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eFigure 37–41. Life cycle of Dracunculus medinensis (Guinea worm). Humans become infected by drinking unfiltered water containing copepods (small crustaceans) that are infected with larvae of D medinensis . Following ingestion, the copepods die and release the larvae, which penetrate the host stomach and intestinal wall and enter the abdominal cavity and retroperitoneal space . After maturation into adults and copulation, the male worms die and the females (length: 70–120 cm) migrate in the subcutaneous tissues toward the skin surface . Approximately 1 year after infection, the female worm induces a blister on the skin, generally on the distal lower extremity, which ruptures. When this lesion comes into contact with water, a contact that the patient seeks to relieve the local discomfort, the female worm emerges and releases larvae . The larvae are ingested by a copepod and after 2 weeks (and two molts) have developed into infective larvae . Ingestion of the copepods closes the cycle. (From Global Health, Division of Parasitic Diseases and Malaria, CDC.) A flowchart of the life cycle of the nematode or roundworm Dracunculus medinensis.

Current Medical Diagnosis & Treatment 2024 > Dracunculiasis

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eFigure 37–41. Life cycle of Dracunculus medinensis (Guinea worm). Humans become infected by drinking unfiltered water containing copepods (small crustaceans) that are infected with larvae of D medinensis . Following ingestion, the copepods die and release the larvae, which penetrate the host stomach and intestinal wall and enter the abdominal cavity and retroperitoneal space . After maturation into adults and copulation, the male worms die and the females (length: 70–120 cm) migrate in the subcutaneous tissues toward the skin surface . Approximately 1 year after infection, the female worm induces a blister on the skin, generally on the distal lower extremity, which ruptures. When this lesion comes into contact with water, a contact that the patient seeks to relieve the local discomfort, the female worm emerges and releases larvae . The larvae are ingested by a copepod and after 2 weeks (and two molts) have developed into infective larvae . Ingestion of the copepods closes the cycle. (From Global Health, Division of Parasitic Diseases and Malaria, CDC.) A flowchart of the life cycle of the nematode or roundworm Dracunculus medinensis.

Current Medical Diagnosis & Treatment 2024 > Dracunculiasis

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eFigure 37–41. Life cycle of Dracunculus medinensis (Guinea worm). Humans become infected by drinking unfiltered water containing copepods (small crustaceans) that are infected with larvae of D medinensis . Following ingestion, the copepods die and release the larvae, which penetrate the host stomach and intestinal wall and enter the abdominal cavity and retroperitoneal space . After maturation into adults and copulation, the male worms die and the females (length: 70–120 cm) migrate in the subcutaneous tissues toward the skin surface . Approximately 1 year after infection, the female worm induces a blister on the skin, generally on the distal lower extremity, which ruptures. When this lesion comes into contact with water, a contact that the patient seeks to relieve the local discomfort, the female worm emerges and releases larvae . The larvae are ingested by a copepod and after 2 weeks (and two molts) have developed into infective larvae . Ingestion of the copepods closes the cycle. (From Global Health, Division of Parasitic Diseases and Malaria, CDC.) A flowchart of the life cycle of the nematode or roundworm Dracunculus medinensis.

Current Medical Diagnosis & Treatment 2024 > Dracunculiasis

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eFigure 37–41. Life cycle of Dracunculus medinensis (Guinea worm). Humans become infected by drinking unfiltered water containing copepods (small crustaceans) that are infected with larvae of D medinensis . Following ingestion, the copepods die and release the larvae, which penetrate the host stomach and intestinal wall and enter the abdominal cavity and retroperitoneal space . After maturation into adults and copulation, the male worms die and the females (length: 70–120 cm) migrate in the subcutaneous tissues toward the skin surface . Approximately 1 year after infection, the female worm induces a blister on the skin, generally on the distal lower extremity, which ruptures. When this lesion comes into contact with water, a contact that the patient seeks to relieve the local discomfort, the female worm emerges and releases larvae . The larvae are ingested by a copepod and after 2 weeks (and two molts) have developed into infective larvae . Ingestion of the copepods closes the cycle. (From Global Health, Division of Parasitic Diseases and Malaria, CDC.) A flowchart of the life cycle of the nematode or roundworm Dracunculus medinensis.

