Torula infection in man : a group of cases, characterized by chronic lesions of the central nervous system, with clinical symptoms suggestive of cerebral tumor, produced by an organism belonging to the Torula group (Torula histolytica, n. sp.) / by James L. Stoddard and Elliott C. Cutler.

  • Stoddard, James L. (James Leavitt), 1888-
Date:
1916
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Licence: Public Domain Mark

Credit: Torula infection in man : a group of cases, characterized by chronic lesions of the central nervous system, with clinical symptoms suggestive of cerebral tumor, produced by an organism belonging to the Torula group (Torula histolytica, n. sp.) / by James L. Stoddard and Elliott C. Cutler. Source: Wellcome Collection.

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    mycelium was found. Cultures from the throat gave organisms similar to those from the meninges, with no mycelium formation. Organisms.—The organisms in the lumbar puncture were found to be elliptical or ovoid, and equal in size to a red blood cell or slightly smaller. They almost always had typical yeast joinings to the number of two to four elements. The long diameter varied from 3.33 to 8.334, the width from 2.2 to 6.664. The small ones were usually ovoid; the large ones approached a spherical form, and often had a double contour. One or two poorly marked eccentric oval nuclei were present, and one to eight refractive droplets. Many giant forms of from 10 to 154 were found, which were more refractive, with larger oil droplets, a double contour, frequent yeast joinings, and a Gram-negative capsule. The phagocytized cells showed a clear capsule almost equal in width to the yeast cell. Cultures.—Mycelium formation was never found. The yeast grew least well on bouillon, gelatin, and agar. Growth appeared in 4 to 5 days and then pro- ceeded slowly. No liquefaction of the gelatin took place. Glucose was not fermented. The best growth was obtained on glucose-agar. No spore production was noted. The atrium of infection was considered to be the throat. Case 3.—Reported by Eisendrath and Ormsby. Final report by Le Count and Myers. Patient.—A Polish laborer, 33 years old. Iliness—Discomfort in the right chest for 6 months, then numerous cutane- ous lesions, followed in 4 months by edema of the face and extremities, muscular weakness, emaciation, pallor, and elevated temperature. Shortly before death incontinence of urine and feces was frequent. Death occurred during a convul- sion, after 30 months’ illness. Autopsy.—Blastomycotic bronchopneumonia; blastomycosis of the peri- _ bronchial lymph nodes, of the pleura, the subpleural and retropharyngeal tissue, the liver, kidneys, colon, spinal column, external spinal dura, cerebellum, left elbow, both knee and ankle joints, skin, and subcutaneous tissues. Emaciation. Cerebellum.—On horizontal section nearly the entire external half of the right lobe was involved in coalescent areas of softening with wide margins of necrotic tissue in which small nodules were present. Microscopical Examination.—Small areas of necrosis surrounded by granu- lation tissue and inflamed cerebellar tissue. The margins of the lesion were made irregular by very minute abscesses, some no larger than a fat cell, containing mono- and polymorphonuclear leukocytes and organisms multiplying by budding, Giant cells containing organisms were found at the periphery of the larger lesions. The granulation tissue often occurred in peculiar masses, containing many cells of chronic inflammation, and very small non-budding blastomycetes. Several large empty capsules were found, with numerous small forms near by. Intact large forms contained several granules resembling nucleoli, with pale areas oc-