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REVIEW ARTICLE
The Language of Infectious Disease: A Light-Hearted Review
Ludwig A. Lettau
Contemporary terminology related to infectious disease (ID)
is a patchwork collection that includes foreign words, slang,
euphemisms, misnomers, acronyms, and a variety of other
terms referring to people, places, foods, colors, and animals.
The only constant of any language is change, and, from early
concepts of contagion to modern day “ID speak,” the language
of the field has evolved in response to new developments in the
identification, classification, epidemiology, diagnosis, and treatment of infectious agents and the associated diseases.
This seriously light-hearted review of the ID language is in
large part a personal perspective and commentary. Resources
used include several dictionaries [1–3], the International Classification of Diseases, Ninth Revision (ICD-9), various other
references as noted, and the author’s experience and imagination. This review is written for the general ID community,
but it may also be of interest to medical students, international
medical graduates, ivy-covered professors in ivory towers, and
aspiring authors of the “hot zone” type of infection-related
fiction.
A Visit to the Graveyard
Terms and expressions related to infection are conceived, go
on to mature, and may eventually die of causes varying from
disuse atrophy to political incorrectness. It seems appropriate
to begin by paying due respect to a few deceased terms and
expressions now found only in dictionaries, historical reviews,
archival medical writings, and, surprisingly, the ICD-9. The
latter includes many archaic terms—such as pseudoscarlatina,
Chicago disease, Whitmore’s bacillus, uta, and Posada-Wernicke disease—that have no meaning for most ID physicians
in practice.
Venereal disease (VD) has almost been eradicated! Unfortunately, this was accomplished mainly by a name change to
“sexually transmitted disease” (STD), a substitution likely promoted by the Valentine’s Day flower and greeting card lobbies.
Received 5 January 2000; revised 1 May 2000; electronically published 4
October 2000.
Reprints or correspondence: Dr. Ludwig A. Lettau, Lowcountry Infectious Diseases, 2093 Henry Tecklenburg Dr., Suite 308, Charleston, SC
29414 ([email protected]).
Clinical Infectious Diseases 2000; 31:734–8
q 2000 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2000/3103-0017$03.00
Lowcountry Infectious Diseases, Charleston, South Carolina
VD does still survive as part of the Venereal Disease Research
Laboratory (VDRL) test. A number of deceased terms refer to
other laboratory tests no longer in use, such as the quellung
reaction and the Widal test.
One notable acronym died in infancy: “GRID” was an acronym for “gay-related immune deficiency,” an early term for
AIDS in the 1980s. Death came quickly as a result of both
political and epidemiological incorrectness. “Lymphadenopathy-associated virus–human T cell lymphotropic virus type III”
(LAV-HTLV-III, or was it HTLV-III-LAV?) was the original
name for HIV that was coined by the Centers for Disease Control and Prevention in an attempt to stay neutral with respect
to conflicting claims of the discovery of HIV by leading French
and American researchers.
A number of terms referring to upper respiratory tract infection have become obsolete. Influenza used to be called
“grippe,” but this term has been lost. “Quinsy” was a term for
peritonsillar abscess, and “angina” referred to a sore throat due
to any of a variety of causes. “Angina” has been usurped by
the cardiologists and now only lives on in the ID field as “Ludwig’s angina” (one of my personal favorites) and as “Vincent’s
angina,” although Vincent’s term is probably about to expire.
Current Terms for Germs and Infectious Infirmities
Because a specific etiology is never determined for most human infections that occur, some general terminology for microbes remains useful. The lay public’s catchall term is “germs,”
and health professionals use the terms “pathogens,” “microbes,” or, commonly, “bugs.” Like it or not, ID physicians
are sometimes referred to as “bug doctors” or “bug fleas” [4].
For a patient with “the crud that is going around,” the expression “probably a virus” is commonly cited for the presumed
etiology.
