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October, 1950                    COCCIDIOIDOMYCOSIS                                   321

         this specific antigen. A third possibility is that some       REFERENCES
         other fungus in the area induces intradermal sensi-  1. Aronson, J. D., Saylor, R. M., and Parr, E. I.: Relation-
         tivity to histoplasmin. The latter two possibilities  ship of coccidioidomycosis to calcified pulmonary nodules,
         can be determined only by future investigation, and  Arch. Pathol., 34:31, July 1942.
                                                        2. Beadenkopf, W. G., Loosli, C. G., Rice, F. A., and
         at present only the first suggestion will be reviewed.  Slattery, Robt. V.: Tuberculin, coccidioidin and histoplas-
           Emmons7 in animal experiments observed that  min sensitivity in relation to pulmonary calcifications, Pub.
         two out of seven guinea pigs infected with Coccidi-  Health Rep., 64:17, Jan. 7, 1949.
         oides immitis gave positive reactions when tested  3. Butt, E. M., and Hoffman, A. M.: Healed or arrested
         with histoplasmin. Of ten animals inoculated with  pulmonary coccidioidomycosis correlation of coccidioidin
                                                      skin tests with autopsy findings, Amer. Jour. Path., 3:485,
         Coccidioides immitis in a study by the authors, two  May 1945.
         had slight histoplasmin reaction. Since the cross-  4. Crumrine, R. M., and Kessel, John F.: Histoplasmosis
         reactions both in experimental animals and in man  (Darling) without splenomegaly, Amer. Jour. Trop. Med.,
         observed in these studies are consistently less severe  11:435, Nov. 1931.
                                                        5. Edwards, L. B., Lewis, I., and Palmer, C. E.: Studies
         than the reaction with the specific or homologous  of pulmonary findings and antigen sensitivity among student
         antigen, there is little danger of confusion in read-  nurses. III. Pulmonary infiltrates and mediastinal adeno-
         ing the test. Smith and co-workers also drew this  pathy observed among student nurses at the beginning of
         conclusion, although they left the impression that  training, Pub. Health Rep., 63:1569, Dec. 3, 1948.
                                                        6. Emmons, C. W., and Ashburn, L. L.: Isolation of Hap-
         cross-reactions between coccidioidin and histoplas-  losporangium parvum N. Sp. and Coccidioides immitis from
         min occur in a considerably higher percentage of  wild rodents. Their relationship to coccidioidomycosis, Pub.
         persons than was observed in this study. They did  Health Rep., 57:1715, Nov. 13, 1942.
         not, however, give the previous residential histories  7. Emmons, C. W., Olson, B. J., Eldridge, W. W.: Studies
         of the persons tested. In fact, they stated, "Of  of the role of fungi in pulmonary disease. I. Cross reactions
         course, one asks if these reactions to histoplasmin  of histoplasmin, Pub. Health Rep., 60:1385, Nov. 23, 1945.
                                                        8. Gifford, M. A.: Coccidioidomycosis, Kern County, Ap-
         might not have been the results of independently  pendix of Annual Report Kern County Department of Public
         acquired sensitivity to histoplasmin. In most in-  Health for the fiscal year July 1, 1938, to June 30, 1939,
         stances this possibility could not be excluded." They  p. 73.
                                                        9. Kessel, J. F.: Recent observations on coccidioides in-
         did, however, cite 31 cases of coccidioidomycosis  fection, Amer. Jour. Trop. Med., 21:447, May 1941.
         in which, prior to the onset of symptoms, the pa-  10. Kessel, John F., Yeaman, A., and Holtzwart, F.: My-
         tients had negative reaction to both coccidioidin  coses encountered in the Pacific Southwest area of* the
         and histoplasmin. In this group, all patients subse-  United States of North America, New Zealand Medical Jour-
         quently had positive reaction to both coccidioidin  nal, 48:346, Aug. 1949.
                                                        11. Kritzer, M. D., Biddle, M., and Kessel, J. F.: An out-
         and histoplasmin. In correspondence concerning the  break of primary pulmonary coccidioidomycosis in Los An-
         differences in incidence observed in the two differ-  geles County, California, Annals Int. Med., Sept. 1950.
         ent surveys, Dr. Smith suggested that the variable  12. Martin, Walter P., and Silber, B.: Histoplasmosis of
         results may lie in differences in the histoplasmin  Darling (reticuloendothelial cytomycosis), Amer. Jour. Clin.
         used.                                        Path., 14:119, Feb. 1944.
