . . . . . 470 a) Cultural Characteristics 470 p) Clinical Specimens . . 474 y) Animal Inoculation. . 475

Pathogenesis and Immunology. 475 Pathology. . . . . . . 476

a) General Pathology 476 b) Special Pathology 479 Lung . . . . . . . 479 Skin. . . . . . . . 481 Bone . . . . . . . 485 Genitourinary Tract . 486 Liver and Spleen . . 491 Other Organs. . . . 493 Central Nervous System 497 Clinical Features 500

Therapy. . . 502 References. . . . . 503

Chapter X: Paracoccidioidomycosis. A. ANGULO 0., and L. POLLAK, Caracas, Vene-zuela (With 70 Figures) . 507

History. . . . 507 Etiology . . . 507 Epidemiology . 511 Portal of Entry 513 Histopathology 514 Clinical Forms . 523 Mucocutaneous Lesions 525

a) Mucosal Lesions. 527 b) Cutaneous Lesions. 529

Pulmonary Lesions. . . 531 Lesions of Lymph Nodes 542 Lesions of the Spleen. . 543 Lesions of the Nervous System. 545 Lesions of the Cardiovascular System . 545 Lesions of the Digestive System . 547 Hepatic Lesions . . . . . . 550 Pancreatic Lesions . . . . . 551 Lesions of Endocrine Glands . 551 Urinary Tract . . . . . . . 554 Lesions of the Genital System 554 Osteoarticular Lesions. . . . 555 Paracoccidioidomycosis in Association with other Diseases 556 Immunology 557 Laboratory Tests 557 Treatment . 558 References. . . . 560

Chapter XI: Lobo's Disease (Keloidal Blastomycosis). J.P. WIERSEMA, Washington, D.C., USA (With 13 Figures) . . . 577

Definition. . . . . . . . . . . . . . . . . . . 577 History. . . . . . . . . . . . . . . . . . . . 577 Geographical Distribution, Incidence, Epidemiology 577 Clinical Picture. . . . 578 Macroscopic Pathology 580 Microscopic Pathology 581 Mycology . . . . . . 585 Differential Diagnosis . 588 References. . . . . . 588

x Contents

Chapter XII: Mycetoma. D.J. WINSLOW, Bay Pines, Florida, USA (With 24 Figures) 589 Historical . . 589 Terminology ...... 590 Definition. . . . . . . . 591 Etiology and Pathogenesis 593 Geographic Distribution and Prevalence . 596 Clinical Features 598 Pathology 599 Treatment 611 References. 612

Chapter XIII: Sporotrichosis. H.I. LURIE, Richmond, Virginia, USA (With 22 Figures) 614 Mycology . . . . . . . 614 Sporotrichum Schenckii . 615 Geographical Distribution 616 Etiology 618 Age Incidence . . . . . 621 Sex Incidence . . . . . 621 Incubation Period . . . 621 Anatomic Site of Primary Lesion 622 Clinical Manifestations . . . 623 A. Cutaneous Sporotrichosis . 623

l. Epidermal . . 623 2. Dermal . . . . . . . 624 3. Subcutaneous. . . . . 627

B. Extracutaneous Sporotrichosis 629 l. Mucous Membranes . . 629 2. Musculoskeletal System . 629 3. Visceral . . . . . . . . 630

a) Pulmonary . . . . . 630 b) Other Visceral Lesions . 631

4. Central Nervous System. 631 5. Organs of Special Senses . 632

C. Acute and Subacute Febrile Sporotrichosis 632 D. Sporotrichids and Other Allergic Manifestations. 632 E. Carrier States ........ 633 Relative Frequency of Clinical Types 633 Histopathology 635 Nodular Dermal Lesion 635 Other Dermal Lesions 640 Epidermal Lesions . . 640 Subcutaneous Gumma 640 Musculoskeletal Lesions . 642 Pulmonary Sporotrichosis . 642 Central Nervous System 643 Ocular Sporotrichosis. . . 643 Fungal Elements in Smears of Exudates and in Tissue Sections 643 Cigar Bodies and their Variants . . . . . 645 The Asteroid Body. . . . . . . . . . . 646 Hyphal Forms. . . . . . . . . . . . . 651 Fungal Elements in the Circulating Blood . 652 Eosinophilia in the Circulating Blood 652 Serology . . . . . . . . . . 652

l. Complement Fixation Test . 652 2. Agglutination Reaction . . 652 3. Precipitin Reaction . . . . 653 4. Hemagglutination Reaction 653