Unidentified perpetrators of infection. An unknown or incompletely characterized etiologic microbe is sometimes called
an agent (e.g., the Delta agent) or is described as “-like” (e.g.,
Legionella-like and Norwalk virus–like). The disease itself may
be called a syndrome (e.g., AIDS and chronic fatigue syndrome)
or described with the “-oid” suffix (e.g., typhoid and erysipeloid) to denote similarity to a known entity.
A disease of uncertain microbial etiology can also be named
according to what the disease is not, by use of the prefix
“non-.” Examples include nonspecific urethritis, nontyphoid
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salmonellosis, and the current non-A, non-B, non-C, non-D,
non-E, non-F, and non-G viral hepatitis. As the nomenclature
of newly identified hepatotropic viruses marches through the
alphabet, such terminology becomes more and more ponderous
[5].
Certain infections can also be presumed by the clinical response to an antibiotic—the so-called antibiotic deficiency state.
One example of this is doxycycline deficiency, as evident in
patients who have a clinical history, symptoms, signs, or laboratory test results suspicious for a rickettsial infection and then
respond promptly to the drug. Sometimes persistent diarrhea
turns out to be metronidazole deficiency.
Abbreviations of microbial names. Names of microorganisms are often long and unwieldy; thus, shortened forms are
popular because they save time. They are often used for fungi
(e.g., “histo,” “blasto,” and “crypto”) or bacteria (e.g., “strep,”
“staph,” and “actino”). In other cases, such as in the shortening
of “Coccidioides immitis” to “cocci” or “Bacille CalmetteGuérin” to “BCG,” uncertainty as to spelling and pronunciation would also favor use of a shortened form.
Many shortened names for microbes simply consist of initials,
such as “HIV” or “MAC” (Mycobacterium avium complex). Initials and acronyms are even more common when referring to
drug-resistant bacteria, because adding “wondercillin-resistant”
usually at least doubles the length of the name. The abbreviation
“MDR” (multidrug resistant) is sometimes used as a prefix, such
as in “MDR tuberculosis.”
IDs personified. It has been a common practice to honor
leading researchers in the ID field through the incorporation
of their name into terminology. The honored person’s name may
be part of terminology of a genus, species, disease, syndrome,
technique, laboratory test, set of criteria or postulates, clinical
symptom or sign, or even a commercial product (Listerine).
Sometimes multiple persons share hyphenated credit, although who gets top billing may be a matter of dispute; for
example, Creutzfeldt-Jakob disease was at one time called Jakob-Creutzfeldt disease.
Nonmedical persons are sometimes immortalized through
nomenclature. A noted mycologist reportedly named a new
Trichophyton species (T. gloriae) after his spouse (M. Rinaldi,
personal communication). Celebrities are also sometimes honored. A few years ago a Chicago researcher named a new species
“Salmonella mjordan” [6]. One would think that a species in a
loftier-sounding genus such as Aeromonas or Helicobacter
might have been more appropriate to honor Michael Jordan.
The only connection between diarrhea and basketball that readily comes to mind is “dribbling on the fast break.”
Because of the negative image of Salmonella, the salmon
industry has been lobbying for years to get the name of the
genus changed to something less offensive to their food product.
However, perhaps because the genus is named for a pathologist,
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Daniel Salmon, rather than the fish, the pleas of “Big Salmon”
have fallen on deaf ears.
“Shaking and Baking”
A shaking chill is a symptom frequently encountered in ID
practice. A severe chill is called a rigor, sometimes vividly described as a “bed-shaking” chill. A patient of mine once exclaimed, “I shook so hard my eyeglasses flew off.” A more
rigorous and quantitative classification of the magnitude of
chills and shaking is provided by the rigor scale [7].
Several other cold-related terms are in use. “Cold abscess”
refers to a collection of pus lacking the calor component, and
therefore the expression qualifies as an oxymoron. “Cold sore”
would seem to be likewise, but “cold” in this case refers to
induction of the lesion by rhinovirus infection. Finally, although procedural specialists in medicine get gold chains, we
in the ID field have only cold chains.