                                                        13. McKenney, F. D., Traum, J., and Bonestell, A. E.:
           In the Los Angeles County Hospital 15 patients  Acute coccidioidomycosis in mountain gorilla (Gorilla ber-
         with proven active coccidioidomycosis recently were  ingeri) with anatomic notes, Jour. Amer. Vet. M. A., 104:
         tested with both coccidioidin and histoplasmin. Five  136, March 1944.
         were tested with Lot H3 histoplasmin used in the  14. Miller, H. E., Keddie, F. M., Johnstone, H. G., and
                                                      Bostick, W. L.: Histoplasmosis, cutaneous and mucomem-
         survey herein reported, and ten with Lot H40 pro-  branous lesions, mycologic and pathologic observations,
         cured from Dr. E. S. Weiss and used in a dilution  Arch. Dermat. & Syph., 56:715, Dec. 1947.
         of 1:500. None of the 15 patients had previously  15. Norman, I. L., and Lawler, A. L.: Coccidioido,mycosis:
         lived in a known histoplasmosis area. All had posi-  Review of literature and report of nine cases, U. S. Naval
         tive reaction to coccidioidin and none had a posi-  Med. Bull., 49:1005, Nov.-Dec. 1949.
                                                        16. Palmer, C. E.: Nontuberculous pulmonary calcifica-
         tive reaction to histoplasmin. This observation fur-  tion and sensitivity to histoplasmin, Pub. Health Rep., 60:
         ther supports the thesis that minimal confusion oc-  513, May 11, 1945.
         curs in the differentiation of coccidioidin and histo-  17. Palmer, C. E.: Geographic differences in sensitivity
         plasmin reactions.                           to histoplasmin among student nurses, Pub. Health Rep.,
                                                      61:475, April 5, 1946.
           The authors wish to express their appreciation to the fol-  18. Pfanner, Eugene F.: Coccidioidomycosis at U.S.M.C.
         lowing for their cooperation in procuring data used in this  Air Station, Mojave, California, U. S. Naval Med. Bul., 46:
         report: Dr. H. A. Ball, pathologist, San Diego County Hos-
         pital; Dr. J. P. Blanchard, pathologist, Santa Barbara  229, Feb. 1946.
         County Hospital; Mr. Lester C. Dalbey, principal, Wm. S.
         Hart Union High School at Newhall; Dr. Warren Fox,  19. Russell, W. O.: Clinical-Pathological Conference, Cali-
         health officer, Riverside County, and cooperating staff  fornia Medicine, 67:194, Sept. 1947.
         members of Banning and Palm Springs high schools; Dr.  20. Shelton, R. M.: Survey of coccidioidomycosis at Camp
         Roy 0. Gilbert, director, Los Angeles County Health De-
         partment, and staff of the Division of Epidemiology and of  Roberts, California, J.A.M.A., 118:1186, April 4, 1942.
         the San Fernando District; Dr. J. D. Kirshbaum, patho-  21. Smith, C. E., Saito, M. T., Beard, R. R., Rosenberger,
         logist, San Bernardino County Hospital; Dr. J. J. Mon-
         tanus, pathologist, Orange County Hospital; Dr. G. Wendell  H. G., and Whiting, E. G.: Histoplasmin sensitivity and coc-
         Olson, Fullerton; Dr. C. M. Sellery, director, Health Serv-  cidioidal infection, Amer. Jour. Pub. Health, 39:722, June
         ices Branch, Los Angeles City Schools, and the cooperating
         staff members of the Los Angeles and Canoga Park high  1949.
         schools; Dr. H. D. Stailey, superintendent, Riverside County  22. Willett, F. M., and Weiss, A.: Coccidioidomycosis in
         Hospital; Dr. C. T. Steggal, resident, Ventura County Hos-
         pital; Mr. John Zuck, director, Los Angeles County Proba-  Southern California: Report of a new endemic area with
         tion Department, and his staff.              review of 100 cases, Ann. Int. Med., 23:349, Sept. 1945.
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