2025 – PAGE 321 – INFECTIOUS DISEASES

CUTANEOUS LARVA MIGRANS

Cutaneous larva migrans is a variant form of hookworm that cannot complete its life cycle in humans. It can infect the skin, however, and migrate around in the skin for weeks, leaving itchy, red serpiginous (snake-like) tracks. Treat with ALBENDAZOLE or IVERMECTIN.

• IMAGE: www.pbrlinks.com/HOOKWORM1
• MNEMONIC: As the name suggests, this is a CUTANEOUS infection. Also, imagine walking on a beach and stepping on a HOOK. You get a SNAKE-LIKE RASH that starts at your foot and ends at your CHEST (lungs). You then start coughing up some nastiness that you then have to SWALLOW! (This mnemonic mixes both human and non-human species, but you should not be asked to distinguish between the two.)

TRICHURIS

Trichuris is a whip worm that is associated with diarrhea and RECTAL PROLAPSE. Treat with ALBENDAZOLE.

MNEMONIC: Imagine Indiana Jones saying, “My WHIP is going to TRICK YOUR A$$. Do you think I can do it?” He takes the WHIP, hits your bum, and TRICKS YOUR A$$ into EJECTING his favorite hat! Unfortunately, it’s all WET.

• KEY: WHIP = Whipworm, TRICK YOUR A$$ = Trich-ur-is, EJECTING = rectal prolapse, and WET = diarrhea

MNEMONIC: (IMAGE) www.pbrlinks.com/TRICHURIS1

FILARIASIS

Filariasis can be caused by a few different roundworms and is mostly a tropical disease. Look for ORCHITIS, epididymitis, and inguinal adenopathy. Patients may have “elephantiasis” due to LYMPHATIC FILARIASIS. Treat with DIETHYLCARBAMAZINE (DEC). Alternatively, treat with DOXYCYCLINE.

IMAGE: www.pbrlinks.com/FILARIASIS1

STRONGYLOIDES

Strongyloides causes abdominal discomfort and a pneumonitis. Treat with thiabendazole, ivermectin, or albendazole.

MNEMONIC: Imagine a STRONG LADY (Strongyloides) able to do such STRONG THIGH BENDS (thiabendazole) that they crush her CHEST (pneumonitis).

DIPHYLLOBOTHRIUM LATUM

Diphyllobothrium latum infections occur from consuming raw fish. They can cause B12 deficiency. Treat with praziquantel.

MNEMONIC: Di-PHYLL-o-BOTHR-ium latum = “I FILL up a BROTH with that FISHy stuff.”

INFECTIOUS “SYNDROMES”

GROUND GLASS PNEUMONIA

If a ground glass pneumonia is noted, consider Pneumocystis pneumonia (AKA PCP or PJP) if the patient is immunocompromised. PCP can be seen in patients with a history of HIV, Hyper IgM Syndrome, and Severe Combined Immunodeficiency (SCID). In Hyper-IgM, look for a lymphoCYTOSIS and NEUTROpenia. In SCID, look for lymphoPENIA since there is a deficiency of T and B cells.

• OTHER CONSIDERATIONS: If the patient is a neonate, consider surfactant deficiency, respiratory distress syndrome (RDS), and Group B Streptococcus (GBS).
• PEARL: Look for underinflated lungs with air bronchograms on imaging for surfactant deficiency and GBS.