MICROBIOLOGY and DERMATOLOGY* with SPECIAL REFERENCE to SOME OBSERVATIONS on FUNGUS Infecfions in the CAPE H

1094 S.A. MEDICAL JOURNAL 29 December 1962 McCormack and Searlt' where all cases were over 60. Beare'• something of a misnomer, since it appears that some of the had an average age incidence of 55. This feature may be due lesions are self-healing and some progressively destructive.' to the influence of sunlight in South Africa as compared with In this connection support must be given to Beare'• who the two British series. maintains that molluscum sebaceum is distinct from multiple, 'self-healing', squamous carcinoma, in contradistinction to 2. The lesions in this series were not confined to the face, u but, as seen in Table I, occurred also on ear, neck and Fouracres and Whittick who fail to make this distinction. dorsum of hand - sites also exposed to sunlight. The case of Grzybowski5 is of obscure nature and is possibly 3. It seems that there is considerable evidence, on the neither a molluscum sebaceum nor a typical multiple squamous basis of this investigation, that molluscum sebaceum can be carcinoma. caused or precipitated by sunlight, namely: 6. The difficulty of certain histological diagnosis., even in conjunction with clinical information, must be emphasized. (i) Basophilic degeneration of the upper dermal collagen n was present in every case. Beare correctly maintains that clinical diagnosis of the (iz) The condition occurs in men more than women condition is more reliable ·than histological diagnosis. (Table II). This finding differs from that of McCormack and In my 22 patients certain histological diagnosis was made in SearfP who found an equal distribution between the sexes only 8. In a further 2 clinical information confirmed the in Britain. diagnosis by reason of young age or very short history. It is (iiz) The lesion occurs approximately 10 times as fre clear, however, that despite considerable study of this con quently in white <railwaymen as in white private patients. dition, the diagnosis cannot be made with sufficient assurance Railwaymen generally are outdoor workers, and private in enough cases to justify treatment other than by complete patients are usually employed indoors. excision. Willis, Muir, Shaw-Dunn and Lever have all diag (iv) All the lesions in this investigation occurred in sites nosed this type of lesion as well-differentiated squamous car exposed to sunlight (Tables I and II). cinoma. Beare's advoice to cut the lesion off flush with the (v) All cases were of the white or non-pigmented racial skin is regarded as unsound. These lesions should always be group. completely excised. 4. It is speculatively suggested that some cases of molluscum My thanks are due to the many general practitioners, dermatologists and sebaceum may arise as slowly growing, well-differentiated surgeons of the Cape Province and Cape Town who so helpfully assisted squamous carcinomata of sebaceous ducts, that the duct this work by allowing their cases to be quoted and by providing clinical dilates, and that finally the carcinoma, together possibly with advice. The microphotographs were taken in the Department of SuraerY. a collar of chronic inflammatory exudate, ,is sloughed off and University of Cape Town by the courtesy of Prof. 1. H. Louw. the area heals. Where this sloughing fails to occur or is in complete, squamous carcinoma persists. REFERENCES 5. Molluscum sebaceum must be clearly distinguished from 1. Smith, 1. F. (1934): Brit. J. Derm., 46. 267. familial, multiple, 'self-healing', squamous carcinoma as 2. Idem (1948): Ibid., 60, 315. described by Smith;·· Somerville and Milne; and Charteris: 8 3. McCormack, H. and Scarff, R. W. (1936): Ibid., 43, 625. 4. SomerviIle, J. and Milne, 1. A. (1950): Ibid., 62, 485. (a) Family history is entirely absent in the present series. 5. Grzybowski, M. (1950): Ibid., '2. 310. 6. Musso, L. (1951): Ibid., 63, 151. (b) None of the lesions was multiple. Where more than one 7. Go'.don, H. (1950): Pree. Roy. Soc. Med., 43. 838. had occurred they were not concurrent (3 cases, Table 1). 8. Charteris, A. A. (1951): Amer. 1. Roentgenol., 65. 459. 9. Witten. V. H. and Zak, F. G. (1952): Cancer, 5. 539. (c) Molluscum sebaceum is a common condition, particu 10. Beare, J. M. (1953): Brit. J. Surg., 41, 109. larly in South Africa where, in my own experience, it occurs 11. Fouracres, F. A. and Whittick, 1. W. (1953): Brit. 1. Cancer, 7. 58. more frequently than was found in Scotland. Multiple, 'self 12. Willis, R. A. (1953): Pathology of TumOUTS, 2nd ed., p. 993. London: Butterworth. healing', squamous carcinoma on the other hand is a rare 13. Lever, W. S. (1954): Histopathology of the Ski", 2nd ed., p. 336. disease. 