2025 – PAGE 319 – INFECTIOUS DISEASES

TRYPANOSOMA CRUZI

Trypanosoma cruzi causes CHAGAS DISEASE. The mild illness initially goes undiagnosed in the child. The bug slowly damages the heart over many years until the patient eventually dies because of HEART FAILURE (CHF) or HEART BLOCKS. The patient may present with some type of swelling and a heart block. Can also cause THROMBOEMBOLIC events. Transmitted by the REDUVIID bug in the Southern or Southwestern U.S. but more commonly in South America.

MNEMONIC: I TRYPPED over a CHAGGY carpet. When I fell, the left side of my CHEST landed on a RED BUG, which started EATING MY HEART!

TRYPANOSOMA BRUCEI

Trypanosoma brucei causes “African Sleeping Sickness.” It’s unlikely to be tested by the AMERICAN Board of Pediatrics (ABP) since it’s almost never seen (< 1 case/year) in the U.S. Look for travel to Africa. It starts with a chancre, and symptoms can include trouble sleeping (initially), edema, fever, poor appetite, tremors, irritability, and headache. Kids can have seizures. Patients can eventually end up in a stuporous coma (hence the name). It is transmitted by the tsetse fly.

MNEMONIC: I was having trouble SLEEPING, so I went to the doctor. As I entered his office I TRYPPED on a BRUUUM (broom), fell, hit my head on his TSETSES and got knocked out into a STUPOROUS COMA! Finally… some sleep!

WORMS

USE THE FOLLOWING ONLY FOR THE IMAGES! THEN MOVE ON!

IMAGE: www.pbrlinks.com/WORMS1
IMAGE: www.pbrlinks.com/WORMS2

ENTEROBIUS (AKA PINWORMS)

If the pediatric board exam mentions a child scratching his butt, the diagnosis is probably Enterobius (pinworms). Diagnose with a TAPE TEST: apply 1 inch of the tape to the anus in the MORNING, pull, apply to slide, and examine for eggs. Treat with ALBENDAZOLE.

PEARL: Give the first dose and then repeat two weeks later. For all other worms, treatment usually requires multiple doses.

MNEMONIC: ENTER-obius = ENTERS-your-butt!

(DOUBLE TAKE) ASCARIS LUMBRICOIDES

Look for a history of travel to a tropical climate or immigrant status if Ascaris lumbricoides is suspected. Patients will have abdominal discomfort and pain. They can also have pancreatitis as well as INTESTINAL OBSTRUCTION. Can also have RESPIRATORY symptoms including a bronchitis that appears as SHIFTING INFILTRATES on serial chest X-rays and is associated with EOSINOPHILIA. Diagnose by examining stool for worms or barrel-shaped eggs. Treat with ALBENDAZOLE or PYRANTEL PAMOATE.

NOTE: Loffler Syndrome is the buildup of pulmonary eosinophils in the lungs due to a parasitic infection. This is also called chronic eosinophilic pneumonia. As mentioned, look for SHIFTING INFILTRATES on serial chest X-rays.

IMAGE: www.pbrlinks.com/ASCARIS1

MNEMONIC: A SCARE-E bunch of earthworm-like, BENDY creatures CLOGGED UP a BARREL.

• Key: Ascaris, eosinophilia, albendazole, intestinal obstruction, and barrel-shaped eggs.

MNEMONIC: Imagine A SCARE-E PYRATE (pyrantel pamoate) playing A NEW PIANO (pneumonia) on his ship. As the waves get rough, the NEW PIANO starts to SHIFT all over the deck (shifting infiltrates).