Dermal Reaction. . . . . . . . 653 Sporotrichin or Sporotrichosin Test 653 Immunity .......... 654 Experimental Sporotrichosis in Laboratory Animals 656 Fungal Elements in Tissue of Experimental Animals 660

Contents XI

Therapy. . 662 Prognosis . 663 References. 663

Chapter XIV: Rhinosporidiosis. L. N. MOHAPATRA, New Delhi, India (With 9 Figures) 676

Definition. . . . . . . 676 Geographic Distribution. 676 Epidemiology . . . 677 Etiologic Agent . . 678 Pathologic Anatomy 680 Clinical Features 681 Diagnosis . 682 Prognosis . 682 Treatment 682 References. 682

Chapter XV: Subcutaneous Phycomycosis and Rhino-Entomophthoromycosis. B.M. CLARK, and G.M. EDINGTON, Ibadan, Nigeria (With 3 Figures) . 684

Subcutaneous Phycomycosis 684 Rhino-Entomophthoromycosis . 687 References. . . . . . . . . . 689

Mycoses Caused by Dematiaceous (Brown) Fungi (Chapter XVI-XVIII)

Chapter XVI: Chromoblastomycosis (Chromomycosis). R. CESPEDES F., San Jose, Costa Rica (With 4 Figures) ....... 691

Geographical Distribution and Incidence 691 References. . . . . . . . . . . . . . 699

Chapter XVII: Cladosporiosis of the Central Nervous Tissue. O. DUQUE, Medellin, Colombia (With 17 Figures) 701

Summary of Illustrative Cases 715 References. . . . . . . . . 717

Chapter XVIII: Subcutaneous Abscesses due to Brown Fungi. H. ICHINOSE, New Orleans, Louisiana, USA (With 19 Figures) 719

Introduction. . . . . . . . . 719 Definition of the Disease . . . 719 Cases of Subcutaneous Abscesses 719 Mycology . . . 719 Clinical . . . . 720 Gross Pathology 720 Histopathology 722 Organism in Tissue . 724 Summary and Comment. 727 References. . . . . . . 729

Opportunistic Fungus Infections (Chapter XIX-XXI)

Chapter XIX: Candidosis. H.1. WINNER, London, Great Britain (With 33 Figures) 731 1. General . . . . 731

a) Definition . . . . . . . . . . . . 731 b) Epidemiology . . . . . . . . . . 731 c) Incidence and Predisposing Factors. 731

2. Mycology . . . . . . . . . . . . . 732 3. Diagnosis of Candida Infections. . . . 733

a) Identification from Clinical Specimens 733 b) Serological Diagnosis . . . 735 c) Other Methods of Diagnosis . . . . 735

XII Contents

4. Pathogenesis of Candida Infections . . . . . . . . . 736 5. Clinical Features and Pathology of Candida Infections 736

a) Infections of the Mouth 736 ~~. ~ c) Lungs. . . . . . . . 741 d) Gut . . . . . . . . . 743 e) Vagina . . . . . . . 745 f) Candidosis and Endocrine Disorders. 745 g) Systemic (Septicaemic) Candidosis . 746 h) Candida Endocarditis. . . . . . . 753 i) Candidosis of the Urinary Tract. . . 757

6. Experimental Aspects of Candida Infections 758 References. . . . . . . . . . . . . . . . . . 759

Chapter XX: Aspergillosis. C.E. PEN-A, Washington, D.C., USA (With 35 Figures) 762 Introduction. 762 Definition. . . . . . . . . 762 History. . . . . . . . . . 762 Mycology . . . . . . . . . 764 Incidence and Epidemiology . 766 Pathogenesis . . . . . . . 768 General Morphology . . . . 770 Clinical Types and Morphologic Findings. 776 Respiratory System 777 Cardiovascular System . 796 Central Nervous System. 800 Digestive System 805 Endocrine Glands . . . 807 Genito-Urinary System . 807 Spleen and Lymph Nodes 807 Musculo-Skeletal System 807 Eye, Adnexa and Orbit . 808 Nose and Paranasal Sinuses 8lO Ear . . . . . . 812 Skin and Adnexa 814 Nails. . . . . . 815 Mycetoma Pedis . 815

