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Hookworm Infection

Hook Worm

Hookworm infection, a hallmark of poverty nowadays, is a disease mainly caused by Necator americanus and Ancylostoma duodenale, nematodes typically found in tropical and subtropical areas of Latin America, Asia, and sub-Saharan Africa. The disease may be asymptomatic, but affected individuals may be malnourished and anemic as a consequence of infection. Individual eradications may be achieved, but patients may become reinfected as a result of unsuitable living conditions. This condition is especially dangerous for pregnant women and may cause prematurity and low birth weight children due to maternal anemia or even hookworm infection in the newborn, as the parasite is excreted in the human colostrum and milk.


Presentation

After infection, the first symptom patients notice is a palm or sole irritation, that is pruritic and either vesicular or erythematous, that should be differentiated from cutaneous larva migrans. As nematodes migrate to the lungs, cough, wheezing and exertion dyspnea appear; if symptoms are severe and accompanied by pleurisy, hemoptysis, and low fever, Löffler syndrome should be suspected [1]. On the other hand, hookworm infection can also lead to hypothermia, severe enough to lower fever caused by malaria [2].

Gastrointestinal infection leads to abdominal pain, nausea, diarrhea, flatulence and anorexia, that makes the iron deficit even more severe [3]. Some patients may have pica and ingest dirt, which puts them at further risk for infection and Wakana syndrome, characterized by and pharyngeal itching, hoarseness, nausea, vomiting, and cough [4]. Intestinal hookworms cause persistent blood loss, which might manifest as melena and cause anemia, which may trigger symptoms like a headache, palpitations, fatigue and impaired memory and learning capabilities. Eosinophilic enteritis causes severe abdominal pain that might lead to confusion with appendicitis or intestinal perforation.

Other symptoms include weight loss, impotence, joint and sternal pain and pain in the lower extremities [3] [5].

