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Synonym Torula Kistojyicus), Stoddard and Cutler.2 I9x6

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Synonym Torula Kistojyicus), Stoddard and Cutler.2 I9x6 A CASE OF MENINGITIS DUE TO ENDOMYCE CAPSULATUS (NEW SPECIE) * AA G. Rzwumwz, MD. (From the Pmbeega Bduds City Hespia, Bes., Mes.) CmouV W. DoDG, PILD., AmD Tmooa T. Arns, AM. (Fr..Li CrypSog.mic LabeSvy, Hwwd Uiiwsity, CmigeU, Man.) The purpose of this paper is to report the dinical record and autopsy findings of a ftal case of systemica doces capsulatus infection. The o was isolated from the tissues and cultured. This paper indudes a study and description of the morphology, cul- tural chatestics and animal pathogenity of the organism. Fungi may attack any organ or yEstem of the body, the integu- mentary system being most frequently and the nervous syse most rarely affe Dis of fungus origin are called mycoses. The may be dasified into two groups internal mycoses and external mycoses or dermatomycoses, C(stelani1 has stated that in cases of general infections due to fungi like Sacaromyce, Monilia and Endomyces, abss con- taining such fungi may be found in the brain and spinal cord. In is ountry cases of erebr nal-meningitis have been recrded due to Cvpkwxcus kistolyticus (synonym Torula kistoJyicus), Stoddard and Cutler.2 I9x6. It has been shown that Torula has a spcial predilection for the central nervous sstem and lungs. Summaries of our knowledge concerning Toula h ytica infec- tions in man have been made from time to time since Stoddard and Cutlers monograph was published in I9I6. ITne more recent reports are by Shapo and Neal3 in 1925, and Raport and Kaplan 'in I926. Shapiro and Neal mentioned thirteen cases then reported. They added another case and induded a personal mmunication from Sheppe. This made the total reported cases fifteen up to that time, of which thirteen were infections of the central nervous system and meninges, one of the hmg, and one of the musdes of the back. R ort and Kaplan reported a systemic torulosis and MKendree and Cornwall I in the same year reported an infection of the brain * Receid for May x6, x929. 349 350 REWBRIDGE, DODGE AND AYERS and meninges. An account by Hansmann6 in I924 of a case of meningo-encephalitis caused by Torula histolytica was not mentioned by these writers. About this time Lynch and Rose7 reported an additional case of meningo-encephalitis due to Torula histolytica. Hall, Hirsch and Mock 8 in I928 added a case of meningo-encepha- litis. Wortis and Wightman I in I928 reported another case of Torula histolytica meningitis. Hence we have collected a total of eighteen cases in which Torula histolytica was the etiologic factor in meningitis. A case of sporotrichosis meningitis was reported by Hyslop, Neal, Kraus, and Hillman 10 in I926. Vialard, Lancelin, and Darleguy"1 in I925 reported a case of meningo-encephalitis due to Trichomyces in a case of pulmonary tuberculosis. In I9I7 Swift and Bull 12 reported a case of primary blastomycotic meningitis. Since then in 1922 Williams13 has recorded a case of meningitis which followed a case of pulmonary blastomycosis. Badham 14 has mentioned a case which appeared in Sydney in I922. Watanabi 15 reviewed a case in which blastomycotic invasion of the tonsils was reported. REPORT OF CASE Clinical History: J. M. (Hospital No. 568,9II), a white, married male, 48 years of age, who was a furrier by trade, entered the Boston City Hospital, August 30, I928, complaining of continuous frontal and temporal headaches during the past three and a half months. Family history was negative, and the past history was without interest. His present illness began five months before entry when he noticed a hard tender slightly movable mass about the size of a hen's egg on the medial surface of the lower third of the left thigh. It gradually subsided during the next four weeks, at the end of which time a similar mass appeared beneath the anterior surface of the neck. A short time after the first mass subsided the patient began to have continuous and almost unbearable frontal and temporal headaches. Two weeks before entry he developed defects in memory, would lose himself on familiar streets, could not remember places and lost track of time. He lost interest in everything and seemed not to understand questions or conversation. He gradually became worse and was brought to the hospital. Physical Examination: A well developed and emaciated middle-aged white man who was dull mentally and slightly confused. A tender cystic mass about the size of a hen's egg was situated at the level of the thyroid isthmus between the trachea and the anterior border of the left sternocleidomastoid muscle. The chest