Current Medical Diagnosis & Treatment 2024 > Dracunculiasis

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eFigure 37–41. Life cycle of Dracunculus medinensis (Guinea worm). Humans become infected by drinking unfiltered water containing copepods (small crustaceans) that are infected with larvae of D medinensis . Following ingestion, the copepods die and release the larvae, which penetrate the host stomach and intestinal wall and enter the abdominal cavity and retroperitoneal space . After maturation into adults and copulation, the male worms die and the females (length: 70–120 cm) migrate in the subcutaneous tissues toward the skin surface . Approximately 1 year after infection, the female worm induces a blister on the skin, generally on the distal lower extremity, which ruptures. When this lesion comes into contact with water, a contact that the patient seeks to relieve the local discomfort, the female worm emerges and releases larvae . The larvae are ingested by a copepod and after 2 weeks (and two molts) have developed into infective larvae . Ingestion of the copepods closes the cycle. (From Global Health, Division of Parasitic Diseases and Malaria, CDC.) A flowchart of the life cycle of the nematode or roundworm Dracunculus medinensis.

Current Medical Diagnosis & Treatment 2024 > Dracunculiasis

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eFigure 37–41. Life cycle of Dracunculus medinensis (Guinea worm). Humans become infected by drinking unfiltered water containing copepods (small crustaceans) that are infected with larvae of D medinensis . Following ingestion, the copepods die and release the larvae, which penetrate the host stomach and intestinal wall and enter the abdominal cavity and retroperitoneal space . After maturation into adults and copulation, the male worms die and the females (length: 70–120 cm) migrate in the subcutaneous tissues toward the skin surface . Approximately 1 year after infection, the female worm induces a blister on the skin, generally on the distal lower extremity, which ruptures. When this lesion comes into contact with water, a contact that the patient seeks to relieve the local discomfort, the female worm emerges and releases larvae . The larvae are ingested by a copepod and after 2 weeks (and two molts) have developed into infective larvae . Ingestion of the copepods closes the cycle. (From Global Health, Division of Parasitic Diseases and Malaria, CDC.) A flowchart of the life cycle of the nematode or roundworm Dracunculus medinensis.

Current Medical Diagnosis & Treatment 2024 > Dracunculiasis

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eFigure 37–41. Life cycle of Dracunculus medinensis (Guinea worm). Humans become infected by drinking unfiltered water containing copepods (small crustaceans) that are infected with larvae of D medinensis . Following ingestion, the copepods die and release the larvae, which penetrate the host stomach and intestinal wall and enter the abdominal cavity and retroperitoneal space . After maturation into adults and copulation, the male worms die and the females (length: 70–120 cm) migrate in the subcutaneous tissues toward the skin surface . Approximately 1 year after infection, the female worm induces a blister on the skin, generally on the distal lower extremity, which ruptures. When this lesion comes into contact with water, a contact that the patient seeks to relieve the local discomfort, the female worm emerges and releases larvae . The larvae are ingested by a copepod and after 2 weeks (and two molts) have developed into infective larvae . Ingestion of the copepods closes the cycle. (From Global Health, Division of Parasitic Diseases and Malaria, CDC.) A flowchart of the life cycle of the nematode or roundworm Dracunculus medinensis.

Current Medical Diagnosis & Treatment 2024 > Dracunculiasis

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eFigure 37–41. Life cycle of Dracunculus medinensis (Guinea worm). Humans become infected by drinking unfiltered water containing copepods (small crustaceans) that are infected with larvae of D medinensis . Following ingestion, the copepods die and release the larvae, which penetrate the host stomach and intestinal wall and enter the abdominal cavity and retroperitoneal space . After maturation into adults and copulation, the male worms die and the females (length: 70–120 cm) migrate in the subcutaneous tissues toward the skin surface . Approximately 1 year after infection, the female worm induces a blister on the skin, generally on the distal lower extremity, which ruptures. When this lesion comes into contact with water, a contact that the patient seeks to relieve the local discomfort, the female worm emerges and releases larvae . The larvae are ingested by a copepod and after 2 weeks (and two molts) have developed into infective larvae . Ingestion of the copepods closes the cycle. (From Global Health, Division of Parasitic Diseases and Malaria, CDC.) A flowchart of the life cycle of the nematode or roundworm Dracunculus medinensis.