Anemia
  • CONCLUSION: The prevalence of hookworm is higher and it is associated with anemia in East Wollega zone.[ncbi.nlm.nih.gov]
  • The skin might reflect the chronic character of the anemia, as it becomes wax-like and has green-yellow color, typical to tropical chlorosis.[symptoma.com]
  • Necator often coexisted with other potential causes of anemia, such as pregnancy and hemorrhage.[ncbi.nlm.nih.gov]
  • Abstract Iron deficiency anemia poses an important public health problem for women of reproductive age living in developing countries.[ncbi.nlm.nih.gov]
  • Hookworm infection is a relatively common cause of anemia in endemic areas. The most common hookworm species are Ancylostoma duodenale and Necator americanus.[ncbi.nlm.nih.gov]
Fever
  • We studied the temperature at admission of 200 patients with mild malaria and observed that after adjusting for body mass index, the presence of other helminths, and other confounders, only hookworm-infected patients had lower fever at admission that[ncbi.nlm.nih.gov]
  • On the other hand, hookworm infection can also lead to hypothermia, severe enough to lower fever caused by malaria.[symptoma.com]
  • A fever, coughing, and wheezing may be caused by the migration of the larvae through the lungs. Adult worms often cause pain in the upper abdomen. Iron deficiency anemia and low levels of protein in the blood can result from intestinal bleeding.[dawahnigeria.com]
  • At first, people may have an itchy rash where the larvae penetrate the skin, then fever, coughing, and wheezing or abdominal pain, loss of appetite, and diarrhea.[msdmanuals.com]
  • To learn more about how we use cookies, please see our cookies policy Close Intended for healthcare professionals Research Hay fever, hygiene,... Hay fever, hygiene, and household size.[doi.org]
Weight Loss
  • Vaccination of canines with Na-APR-1(mut) and heterologous challenge with A. caninum resulted in significantly reduced parasite egg burdens (P 0.034) and weight loss (P 0.022).[ncbi.nlm.nih.gov]
  • Other symptoms include weight loss, impotence, joint and sternal pain and pain in the lower extremities. The skin might reflect the chronic character of the anemia, as it becomes wax-like and has green-yellow color, typical to tropical chlorosis.[symptoma.com]
  • Hookworm can also produce abdominal pain, weight loss and diarrhea.[livestrong.com]
  • Weight loss. Diarrhea . Difficulty breathing and tiredness . Chronic infections can cause: Abnormal growth development. Impaired mental development. Congestive heart failure. 3 Prevent an infection by hookworm.[wikihow.com]
Fatigue
  • Intestinal hookworms cause persistent blood loss, which might manifest as melena and cause anemia, which may trigger symptoms like a headache, palpitations, fatigue and impaired memory and learning capabilities.[symptoma.com]
  • Severe, chronic infections can cause loss of blood and anemia that is sometimes severe enough to cause fatigue and occasionally heart failure and widespread swelling. Doctors diagnose the infection by identifying hookworm eggs in a stool sample.[msdmanuals.com]
  • Symptoms may include: Abdominal discomfort Cough Diarrhea Fatigue Fever Gas Itchy rash Loss of appetite Nausea, vomiting Pale skin Most people have no symptoms once the worms enter the intestines.[medlineplus.gov]
Malnutrition
  • Hookworms cause severe anemia and malnutrition in developing countries of the tropics, with an estimated one billion people infected worldwide.[ncbi.nlm.nih.gov]
  • Both cause anaemia and malnutrition, and schistosomiasis also results in substantial intestinal, liver and genitourinary pathology.[ncbi.nlm.nih.gov]
  • Although not directly responsible for substantial mortality, it causes significant morbidity in the form of chronic anemia and protein malnutrition.[ncbi.nlm.nih.gov]
  • It was found that those suffering chronic infection were also suffering from protein energy malnutrition as well as anaemia.[www2.shu.ac.uk]
  • The delicate balance may be upset by malnutrition and inter–current infections. Little is known about host immunity.[aarogya.com]
Cough
  • Some patients may have pica and ingest dirt, which puts them at further risk for infection and Wakana syndrome, characterized by and pharyngeal itching, hoarseness, nausea, vomiting, and cough.[symptoma.com]
  • At first, people may have an itchy rash where the larvae penetrate the skin, then fever, coughing, and wheezing or abdominal pain, loss of appetite, and diarrhea.[msdmanuals.com]
  • A fever, coughing, and wheezing may be caused by the migration of the larvae through the lungs. Adult worms often cause pain in the upper abdomen. Iron deficiency anemia and low levels of protein in the blood can result from intestinal bleeding.[dawahnigeria.com]
  • We don’t really know quite how it gets to the lungs, but they migrate to the lungs, and then they get coughed up by that mucous that is pushing all the worms away, the worms are trying to be got rid of, but then it gets swallowed.[sciencelearn.org.nz]
  • Their presence within the lungs usually causes enough irritation to produce coughing. The larvae are coughed up into the throat and mouth, and are then swallowed and passed into the small intestine.[medical-dictionary.thefreedictionary.com]
Dyspnea
  • After a single dose of pyrantel pamoate, his symptoms including dyspnea on exertion and edema diminished. And also hemoglobin and B-type natriuretic peptide (BNP) had improved dramatically.[ncbi.nlm.nih.gov]
  • As nematodes migrate to the lungs, cough, wheezing and exertion dyspnea appear; if symptoms are severe and accompanied by pleurisy, hemoptysis, and low fever, Löffler syndrome should be suspected.[symptoma.com]
  • As iron deficiency anemia develops and worsens, the patient may become indolent and have weakness, palpitations, fainting, dizziness, dyspnea, mental apathy and headache.[isradiology.org]
Dry Cough
  • Within 1 to 2-weeks, pulmonary symptoms may develop which are usually mild and transient, consisting of a dry cough, sore throat, asthmatic wheezing and slight fever. A chest x-ray will usually be negative.[isradiology.org]
Hemoptysis
  • As nematodes migrate to the lungs, cough, wheezing and exertion dyspnea appear; if symptoms are severe and accompanied by pleurisy, hemoptysis, and low fever, Löffler syndrome should be suspected.[symptoma.com]
Diarrhea
  • The diarrhea and eosinophilia subsided after this treatment. Copyright 2011. Published by Elsevier B.V.[ncbi.nlm.nih.gov]
  • While a light infection may cause no symptoms, heavy infection can cause anemia, abdominal pain, diarrhea, loss of appetite, and weight loss. Heavy, chronic infections can cause stunted growth and mental development.[web.archive.org]
  • A Japanese patient who returned from a visit to Thailand and Lao People's Democratic Republic (PDR) was presented with intermittent watery diarrhea with eosinophilia.[ncbi.nlm.nih.gov]
  • Hookworm can also produce abdominal pain, weight loss and diarrhea.[livestrong.com]
  • Hookworm: An intestinal parasite that usually causes diarrhea or cramps. Heavy infestation with hookworm can be serious for newborns, children, pregnant women, and persons who are malnourished.[medicinenet.com]
Abdominal Pain
  • Gastrointestinal infection leads to abdominal pain, nausea, diarrhea, flatulence and anorexia, that makes the iron deficit even more severe.[symptoma.com]
  • In hookworm endemic areas, when empirical treatment for dyspepsia and upper abdominal pain with acid suppressive agents does not offer remedy, antihelminthic agents should be considered even when stool for ova or parasites is negative.[ncbi.nlm.nih.gov]
  • Hookworm can also produce abdominal pain, weight loss and diarrhea.[livestrong.com]
  • While a light infection may cause no symptoms, heavy infection can cause anemia, abdominal pain, diarrhea, loss of appetite, and weight loss. Heavy, chronic infections can cause stunted growth and mental development.[web.archive.org]
  • Additional symptoms may include abdominal pain, the desire to eat soil (geophagy) and lethargy. Cardiac and pulmonary symptoms can arise as a result of the migrating larvae.[msu.edu]
Epigastric Pain
  • Dyspepsia and epigastric pain are common presenting symptoms of patients with either hookworm infection or peptic ulcer disease.[ncbi.nlm.nih.gov]
Cutaneous Larva Migrans
  • migrans Cutaneous larva migrans by Ancylostoma caninum Cutaneous larva migrans due to Uncinaria Diffuse unilateral subacute neuroretinitis Infection by Uncinaria Larva migrans of skin Larva migrans, cutaneous Necatoriasis Strongyloidal cutaneous larva[icd9data.com]
  • After infection, the first symptom patients notice is a palm or sole irritation, that is pruritic and either vesicular or erythematous, that should be differentiated from cutaneous larva migrans.[symptoma.com]
  • See separate Cutaneous Larva Migrans article. Life cycle [ 1 ] Eggs are passed in the stool and (with favourable conditions of moisture, warmth and shade) larvae hatch in one to two days.[patient.info]
Pruritus
  • In the migratory phase, pruritus, erythema and vesiculation will occur once the filariform larvae have penetrated the skin of the feet or hands. This is known as "ground or dew itch" in people who go barefoot.[isradiology.org]
Papular Rash
  • In these areas, repeated exposure to third-stage larvae of Necator americanus or Ancylostoma duodenale results in a local pruritic, erythematous, papular rash known as "ground itch." [ Note: The three main soil-transmitted helminth infections, Ascariasis[histopathology-india.net]
Headache
  • Intestinal hookworms cause persistent blood loss, which might manifest as melena and cause anemia, which may trigger symptoms like a headache, palpitations, fatigue and impaired memory and learning capabilities.[symptoma.com]
  • Cysts in the brain and spinal cord can produce seizures, confusion, headaches, weakness and paralysis. These cysts can be detected with CAT scans or magnetic resonance imaging.[livestrong.com]
  • As iron deficiency anemia develops and worsens, the patient may become indolent and have weakness, palpitations, fainting, dizziness, dyspnea, mental apathy and headache.[isradiology.org]
Apathy
  • As iron deficiency anemia develops and worsens, the patient may become indolent and have weakness, palpitations, fainting, dizziness, dyspnea, mental apathy and headache.[isradiology.org]
Dizziness
  • As iron deficiency anemia develops and worsens, the patient may become indolent and have weakness, palpitations, fainting, dizziness, dyspnea, mental apathy and headache.[isradiology.org]