Chills are typically followed by an elevation in the body
temperature set point that we call a fever (most commonly
defined by an oral temperature of >38.17C). However, it is well
known to any experienced ID practitioner that an astounding
proportion of our patients claim to have a much lower-thannormal baseline body temperature; thus, a temperature of
37.47C should be considered a significant fever for them.
Physicians commonly refer to a “fever spike” and the “temperature curve,” although the line connecting the measurements
on the graphics page more often resembles the western skyline
viewed from Denver. Adjectives describing fever patterns include “continuous,” “remittent,” “intermittent,” “recurrent,”
and “hectic,” most of which mean little, particularly when ward
nurses are plying febrile patients with acetaminophen at every
4-h opportunity.
Fever and the heat of local inflammation have generated
many other terms and expressions that refer to elevated temperature. A fever itself is sometimes referred to as “heat” by
surgeons, as in “Any heat today?” The formal term for fever
is “pyrexia,” which is derived from the Greek stem word pyr,
meaning fire. Relatives often will describe the patient as “burning up with a fever.” Some names for infection refer directly
to fire, such as “St. Anthony’s fire,” which was a term for
erysipelas. The “fiery agent of the Israelites” is not a man from
the Mossad but, rather, another name for filariasis [2].
There are dozens of IDs whose names include the word “fever” preceded by a descriptive symptom, sign, or epidemiological feature. Colorful disease names such as yellow fever, scarlet
fever, and blackwater fever paint a vivid picture of a symptom
or sign of the infection.
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A Broad Spectrum of Living Color
Colors abound in the ID language and may refer to a symptom or sign or to some characteristic of a microorganism. Such
terms span the visual spectrum, but red and its variations seem
to be most common.
We try to dismiss red herrings and to not miss red snappers.
We see pinkeye, red throats, and red necks but not usually in
the same patient. There is a Red Book, but it does not go into
a red bag. There are both rose spots and roseola, but neither
are caused by Roseomonas [8]. We see red diapers caused by
Serratia, green nails caused by Pseudomonas, and purple urine
bags caused by Klebsiella. There is black plague and white
plague (tuberculosis), as well as black piedra and white piedra.
A rapid dose of vancomycin may cause a red man, an overdose of rifampin may cause an orange person, and a high dose
of chloramphenicol may cause a gray baby. Such antibiotic side
effects serve to introduce the subject of antimicrobial use, an
integral part of both the practice and the ID language.
The Great Antimicrobial Wars
Pathogenic microbes are the enemy, and military terms are
commonly used to describe the battle against infection. For
example, bacteria invade the lung by breaching host defenses
in an attack of pneumonia. We boast of our armamentarium
of “big gun” antibiotics with powerful bactericidal action. We
long for an effective narrow-spectrum “magic bullet” to fight
an infection, but too often we use broad-spectrum “shotgun”
therapy that inflicts major collateral damage on innocent bystander normal flora and peace-loving commensals. Such broad
antibacterial coverage generally also includes the flora inhabiting the lower backside of the prescriber.
The desired powerful action of an antimicrobial drug may
be suggested by the trade name, which is always carefully chosen by the manufacturer. Word elements such as “max,” “sup,”
“dyna,” and “omni” are incorporated to convey an aura of
strength, superiority, or broad action [9]. Combining word elements are also used in drug names to designate a specific class
of antimicrobial. Examples include “vir” for antivirals, “flox”
for fluoroquinolones, “ceph” for cephalosporins, and “conazole” for azole antifungal drugs. One exception is “mycin,”
which is part of the name of drugs in at least 5 different classes
of antibiotics (thus accounting for the consternation that results
when a patient declares that he or she is “allergic to all mycins”).
There appear to be rules of nomenclature that apply to certain classes of antimicrobials. For example, generic names of
third-generation cephalosporins must consist of mind-boggling
permutations of the letters “c,” “f,” “t,” “z,” and “x.” Another
rule is that nucleoside-analogue antiretrovirals must have 3
names: an easy-to-forget generic name, a trade name, and an
easy-to-remember designation of 3 letters and/or numbers (e.g.,
AZT or 3TC)—and we wonder why medication adherence is
a problem in the treatment of patients with HIV.