. Aspergillosis in Children . 815 Aspergillosis in Animals. 816 Mycotic Abortion 816 Pulmonary Aspergillosis in Mammals 816 Avian Aspergillosis . 817 Toxins . . . . . 817 Aflatoxins 818 Biological Effects. . 819 References. . . . . 821

Chapter XXI: Mucormycosis (Opportunistic Phycomycosis). R.D. BAKER, New Bruns-wick, New Jersey, USA (With 43 Figures) 832

Definition. . . . . . . . . . . . 832 The History of Mucormycosis . . . 834 Mycology. . . . . . . . . . . . 835 Appearance of Mucoraceae in Tissues 838 Epidemiology . . . . . . . . . . 840 Predisposing Diseases and Conditions 841 Experimental Mucormycosis . 843 Cranial Mucormycosis 843 Nasal Mucormycosis . . . 856 Palatal Mucormycosis. . . 858 Paranasal Mucormycosis. . 858 Mucormycotic Otitis Media 859 Orbital Mucormycosis 859 Ocular Mucormycosis. . . 860

Contents

Mucormycosis of the Brain . . . . . . . . . . . Cerebral Lesions from the Systemic Blood Stream

Mucormycotic Mycotic Aneurysms . . . . . . . . Mucormycosis of the Spinal Cord ....... . Primary Pulmonary Mucormycosis . . . . . . . .

Summary of Primary Pulmonary Mucormycosis Hematogenous Pulmonary Mucormycosis Esophageal Mucormycosis. . Mycormycosis of the Stomach . . . . . Intestinal Mucormycosis. . . . . . . . Disseminated Mucormycosis ..... . Cutaneous and Subcutaneous Mucormycosis Focal Mucormycosis . . . . . . . . Spontaneous Mucormycosis in Animals References. . . . . . . . . . . . .

Unusual and Rare Mycoses (Chapter XXII-XXIII)

XIII

864 873 874 880 888 888 880 894 895 901 905 906 910 910 913

Chapter XXII: Geotrichosis. J. MORENZ, Magdeburg, DDR (With 12 Figures) 919 A. Definition . . . . . . . . . . . . . . . . 919 B. Geographical Extent and Epidemiology 919 C. Geotrichum Candidum-Occurrence in Humans 920

1. Intestinal Tract. . 920 2. Respiratory Tract 921 3. Skin . . . . . 922 4. Urogenital Tract 922

D. Mycology 923 1. Micromorphology 923 2. Direct Preparations 923 3. Culture . . . . . 924 4. Physiology. . . . 925

E. Pathogenesis and Immunology 926 1. Pathogenesis . . . . . . . 926 2. Immunology . . . . . . . 926

F. Symptomatology, Diagnosis, and Therapy 927 1. Bronchopulmonary Geotrichosis 928 2. Bronchial Geotrichosis . 935 3. Oral Geotrichosis . . . 936 4. Cutaneous Geotrichosis 939 5. Other Geotrichoses . . 942 6. Specific Therapy . . . 944

G. Geotrichum Candidum Infection in Animals 945 References. . . . . . . . . . . . . . . . . 949

Chapter XXIII: Miscellaneous Uncommon Diseases Attributed to Fungi and Actinomy­cetes. J.C. PARKER jr., Boston, Mass., USA, and G.K. KLINTWORTH, Durham, N.C., USA (With 60 Figures) . . . . 953

Adiaspiromycosis (Haplomycosis) . 953 Allescheriosis (Monosporiosis) 956 Alternariosis 962 Arthrodermosis 963 Beauveriosis. . 967 Cephalosporiosis 968 Cercosporamycosis 973 Cryptostromosis (Coniosporiosis or Maple-Bark Disease) . 974 Curvulariosis. . . . . . . . . . . . . . . 977 Dermatophilosis (Cutaneous Streptothricosis) 978 Fusariosis. . . . . 982 Helminthosporiosis . 985 Keratomycosis 986 Otomycosis . . 987 Paecilomycosis 989

XIV

Penicilliosis Rhodotorulosis . Streptomycosis Torulopsiosis. . Ustilagosis (Ustilagomycosis) References. . . . . . . . .

