2025 – PAGE 320 – INFECTIOUS DISEASES
SCHISTOSOMIASIS (SCHISTOSOMA)
Schistosomiasis is caused by Schistosoma, a fluke. FLukes are FLatworms. Variable presentation. For the pediatric certification exam, you would likely be presented with a child who has chronic, intermittent abdominal pain, possibly blood in the stool, and possibly hepatosplenomegaly. (Schistosoma japonicum can result in both intestinal and liver schistosomiasis.) Treat with praziquantel.
TAENIA SOLIUM
Taenia solium is a tapeworm from PORK. Symptoms include GI discomfort. Can also result in NEUROCYSTICERCOSIS, in which case the patient can present with SEIZURES. Treat with ALBENDAZOLE or praziquantel.
IMAGE: (CT) www.pbrlinks.com/TAENIASOLIUM1
IMAGE: (MRI) www.pbrlinks.com/TAENIASOLIUM2
TAENIA SAGINATA
Taenia saginata is a tapeworm from BEEF. Often asymptomatic. Severe disease can result in abdominal pain, diarrhea or constipation, and a loss of appetite. Treat with praziquantel.
MNEMONIC: TAENIA SAGIN-UTA is from the “SAGGIN UTTA” of a cow!
MNEMONIC: (IMAGE) www.pbrlinks.com/TAENIASAGINATA1
(DOUBLE TAKE) TOXOCARA CANIS
Toxocara canis is a roundworm that causes VISCERAL LARVA MIGRANS. Look for a child presenting with multisystem complaints. Usually affects the LUNGS and the GI TRACT, but can also affect the eyes. May present as abdominal pain in a child who has hepatosplenomegaly and wheezing on exam. Labs will show a HIGH LEUKOCYTOSIS with EOSINOPHILIA. Imaging will show lung infiltrates. The roundworm is found in cats, dogs, and dirt, so look for a kid that likes to eat dirt! It is often self-limited, but can be treated with albendazole.
- PEARL: The words VISCERAL and MIGRANS in an answer choice should help you remember that this is a disease of the deep organs (viscera), and it migrates to multiple organs. Lung infiltrates may be noted to change or “migrate” over time as noted on serial chest X-rays.
HOOKWORM
Hookworm infection is usually due to penetration of the skin. Species that infect humans can affect the small intestine, lungs, and skin. It is commonly acquired by walking barefoot through contaminated soil. Organisms migrate from the site of infection to the lungs, then glottis, and are then swallowed into the GI tract where they attach. In the early stages there may be local itching, then coughing and wheezing, followed by non-specific GI symptoms. It can also be fairly asymptomatic. In severe cases, the chest x-ray may show diffuse infiltrates in the pulmonary phase. The most important morbidity is anemia and malnutrition due to blood loss (consumed by the parasite) in heavy, chronic infestations. If left untreated, as is the case in many 3rd world countries, cognitive and growth retardation may occur. Treat with ALBENDAZOLE, and remember to give iron if the child is anemic.