Current Medical Diagnosis & Treatment 2024 > Dracunculiasis

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Figure 37–4. Elephantiasis of legs due to filariasis. (Used with permission from Rungtip Chatadee/Alamy Stock Photo.) A patient with filariasis exhibits elephantiasis in the right leg, represented by excessive swelling of the ankle and foot. The toes also appear swollen and misshapen.

Current Medical Diagnosis & Treatment 2024 > Lymphatic Filariasis

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eFigure 37–50. Pretibial atrophy and depigmentation—a characteristic dermatologic symptom of onchocerciasis. (Used, with permission, from W Peters and HM Gilles.) A photo shows regions of white spots on a patient's legs.

Current Medical Diagnosis & Treatment 2024 > Onchocerciasis

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eFigure 39–3. Severely burned firefighter prior to initial debridement. Burns proved to be 40% total body surface area. (Used, with permission, from Brent R.W. Moelleken, MD, FACS.) A photo shows that the legs of a firefighter are severly burned and appear black. A photo shows severly burned arms of a patient, with a layer of skin peeling off. A photo shows skin and tissues peeling off the chest of a patient.

Current Medical Diagnosis & Treatment 2024 > Thermal Burns

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eFigure 39–3. Severely burned firefighter prior to initial debridement. Burns proved to be 40% total body surface area. (Used, with permission, from Brent R.W. Moelleken, MD, FACS.) A photo shows that the legs of a firefighter are severly burned and appear black. A photo shows severly burned arms of a patient, with a layer of skin peeling off. A photo shows skin and tissues peeling off the chest of a patient.

Current Medical Diagnosis & Treatment 2024 > Thermal Burns

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eFigure 39–3. Severely burned firefighter prior to initial debridement. Burns proved to be 40% total body surface area. (Used, with permission, from Brent R.W. Moelleken, MD, FACS.) A photo shows that the legs of a firefighter are severly burned and appear black. A photo shows severly burned arms of a patient, with a layer of skin peeling off. A photo shows skin and tissues peeling off the chest of a patient.

Current Medical Diagnosis & Treatment 2024 > Thermal Burns

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eFigure 39–5. Successfully grafted patient with 40% total body surface area burns. (Used, with permission, from Brent R.W. Moelleken, MD, FACS.) A photo shows grafted leg of a patient. The skin appears scaly and dark. A photo shows grafted wrists of a patient. The skin appears scaly and dark. A photo shows grafted forearm of a patient. The skin appears scaly and dark. A photo shows grafted skin of a patient. The skin appears scaly and pink.

Current Medical Diagnosis & Treatment 2024 > Thermal Burns

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eFigure 39–5. Successfully grafted patient with 40% total body surface area burns. (Used, with permission, from Brent R.W. Moelleken, MD, FACS.) A photo shows grafted leg of a patient. The skin appears scaly and dark. A photo shows grafted wrists of a patient. The skin appears scaly and dark. A photo shows grafted forearm of a patient. The skin appears scaly and dark. A photo shows grafted skin of a patient. The skin appears scaly and pink.

Current Medical Diagnosis & Treatment 2024 > Thermal Burns

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eFigure 39–5. Successfully grafted patient with 40% total body surface area burns. (Used, with permission, from Brent R.W. Moelleken, MD, FACS.) A photo shows grafted leg of a patient. The skin appears scaly and dark. A photo shows grafted wrists of a patient. The skin appears scaly and dark. A photo shows grafted forearm of a patient. The skin appears scaly and dark. A photo shows grafted skin of a patient. The skin appears scaly and pink.

Current Medical Diagnosis & Treatment 2024 > Thermal Burns

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eFigure 39–5. Successfully grafted patient with 40% total body surface area burns. (Used, with permission, from Brent R.W. Moelleken, MD, FACS.) A photo shows grafted leg of a patient. The skin appears scaly and dark. A photo shows grafted wrists of a patient. The skin appears scaly and dark. A photo shows grafted forearm of a patient. The skin appears scaly and dark. A photo shows grafted skin of a patient. The skin appears scaly and pink.