'Self-healing' in reference to this latter condition is London: Pitman. MICROBIOLOGY AND DERMATOLOGY* WITH SPECIAL REFERENCE TO SOME OBSERVATIONS ON FUNGUS INFECfIONS IN THE CAPE H. D. BREDE, Professor and Head of the Department of Medical Mierobiology, University of Stellenbosch and Karl Bremer Hospital, Bellville, Cape Dermatologists have a particular interest in medical mycology described filamentous organisms in the yellow patches of roses. - a branch of medical microbiology. It is a scientific discipline The discoveries of Bassi in 1835 of the muscordine disease of dealing with many of the problems confronting a dermatologist. silkworms and those made shortly afterwards by Remak, Microbiology itself is a mosaic-like science with its roots in Schoeulein and Gruby of the fungus nature of favus and ring botany, zoology, physics and chemistry - briefly in all fields worm, are a source of satisfaction to all medical mycologists. of natural science. The main object of microbiology is the Equally important are the IDvestigations of Langenbeck, Berry, development of prophylactic methods; diagnostic work in the Gruby and Robin on candidiasis and the first description of eyes of a microbiologist represents only a step towards the a human-aspergillosis by Virchow in 1856. Virchow also intro development of preventive methods. duced the term mycosis. Up to the present time dermatology served to focus attention Following the historical line, we come to Raimond Sabouraud on fungi as pathogens of man, in spite of the fact that the who studied the very common cutaneous mycoses in detail. so-called fungi sometimes were ,bacteria, as in the case of Sabouraud's works are noteworthy for their e}(cellent clinical actinomyces, nocardia and erythrasma. descriptions and mycological observations, but his careful and Microbiology developed pure-culture techniques by means fair evaluation of the contemporary literature is also of con of which the aetiology of fungus infections could be established siderable value. The outstanding names in the history of any convincingly. Medical training made it possible to integrate branch of science are not always those of the men who made the mycological and the clinical aspects of fungus diseases. the primary observations. Very ofte-n they only crystallized ideas which were nearing supersaturation. But Sabouraud gave Relationships between dermatology, microbiology and the due credit to earlier workers. In 1910 he codified both his natural sciences developed naturally through the years. The own and their results in the monumental Les Teignes, one historical roots of mycology go back to 1677, when Hook of the most comprehensive treatments ever given to a group 'Paper p=ted at the 43rd South African Medical Congress (M.A.S.A.), of pathogenic fungi. Cape Town, 24 - 30 September 1961. In the following decades clinical experience continued, but 29 Desember 1962 S.A. TYDSKRIF VIR GE EESKU DE 1095 there was little evaluation of results, and the literature was TABl.E I. THE 01 BUTIO OF oERMATOPH IN THE scattered and difficult to interpret. The study of the my 0 TR. ~ AAL AND CAP became more and more diffi uh, and the taxonomy of the fungi of medical myco es seemed to glide down in a bewilde Species Percenta e ring chao . The result was th t thi ubject, hi h .is intrin Tr 11SV I W. Cape sically difficult, has been made repellent to the ID jority of Microsporum medical workers. A marked aversion to the tudy of medical canis 75 5 mycology was indeed frequent and persi ts to a certain extent other 3'5 3 even today. Many problems of nomenclature were di cussed Epidermoph ton 5 15 in the medical mycology section of the Fifth International Trichophyton Congres for Microbiology in Rio de Janeir in 1950, and mentagrophyt 1 the con lusions were publi hed in the International Bulletin viol um 4 24 of Bacteriological Nomenclarure and Ta.xonomy in 1952. But ch nleini 4 5 even today the view is commonly held that medical mycology clado porium 0 5 is a confused and somewhat esoteric subject. Our opinion is Other fungi 0'5 12 that the apparent confusion must in a large measure be attributed to the neglect into which this branch of medicine Total 100·0 100 has fallen, and to the failure to appreciate the results of modern research. Mainly owing to the abuse of antibiotic treatment there has been an .increase in fungus infections and general onditions are quite oppo ite. Fungi which are com consequently a new increase of intere t in medical mycology, monly found on the Witwatersrand 0 ur dom in the Cape. especially in the sy ternic fungus diseases by which the For in tan e: dermatomyco e themselves are overshadowed today. M. canis 75% on the Witwatersrand but only 5% in the Cape. Little information is available on the incidence of fungal T. mentagroplrytes 8% OIl the Wi"twatersrand but 31 % in diseases in South Africa. For this we cannot blame the few the ape. laboratories which are able to deal with fungus specimens. T. violaceum 4% on the Witwatersrand but 24% in the Cape.

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