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Other ID slang related to antimicrobial treatment includes
“bug juice” or “bug killer” for antibiotics in general, “amphoterrible” for the unpleasant side effects of amphotericin B, and
“wondercillin” or “ceph-du-jour” for the latest powerful broadspectrum antibiotic. Such medical slang and euphemisms are
quite common in the ID language.
Slang and Euphemisms
ID practice occasionally requires detailed description and
discussion of sex, drug use, and disagreeable body secretions
and excretions, as well as unpleasant medical conditions such
as an STD, diarrhea, or ectoparasite infestation. It is not surprising, then, that slang and euphemisms spice up the ID
language.
Zesty liaisons and social diseases. “Social disease” is a euphemism for an STD, and most of the social diseases in turn
have multiple other common names. Syphilis was called “the
great pox” as it ravaged Europe in the years after Columbus’s
return from the New World. An international blame game was
in full force at the time, because syphilis was also called “the
French disease” by the English and Germans, “the Spanish
pox” by the French, “the Polish disease” by the Russians, “the
Turkish disease” by the Persians, and so on [3]. “Lues” is a
more formal name for syphilis that is most often used when
speaking about this infection at the bedside of the patient for
whom the diagnosis is being considered. “Bad blood” as an
old lay term for syphilis is just too ambiguous to be useful in
the era of bloodborne viruses. Gonorrhea has been called a
“dose of the clap,” just “a dose,” or just “the clap.”
Ectoparasites. Lice and mites include most human ectoparasites, and they are often referred to generically as “cooties”
or “bugs.” Pubic lice have classically been called “crabs,” although their microscopic appearance is rather more turtle-like.
Colorful street names for pubic lice include “crotch crickets,”
“gentlemen’s companions,” and “neighbors to the south” (head
lice should logically then be called “neighbors to the north”).
Body lice should really be called “clothing lice,” since they
spend most of their time in the seams of clothing and only visit
the skin to take a blood meal. Therefore, “seam squirrels” and
“pants rabbits” are fitting slang names.
Scabies has been referred to as the “7-year itch,” attesting
to its capacity for chronic infestation. Scabies plagued Napoleon and his troops in epidemic proportions during the Russian
campaign, perhaps explaining the mystery of why Napoleon
has almost always been depicted with one hand inside his shirt
(he was scratching himself).
Diarrhea.
Unpleasant gastrointestinal experiences have
generated a variety of cute slang terms, such as “technicolor
yawn” for vomiting. Diarrheal stools are generically called “the
runs” or “the trots.” Giardiasis has at least 2 colorful synonyms:
“purple burps,” which refers to the associated metallic gassy
dyspepsia, and “beaver fever,” which stems from its possible
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Language of Infectious Disease
acquisition as a result of drinking stream water contaminated
by beavers.
Analysis of the scatological euphemisms for traveler’s diarrhea reveals that almost all are made up of 2 parts [10]. First
is the localizing word or expression that is usually a geographic
reference to a specific city, region, or country. It can also refer
to an ethnic group (“Aztec 2-step”) or a well-known deceased
person associated with a certain region (“Montezuma’s revenge”). This person must have been wronged by others (travelers
perhaps) while alive, and therefore his or her spirit is still extracting revenge to this day. Reference to a specific person also
fulfills the need to blame someone else for the intestinal misfortune rather than the traveler’s own promiscuous gormandizing.
The second part of the typical euphemism for traveler’s diarrhea most often refers to some type of fast movement. Because the onset of traveler’s diarrhea may strike with an intense
urge to purge to the point of impending fecal incontinence, the
fast movement is usually locomotion in the direction of the
nearest bathroom (“back door sprint” or “Bangladash”). The
fast movement may also refer to the speed of peristalsis (“coeliac flux”). Other synonyms for traveler’s diarrhea may be completed with a reference to abdominal anatomy (“Delhi belly”),
with a reference to the liquid nature of stools (“Chile waters”),
or by simply adding the letter “s” to almost anything else, with
the plurality used as an indicator of the multiple trips to the
bathroom typically endured. To make the whole expression a
little cuter and more memorable, it is helpful to use alliteration
(“Rome runs”), rhyme (“mummy tummy”), or a play on words
(“Turkey trots”).