was symmetrical. Resonance over both lungs was impaired and over the right apex were heard both fine and medium crepitant rales. A small tender cystic mass about the size of a walnut was felt on the medial surface of the lower MENINGrTIS DUE TO ENDOMYCES CAPSUIATUS 35I1 third of the lt thig Tnperature, 98.60 F; pulse, 84; piratio, 20; blood presure, 130 sYstoh and 8o diastolic. Nerdgic The pupils were ontract and reacted slwly to light and .ot Te fmni s d Aibr ing, venous engrgement and slight palBor of both d Bilatel diminution of hering. The dee rexes wee eaate more marly on the right. The crenas- teric and Babinski reflexes we absent During the exainti the patiet was very , ha fits of cying and lauhing. Laboratory Findixgs: lhee and blood mintion we negative except for a s per cent es -l The blood Kahn was negative Te spinal Huid showed an initial prure of 210mm., a slow fall after abdominal and jugular compression, leucocytes 20,of whIh wet polymorp nudear and S lympho- cytes, Wassermann positive and gold soL o000022220. ITe sal fluid was cultud on bd apr, c ate agr and Sabouraud's ium, and showed no growth at the end of f days. A smear of this spnal fluid was negative The se d spinal uid was similar except that the pesure and dynamics wre normal and the goId so. ooou242zio. Culture of the snal fluid on blood apr, aar and Sabourauds,s medium, showed no growth at the end of four- teen days. SepUsber iI, I92& The cst in the thyroid region was a Pated, and 30cc. of thick creamy tenaceus yellow pus was obtained. Sms of this pus con- tained numrous polymorphonuear lucocytes and cte numbs of round 'granular cellswith vacuoe and refractle bodies in their cytolasm. Ise s we lAted and we one fourth the size of a red blood celL Numerous bding forms we present. he oranism was cult and tified as Eudomyces capsxlauss (new speces). Organisns, which we idtial morpho- l~ally and cultually with the or cultured from the pus from the neck, we found in the pus asate fm the nodule on the left thigh September I6: X-ay report: extNsve itral l y t losis; sku plte w negative. After a shrt stay the patiet loft the hospital aginst advice when a biopsy was sugste. His codition was unchnged Ciica Diagoses: Mycotic e at(?); mytc es of the neck and lft thigh; al pulmonry e (Oobff 3, I928 The patiet was reamitted Inifeal History: itl No. 571I,024). SInce his discarge the patient had bkcome c plely di ted. A W before entry he became incontient and 1 Pksa The patient was comatose and had mild choing of the discs. He had a stiff neck and bilateal Babinski's sign was positive on the let and questionable on the right. Tanperature, 98.60 F; puls, 8o; tion, 20. Laboratory Findings: The rine and blood e ions we negative except for a 4 per cent e ilia in one smear. Spinal fluid showed an initial pre of Ixo mm., the dynamics we normal, total Protein I7I mg., eucocYtes SI, of which 62 per cent were lymphocytes, gold So. 22334431O0, chlrides 568 mg. and sugpr 36 mg. Culture of the spinal uid on blood apr, late aga and Sabourad's ium showed no growth at the end of fourtee days. The second pinal fluid showed chlorides 579 mg., sugar 39 mg., total protein 190 mg., and lucocytes 68. Calture, guine pig, and mouse inuations were negafive. These animal we killed and aut i t months after the inoulaton. 352 REWBRIDGE, DODGE AND AYERS .The patient's condition became worse, his temperature, pulse and respirations rose rapidly, and he died October 31, I928. Clinic Diagnoses: Mycotic meningo-encephalitis(?); bilateral pulmonary tuberculosis. An autopsy (A-28-35o) was performed eleven hours postmortem. The tissues were immediately placed in Zenker's fixative and later embedded in paraffin and stained with eosin-methylene blue, phos- photungstic acid hematoxylin, Mallory's aniline blue, Gram Wei- gert's method and by Ziehl-Neelson's method for tuberde bacilli in paraffin sections. AUToPsY REPORT The body is that of a well developed and emaciated middle-aged white man. A red scar i.5 cm. long is present to the left of the mid- line on the anterior surface of the neck. A similar scar is present on the medial surface of the lower third of the left thigh. The left femoral lymph nodes are palpable. Peritoneal Cavity: On the serosal surface of the ileum are two congested areas 2 cm. in diameter, and a third is present on the cecum near the ileocecal valve. In these congested areas are numerous firm gray nodules measuring about o.i cm. in diameter. The remainder of the peritoneal cavity is without interest. Pleura and Lungs: The pleural surfaces are smooth and glistening save for the left apex where there are dense fibrous adhesions joining the visceral and parietal pleural surfaces.
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