Abdominal pain, severe anemia, and red burrows underneath the skin are characteristic of which infection?

• A. Strongyloidiasis
• B. Hookworm infection (Necator americanus)
• C. Ascariasis
• D. Schistosomiasis

Answer: (B)

This question hinges on how a skin-penetrating intestinal nematode causes both a local skin reaction and systemic blood loss leading to anemia. Hookworms, such as Necator americanus, enter the body by penetrating the skin, often through bare feet. The initial skin reaction is the ground itch, and you can see red, serpiginous tracks as the larvae migrate under the skin—these are the red burrows described. After reaching the intestines, the adult worms attach to the mucosa and feed on blood, which over time leads to chronic blood loss and iron-deficiency anemia. Abdominal pain can accompany the intestinal phase as well.

Strongyloidiasis can cause GI symptoms and a peculiar skin eruption (larva currens), but severe anemia is not a defining feature. Ascariasis tends to cause biliary or intestinal issues rather than marked anemia, and schistosomiasis has a different pattern of organ involvement and skin reactions. The combination of a skin migration track and significant blood loss from intestinal nematodes best fits hookworm infection.