Many of these synonyms for traveler’s diarrhea might be
considered by some to be politically incorrect. It is also likely
in this “be-sensitive-or-else” era that many traditional names
of IDs are now considered by some people to be offensive either
to themselves or to some other group.
Politically Correct, Microbially Challenging Conditions
The general concept of political correctness should come easily to us since ID specialists regularly “do it” with culture and
sensitivity, although the political correctness crowd does seem
to carry the process to extremes.
“Oriental sore” makes Orientals sore. Infectious agents recognize neither race nor national boundaries; therefore, traditional infection names that include a nationality or race could
be considered insensitive. “Norwegian scabies” was the name
derived from Boeck’s original description of the entity in Norwegian persons with leprosy. A change in terminology to
“crusted scabies” was proposed in 1976 but has never completely caught on [11]. One wonders whether Bolivians, Argentines, Venezuelans, or Koreans are actually bothered by the
notoriety of having one of the hemorrhagic fevers named for
their country, but no other names for these diseases have been
proposed.
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The AIDS era. Societal reaction to the AIDS epidemic in
the 1980s was notable for the frequent insensitivity displayed
toward patients and the disease in general. Early reference to
AIDS as “the Haitian disease” is reminiscent of the international blame game that occurred with “the great pox” epidemic
of the late 15th century in Europe. Undoubtedly, however, some
people in other countries to this day refer to AIDS as “the
American disease.”
Other conditions. Words or phrases with both a negative
connotation and any suggestion of a specific gender are verboten under the rules of political correctness [12]. “Herpes”
becomes gender neutral with a change to “his-n-herpes,” as
does “cowpox” with a change to “bovinepox.” With respect to
the other poxes, because the words “chicken” and “small” both
have negative connotations, changes to “fowl-american–pox”
and “size-challenged–pox,” respectively, would be appropriate.
Proposed Additions to the ID Vocabulary
Aside from political correctness–driven proposals for new
terminology, there are a number of other words that are not
in any ID dictionary but that, for various reasons, should be
a part of our official vocabulary.
A good example of a word that should logically be in our
lexicon is “ergic,” which would mean “capable of responding to
common skin-test antigens.” Currently, the awkward double negative “not anergic” must be used to express the same concept.
The “-demic” family of words describes the occurrence of
disease in populations and includes “epidemic” (outbreak), “endemic” (background rate), and “pandemic” (widespread, possibly worldwide). One other family member is “academic,”
which means very rare and usually only seen or spoken of in
quaternary care institutions of higher learning.
Several new “-demic” word-family members need to be introduced. The first is “circumdemic,” which would refer to the
“going around” nature of whatever flu or other infectious condition happens to be circulating in a community at a given
time. Another is “emergidemic,” which would describe an
emerging infectious disease. “Re-” or “neo-” could be added
as combining elements to distinguish reemergence of an old
infectious disease versus emergence of a new one. For example,
MDR tuberculosis was a neoemergidemic ID that was circumdemic in hospitals in New York City a few years ago.
Another proposed addition to the family is “pharmacodemic,” which would describe the rate of prescription drug
usage in a population over a given time. The standard and the
newly proposed “-demic” word elements may also be combined
as in the following example: quinolone use has been epipharmacodemic for several years in this country, and expandedspectrum quinolones are currently emergipharmacodemic.
“Epimedia” should be a word to designate an outbreak of
stories in the print or electronic media that are about either a
small number of cases or merely the potential for occurrence
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of an infection or other health problem. Examples of recent
“epimedias,” where the story-to-case ratio has been at least 100
(or more) to 1, have been mad cow disease, Ebola virus in the
United States, and HIV antibody–negative AIDS.
