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diarrhea, and CLM lesions; chronic, long lasting infections can cause iron deficiency anemia and growth
retardation; infection can also be asymptomatic.
Focused History: Have you had a rash? (ground itch and CLM are typical) Are you more fatigued?
(due to anemia)
Objective: Signs
Using Basic Tools: Cough, diarrhea, ground itch at entry site, CLM rash (serpentine, slightly elevated,
erythematous, palpable tract)
Using Advanced Tools: Lab: CBC: Anemia noted by hematocrit; Eosinophilia noted on WBC.
O&P of stool: Hookworm eggs may not be seen early in infection (see Color Plates Picture 18), so repeat
test.
Assessment:
Differential Diagnosis:
Anemia - multiple potential causes, but the presence of iron-deficiency anemia in multiple patients in a
community suggests hookworm infection.
CLM Rash - cutaneous Larva Currens rash of Strongyloides infection.
Other symptoms of human hookworm are non-specific and may be confused with many diagnoses.
Plan:
Treatment: Hookworm: Repeat Stool O&P and re-treat as needed.
Primary: Mebendazole 100 mg po bid x 3 days
Alternative: Albendazole 400 mg po once
Treatment: CLM
Primary: Ivermectin 150-200 mcg/kg once
Alternative: Albendazole 400 mg po once or topical thiabendazole 10% solution applied 1 cm around
leading edge of the CLM lesion.
Patient Education
General: Avoid contaminated soil, especially sandy beaches with shady areas.
Medications: Watch for occasional gastrointestinal side effects (diarrhea and abdominal pain).
Prevention and Hygiene: Avoid contaminated soil.
No Improvement/Deterioration: Return for reevaluation.
Follow-up Actions
Evacuation/Consultation Criteria: Evacuation not normally necessary, unless patient fails to improve.
Zoonotic Considerations
Principal Animal Hosts: Dogs, cats, sheep, swine
Clinical Disease in Animals: Ancylostoma spp - anemia, unthriftiness, melena, emaciation, weakness of
chronic disease
ID: Leishmaniasis
LTC, Glenn Wortmann, MC, USAIntroduction: Leishmaniasis is transmitted by a bite from an infected sandfly. Infection by Leishmiania
species protozoa can result in cutaneous, mucocutaneous or visceral disease (kala azar). The incubation
period can be long, up to 6 months after exposure. The visceral form, found in most tropical areas worldwide,
is often fatal. Two cutaneous types: Old World disease in Asia, Africa, Middle East; and New World disease
in Americas.