Coccidioidal granuloma: A Classification of the Causative Agent, Coccidioides immitis

The purpose of this paper, as the title indicates, is to attempt a proper determination in the classification of fungi of the agent responsible for the disease clinically known by various names, as blastomycosis (Montgomery and Ormsby, '08), oidiomycosis (Giltner, '18, Ricketts, '01), protozoic (Montgomery, '00), dermatitis coccidioides (Montgomery, Ryfkogel and Morrow, '03, Wolbach, '04), blastomycetic dermatitis, granuloma, and the California disease. Of this list, coccidioidal granuloma has the most widespread acceptance, and in all references in this paper to the pathologic, clinical, or other diagnostic features of the fungus, this term will be used. Since the report of the first case by Wernicke ('92) there have been 286 cases recorded, and with the one involved in this paper the total now is 287. The disease has received a great deal of attention because of its mode of infection, complicated diagnosis, lack of definitely demonstrable prophylactic measures, great percentage of fatality, peculiar pathogenic abilities, and last, but not least, the indefinite classification of the fungus itself. In order to present a clearer perspective of the field, a r6sum6 of the noteworthy points involved would be in order. As stated above, the first case was reported by Wernicke ('92) from Buenos Aires. Clinically, the case was diagnosed as mycosis fungoides. During the examination spherical organisms resembling protozoa were found in the lesions, and the cause of the disease was considered due to these bodies. Later reports showed that the patient had died of a general infection. The second case was reported by Rixford in a brief note in the 'Occidental Medical Times' of 1894, later published with Gilchrist in 'Johns Hopkins Hosp. Repts.' ('96). Six months later in the same year, in conjunction with Thorne, he reported another