“Urosepsis” is a bona fide word that has come into vogue
in recent years and describes a septic state arising from a urinary
tract infection. So why not expand “-osepsis” into a family of
words to include “arthrosepsis,” “pneumosepsis,” “enterosepsis,” “hepatobiliosepsis,” and “dermatosepsis?” “Neurosepsis”
would encompass all the possibilities of brain abscess, encephalitis, and meningitis in 1 word.
In contrast to proposals for more-concise new words, there
is also a need for increasing the complexity of some expressions.
For example, an ID specialist tends to say “bull’s-eye” or “target lesion” for the primary lesion of Lyme disease, whereas a
dermatologist would always call it “erythema chronicum migrans,” which is much more impressive to patients and thirdparty payers. Dermatologists are acknowledged masters at creating elaborate latinized 3-part scientific names of skin lesions
that sound diagnostic but are really only descriptive. In fact,
whole books have been written on the subject of terminology
in dermatology [13].
Accordingly, the “itchy red bump” skin problem seen in patients with AIDS should be called something like “prurigo nodularis rubra,” and the “red man syndrome” resulting from
vancomycin-induced histamine release should be called “hominis rubra glycopeptidogenica.” Another time-honored but dull
phrase that needs a complexity upgrade is “fever of unknown
origin.” Although it does hint a bit of befuddlement, “pyrexia
perplexia” sounds more impressive and more worthy of the
extensive evaluation that is often required to make a diagnosis.
Summary
This eclectic review of various aspects of the ID language
was never intended to be comprehensive. It was written to dem-
CID 2000;31 (September)
onstrate some evolutionary changes in our language, to point
out a few of the quirks and idiosyncrasies, to highlight the
colorful slang and euphemisms, to make suggestions for new
terminology, and to have some fun in the process of doing so.
Unbankable rewards of work in the ID field include the thrill
of the hunt for etiologic microbes, the power to prevent or cure
otherwise lethal infection, and the excitement of meeting the
challenges of emerging infectious agents and resistance to antimicrobial drugs. The richness of our language is the frosting
on the ID cake. We should savor it also.
References
1. Stedman’s medical dictionary. 26th ed. Baltimore: Williams and Wilkins,
1995.
2. Segen JC. Current med talk: a dictionary of medical terms, slang and jargon.
Stamford, CT: Appleton and Lange, 1995.
3. Haubrich WS. Medical meanings: a glossary of word origins. Philadelphia:
American College of Physicians, 1997.
4. Coombs RH, Chopra S, Schenk DR, Yutan E. Medical slang and its functions. Soc Sci Med 1993; 36:987–98.
5. Lettau LA. Alphabet now complete: NIH discovers hepatitis Z virus. Ann
Intern Med 1993; 119:167.
6. Johnson S, Shulman ST. Infectious diarrhea. In: Shulman ST, Phair JP, Peterson LR, Warren JR, eds. The biologic and clinical basis of infectious
diseases. 5th ed. Philadelphia: WB Saunders, 1997:235–62.
7. Lettau LA. The rigor scale. Infect Dis Clin Prac 1998; 7:399.
8. Rihs JD, Brenner DJ, Weaver RE, et al. Roseomonas, a new genus associated
with bacteremia and other human infections. J Clin Microbiol 1993; 31:
3275–83.
9. Cortes E, Diaz J, Verghese A. Antibiotics: too many names. N Engl J Med
1993; 328:1047.
10. Lettau LA. On the run: emporiatric enteritis by every other name.
Stitches—The Journal of Medical Humour 1997; 61:27–31.
11. Spach DH, Fritsche TR. Scabies [letter]. N Engl J Med 1995; 332:611–2.
12. Beard H, Cerf C. The official politically correct dictionary and handbook.
New York: Villard Books, 1994.
13. Carter RL. A dictionary of dermatologic terms. 4th ed. Baltimore: Williams
and Wilkins, 1992.