DISSEMINATED COCCIDIOIDOMYCOSIS AND LYMPHO-HEMATOGENOUS TUBERCULOSIS

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Abstract
COCCIDIOIDOMYCOSIS is a fungous disease endemic to large areas of the southwestern United States. Chlamydospores, the infectious "vegetative" form of Coccidioides immitis, enter the body through the respiratory tract and develop into doubly refractile spherules, which reproduce by endosporulation. Infection through the skin is rare but has been reported.1 The primary pulmonary infection is usually asymptomatic, localized and self limited. The usual course is uncomplicated healing of the primary focus with fibrosis and occasionally cacification. The only evidence of infection may be a positive reaction of the skin to coccidioidin injected intradermally. Dr. Charles E. Smith, in an excellent summary (1947), noted that the initial primary infection is nearly always pulmonary and well focalized. Sixty per cent of infections are asymptomatic and are recognizable only by the development of sensitivity to coccidioidin. Another type produces symptoms of an infection of the upper respiratory tract or of influenza. The fungus may be found in the sputum,

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