Current Medical Diagnosis & Treatment 2024 > Thermal Burns

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eFigure 39–5. Successfully grafted patient with 40% total body surface area burns. (Used, with permission, from Brent R.W. Moelleken, MD, FACS.) A photo shows grafted leg of a patient. The skin appears scaly and dark. A photo shows grafted wrists of a patient. The skin appears scaly and dark. A photo shows grafted forearm of a patient. The skin appears scaly and dark. A photo shows grafted skin of a patient. The skin appears scaly and pink.

Current Medical Diagnosis & Treatment 2024 > Thermal Burns

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eFigure 35–2. Necrotizing fasciitis (early). (Reproduced, with permission, from Dufel S, Martino M. Simple cellulitis or a more serious infection? J Fam Pract. 2006;55:396.) A photo shows engorged leg of a patient with inflammation in the inner thighs.

Current Medical Diagnosis & Treatment 2024 > Streptococcal Infections

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eFigure 35–7. Large methicillin-resistant Staphylococcus aureus (MRSA) abscess on the leg in a 62-year-old man beginning to drain spontaneously. (Used, with permission, from Richard P. Usatine, MD, in Usatine RP, Smith MA, Mayeaux EJ Jr, Chumley HS. The Color Atlas and Synopsis of Family Medicine, 3rd ed. McGraw-Hill, 2019.) A patient with an M R S A abscess exhibits a large, red, erythematous lesion with a pitted center that has begun to drain its fluid.

Current Medical Diagnosis & Treatment 2024 > Staphylococcus Aureus Infections

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eFigure 36–5. Neuropathic arthropathy (Charcot joint) from tertiary syphilis. (From Susan Lindsley, Public Health Image Library, CDC.) A photo shows an enlarged and swollen leg with large patches of discoloration and ulcers.

Current Medical Diagnosis & Treatment 2024 > Clinical Stages of Syphilis

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eFigure 36–6. Acrodermatitis chronica atrophicans. Advanced atrophy of the epidermis and dermis with associated violaceous erythema of legs and feet; the visibility of the superficial veins is striking. (Reproduced with permission from Saavedra AP, Roh EK, Mikailov A. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, 9th ed. New York, NY: McGraw-Hill; 2023.) A patient with Lyme disease exhibits acrodermatitis chronica atrophicans, characterized by prominently visible violaceous veins in the legs.

Current Medical Diagnosis & Treatment 2024 > Lyme Disease (Lyme Borreliosis)

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eFigure 6–37. A: Vitiligo on the hands of a Hispanic man. B: Vitiligo covering more than 50% of this young Hispanic woman's body. The patient is starting topical monobenzone to attempt to bleach the unaffected skin so that she has one matching skin color. (Reproduced with permission from Richard P. Usatine, MD, in Usatine RP, Smith MA, Mayeaux EJ Jr, Chumley HS. The Color Atlas and Synopsis of Family Medicine, 3rd ed. McGraw-Hill, 2019) Two photos show the appearance of vitiligo on the hands and legs of an affected patient.

Current Medical Diagnosis & Treatment 2024 > Tinea Versicolor (Pityriasis Versicolor)

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eFigure 6–37. A: Vitiligo on the hands of a Hispanic man. B: Vitiligo covering more than 50% of this young Hispanic woman's body. The patient is starting topical monobenzone to attempt to bleach the unaffected skin so that she has one matching skin color. (Reproduced with permission from Richard P. Usatine, MD, in Usatine RP, Smith MA, Mayeaux EJ Jr, Chumley HS. The Color Atlas and Synopsis of Family Medicine, 3rd ed. McGraw-Hill, 2019) Two photos show the appearance of vitiligo on the hands and legs of an affected patient.

Current Medical Diagnosis & Treatment 2024 > Tinea Versicolor (Pityriasis Versicolor)

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eFigure 6–47. Ecthyma, shown here, represents a deeper form of impetigo caused by Staphylococcus aureus or streptococci. (Used, with permission, from S Goldstein, MD.) A photo illustrating ecthyma shows gray, scaly, and dry patches on a patient's leg.