Contents

Infecticms with Actinomycetes (Chapter XXIV-XXV)

Chapter XXIV: Actinomycosis. D.J. GUIDRY, New Orleans, Louisiana, USA (With

990 996 997

1001 1003 1004

18 Figures) 1019 Definition. . . 1019 Historical. . . 10 19 Geographic Pathology 1022 Mycology . . . . . . 1023

Actinomyces israelii 1029 Actinomyces bovis 1030 Actinomyces propionicus Sp. nov. 1031 Actinomyces eriksonii . . . . . 1032 Actinomyces naeslundii 1032

Pathogenesis . . . . . . . . . . 1032 Gross and Microscopic Appearances . 1036 Differential Diagnosis . 1050 Clinical Features 1050 Prognosis . 1052 Therapy. . . . 1052 References. . . 1053

Chapter XXV: Nocardiosis. P. PIZZOLATO, New Orleans, Louisiana, USA (With 15 Figures) 1059

Definition . 1059 Mycology . 1059 Incidence . 1061 Clinical Manifestations 1062 Laboratory Findings 1062 Roentgen Findings. . 1063 Gross Lesions . . . . 1064 Microscopic Lesions. . 1073 Animal Pathogenicity 1074 Diagnosis . 1075 Treatment 1075 References. 1077

Infection with Algae (Chapter XXVI) Chapter XXVI: Protothecosis - Algal Infection. B.F. FETTER, G.K. KLINTWORTH,

and H.S. NIELSEN, Jr., Durham, N.C., USA (With 15 Figures) 1081 Organism . . . . . . 1081 Prototheca and Disease 1087 References. . . 1093

Authors Index .

Subject Index .

1094

1178

List of Authors

ALBERTO ANGULO 0., M.D. Profesor Titular, Director del Instituto de Anatomia Patologica Facultad de Medicina, Universidad Central e Instituto National de Tuberculosis Correos de Sabana Grande A partado 50647 Caracas, Venezuela

ROGER DENIO BAKER, M.D. Professor of Pathology Rutgers Medical School New Brunswick, New Jersey 08903, USA Formerly Professor of Pathology, Louisiana State University, School of Medicine New Orleans, Louisiana, USA

CESAR BARROso-ToBILA, M.D., Jefe Dermatologia y Dermapathologia Policlinica Maracaibo Av. 8 (Santa Rita) Esq. Calle 71 Maracaibo, Venezuela

LUIS M. CARBONELL, M.D. Jefe del Departamento de Micro­biologia, Instituto Venezolano de Investigaciones Cientificas (1. V. 1. C), Apartado 1827 Caracas, Venezuela

RODOLFO CESPEDES F., M.D. Profesor de Anatomia Patologica en la Facultad de Medicina, Universidad de Costa Rica, J efe del Servicio de Anatomia Patologica del Hospital San Juan de Dios y Hospital Central del Seguro Social Apartado 3275, San Jose Costa Rica

ERNEST W. CHICK, M.D., Professor Department of Community Medicine Mycology Program, University of Kentucky, College of Medicine Lexington, Kentucky 40506, USA Formerly Professor and Chairman Division of Preventive Medicine West Virginia, Medical Center of Morgantown, West Virginia, USA

BETTY M. CLARK, M.B., M.R.C. Path. Associate Professor Department of Medical Microbiology University College Hospital Ibadan, Nigeria

OSCAR DUQUE, M. D. Profesor y Jefe del Departamento de Patologia, Facultad de Medicina Universidad de Antioquia Medellin, Colombia

GEORGE M. EDINGTON, C. B. E., M. D. M.R.C. Path. Professor and Head of the Department of Pathology University College Hospital Ibadan, Nigeria

BERNARD F. FETTER, M.D. Professor of Pathology Duke University, Medical Center Durham, North Carolina 27706, USA

JAMES H. GRAHAM, M.D. Professor of Medicine (Dermatology) Chairman, Division of Dermatology Professor of Pathology, Department of Pathology, California College of Medicine, University of California Irvine, California, USA Address at Orange County Medical Center 101 South Manchester Avenue Orange, California 92668, USA

D.J. GUIDRY, Ph.D. Associate Professor of Microbiology Louisiana State University Medical Center 1542 Tulane Avenue New Orleans, Louisiana 70112, USA

ROBERT W. HUNTINGTON, JR., M.D. Clinical Professor of Pathology University of Southern California School of Medicine Los Angeles, California. USA Address: Pathologist, Kern County General Hospital Bakersfield, California 93305, USA

HERBERT ICHINOSE, M.D. Associate Professor of Pathology Tulane University, School of Medicine 1430 Tulane Avenue New Orleans, Louisiana 70112, USA

