1)..

A 35-year-old captain in the army reserves has been plagued by a painful, erosive lesion near his ear
lobe since his return from Operation Desert Storm several years ago. He denies exposure to the toxic by-
products of burning oil fields. Punch biopsy of the leading edge of the erosion reveals macrophages
distended with oval amastigotes. How was this infection acquired?

Fecal contamination of food

Bite of tsetse fly

Bite of sandfly

Bite of reduviid bug

Contact with contaminated drinking water

Bite of Anopheles mosquito

At a school nurse's request, a clinic in rural South Carolina sees a 9-year-old girl who appears listless and
inattentive, although hearing and visual testing has been within normal limits. The physician finds the
child thin, with the "potbelly" of malnutrition, and orders a fecal exam and CBC. The CBC reveals a
microcytic, hypochrornic anemia, and the fecal exam detects brown, oval nematode eggs approximately
65 microns in size, too numerous to count. What was the most likely means by which this child was
infected?

Skin penetration by larvae

Ingestion of cysts in muscle

Ingestion of larvae

Mosquito transmission of sporozoites

Ingestion of ova

Explanation

This child has the typical symptoms of hookworm disease, caused in this country usually by Necator
americanus. The infection is acquired by penetration of the filariform larvae through the skin of the feet
or buttocks, after contamination of soil with the eggs of the agent deposited in human feces.