Current Medical Diagnosis & Treatment 2024 > Impetigo

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eFigure 6–61. Erythema nodosum. Nodules on the legs are usually very tender. (Reproduced, with permission, from Orkin M, Maibach HI, Dahl MV [editors]. Dermatology. Originally published by Appleton & Lange. Copyright © 1991 by The McGraw-Hill Companies, Inc.) A photo illustrating erythema nodosum shows a patch of red discoloration on the lower legs of a patient.

Current Medical Diagnosis & Treatment 2024 > Erythema Nodosum

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eFigure 6–107. Leukocytoclastic vasculitis. (Used, with permission, from Lindy Fox, MD.) A photo of innumerous flat, irregular, red lesions spread as a rash over the patient's legs.

Current Medical Diagnosis & Treatment 2024 > Venous Stasis Ulcers

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eFigure 22–10. Osteoarthritis with medial compartment narrowing of both knees. (Used, with permission, from Nicole Richman, MD.) An X-ray of the knee shows that the gap between the patella and the lower bones of the leg has narrowed.

Current Medical Diagnosis & Treatment 2024 > Degenerative Joint Disease (Osteoarthritis)

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Figure 22–8. Livedo reticularis as a manifestation of antiphospholipid antibody syndrome. (Used, with permission, from Imboden JB et al. Current Diagnosis & Treatment: Rheumatology, 3rd ed. McGraw-Hill, 2013.) A patient with antiphospholipid antibody syndrome exhibits extensive a purple rash that resembles netting along the length of the lower extremities.

Current Medical Diagnosis & Treatment 2024 > Polyarteritis Nodosa

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eFigure 28–5. Pretibial myxedema. (Reproduced with permission from Carl Grunfeld, MD) A photo shows a patient's legs with swollen ankle.

Current Medical Diagnosis & Treatment 2024 > Hyperthyroidism (Thyrotoxicosis)

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eFigure 28–18. Bone scan of patient with severe Paget disease of the skull, ribs, spine, pelvis, right femur, and acetabulum. Note localization of bone-seeking isotope (99mTc-labeled bisphosphonate) in these areas. (Reproduced, with permission, from Greenspan FS, Strewler GJ [editors]. Basic & Clinical Endocrinology, 5th ed. Copyright © 1997 by The McGraw-Hill Companies, Inc.) A whole body bone scan shows that the skull, sholders, elbows, wrists, sternum, pelvis, and the right leg appear dark.

Current Medical Diagnosis & Treatment 2024 > Paget Disease of Bone (Osteitis Deformans)

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eFigure 28–22. Necrolytic migratory erythema. (Reproduced with permission from Carl Grunfeld, MD.) A photo shows a red rash spread in the ankles and heels of a patient's legs.

Current Medical Diagnosis & Treatment 2024 > Gastroenteropancreatic Neuroendocrine Tumors (GEP-NETs) & Carcinoid Tumors

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eFigure 14–2. Magnetic resonance angiography of the lower extremity demonstrating preocclusive disease of the superficial femoral artery on the right and occlusion on the left. The left profunda femoris artery is the source of a rich collateral network in this patient. A magnetic resonance angiograph shows occlusion of the right femoral artery. Multiple blood vessels branch from the left femoral artery.

Current Medical Diagnosis & Treatment 2024 > Occlusive Disease: Femoral & Popliteal Arteries

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eFigure 14–12. Venous ulcer on the ankle of an elderly man. The venous ulcer was caused by the restricted oxygen supply to the skin on the leg caused by DVT. (Reproduced with permission from alamy.com.) A patient with D V T exhibits a large red irregular venous ulcer, with thick white margins, on the ankle. The peripheral region shows dark pigmentation.

Current Medical Diagnosis & Treatment 2024 > Chronic Venous Insufficiency

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Figure 14–3. Ascending lymphangitis characterized by lymphatic streaking up the leg in a 55-year-old man with cellulitis. (Used, with permission, from Richard P. Usatine, MD, in Usatine RP, Smith MA, Mayeaux EJ Jr, Chumley HS. The Color Atlas of Family Medicine, 3rd ed. McGraw-Hill, 2019.) A patient with ascending lymphangitis exhibits diffuse erythematous streaks and swelling along the lymphatic vessels of the posterior leg.

Current Medical Diagnosis & Treatment 2024 > Chronic Venous Insufficiency

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