GORDON K. KLINTWORTH, M.D., Ph. D. Associate Professor, Department of Pathology, Duke University Medical Center Durham, North Carolina 27706, USA

XV! List of Authors

HARRY I. LURIE, B.Sc., M.B., Ch.B. M. R. C. Path., Professor of Pathology Medical College of Virginia Richmond, Virginia 23219, USA

L.N. MOHAPATRA, M.D., Dip. Bact. (London), Professor of Microbiology All-India Institute of Medical Sciences New Delhi 16, India

J. MORENZ, M.D. Professor of Medical Microbiology and Epidemiology Medizinische Akademie Magdeburg 301 Magdeburg, Leipziger StraJ3e 44, GDR

HARRY S. NIELSEN, JR., Ph.D. Formerly Assistant Professor of Microbiology, Duke University Medical Center. Presently Director California Allergenics Laboratories 2602 First Avenue, Suite 104 San Diego, California 92103, USA

JOSEPH C. PARKER, JR., M.D., M.S. Formerly Fellow in Neuropathology Duke University, Medical Center Presently at Laboratory of Pathology New England Deaconess Hospital 185 Pilgrim Road Boston, Massachusetts 02215, USA

CARLOS E. PEN-A, M.D. Formerly Assistant Professor of Pathology, University of Pittsburg, School of Medicine Presently Assistant Professor of Pathology, Georgetown University Medical School Washington, D.C. 20007, USA

PHILIP PIZZQI,ATO, M. D. Professor of Pathology, Louisiana State University, Medical Center Pathologist, Veterans Administration Hospital. Address at Veterans Administration Hospital Perdido Street New Orleans, Louisiana 70140, USA

LADISLAO POLLAK, M.D. Profesor Asociado, Jefe de la Catedra de Microbiologia Escuela Vargas, Facultad de Medicina Universidad Central e Instituto National de Tuberculosis Correos de Sabana Grande Apartado 50647 Caracas, Venezuela

K. SALFELDER, M.D. (Prof. Titular) Jefe del Departamento de Patologia Instituto de Anatomia Patol6gica Universidad de los Andes Hospital "Los Andes" Apartado No. 75 Merida, Venezuela

JAN SCHWARZ, M.D. Associate Professor of Pathology The University of Cincinnati School of Medicine The Jewish Hospital Cincinnati, Ohio 45229, USA

JAN P. WIERSEMA, M.D. Formerly Research Pathologist Leonard Wood Memorial Special Mycobacterial Diseases Branch, Geographic Pathology Division, Armed Forces Institute of Pathology Washington, D.C., USA Presently Pathologist Good Samaritan Hospital 1425 West Fairview Avenue Dayton, Ohio 45406, USA

H.I. WINNER, M.D., M.R.C.P. F.C. Path., Professor of Bacteriology Charing Cross Hospital Medical School, University of London 13 William IV Street London WC2N 4DW, England

DONALD J. WINSLOW, M.D. Formerly Chief, Infectious Disease Branch, Geographic Pathology Division, Armed Forces Institute of Pathology Washington, D.C., USA Presently Chief Laboratory Service Veterans Administration Center Bay PiDiols, Florida 33504, USA

Introduction

At the First Symposium on Mycotic Diseases of The International Academy of Pathology, meeting in London, Professor Dr. E.A. UEHLINGER of the Institute of Pathology of the University of ZUrich, Switzerland, invited me to prepare a volume on the pathologic anatomy of the mycoses. This treatise would be a part of the section on the lung ofthe "Handbuch der speziellen pathologischen Anatomie und Histologie", now edited by Professor UEHLINGER, and would be published in English. It was my good fortune to persuade pathologists, microbiologists, and epidemiologists the World over to contribute chapters on subjects in which they had long experience and special competence.

The result is this authoritative volume of monographs, a number of which presently represent the most comprehensive exposition of "Infection with Fungi, Actinomycetes, and Algae". The investigation of the literature necessary to write the chapters has lead to new insights and correlations concerning the nature, epidemiology, diagnosis, prevention, and treatment of these increasingly signifi­cant diseases. This material is indispensable not only to pathologists, but to micro­biologists, research workers, dermatologists and other practising physicians.

I owe a debt of gratitude to the co-authors of this volume, to my wife, ELEANOR U SSHER BAKER, who helped in the preparation and editing of the volume, and to Springer-Verlag.

Professor ROGER DENIO BAKER, M.D. Senior Author New Brunswick, N.J., ]971