Workup

The skin might reflect the chronic character of the anemia, as it becomes wax-like and has green-yellow color, typical to tropical chlorosis. Dermatological examination shows the rash described above, that is sometimes accompanied by scratching lesions or typical cutaneous larva migrans, a serpiginous erythematous lesion that appears at the hookworm entrance site [6]. Lung auscultation reveals wheezing and stool inspection may diagnose melena. Signs of heart failure appear if anemia is severe. Patients might also present with peripheral edema or even anasarca, due to hypoproteinemia [7]. Infected children exhibit growth retardation [8].

Blood tests must include a complete cell blood count, that reveals an iron deficiency anemia and eosinophilia, more prominent in eosinophilic enteritis than larva migrans [7]. Serum immunoglobulin E is high, as in other parasite infections. Serum ferritin and protoporphyrin levels are decreased [9].

Stool evaluation may diagnose infestation by describing eggs or larvae, but may also be negative, in which case disease cannot be excluded. Stool should be processed immediately after emission and look especially for eggs because larvae might be confused with those of Strongyloides stercoralis.

Polymerase chain reaction is another valuable but unfortunately not widely available way to diagnose this disease [10].

Hookworm infection patient may also be susceptible to other diseases, due to the demonstrated down-regulation of the immune system that comes with this condition [11] [12].

Other diagnostic methods include colonoscopy, that describes ulceration and sometimes adult hookworms attached to the colon and thoracic radiography, that might show diffuse infiltrates.

Microcytic Anemia
  • Hookwork disease identification chonic parasitic infection iron deficiency and hypochromic, microcytic anemia, Children w/heavy long term infection may have hypoprteinemia and may be retarded in mental and physical development.[quizlet.com]
Necator Americanus
  • CONCLUSIONS: Necator americanus and gluten microchallenge promoted tolerance and stabilized or improved all tested indices of gluten toxicity in CeD subjects. Copyright 2014 American Academy of Allergy, Asthma & Immunology.[ncbi.nlm.nih.gov]
  • The most common hookworm species are Ancylostoma duodenale and Necator americanus. In this report we present a case of overt gastrointestinal bleeding because of hookworm infection.[ncbi.nlm.nih.gov]
  • In sub-Saharan Africa and Brazil, co-infections with the hookworm, Necator americanus, and the intestinal schistosome, Schistosoma mansoni, are common.[ncbi.nlm.nih.gov]
  • The study was carried out in 37 Nigerian patients with hookworm infection (Necator americanus and Ancylostoma duodenale and 17 healthy Nigerians as controls.[ncbi.nlm.nih.gov]
  • Hookworm infection caused by the soil-transmitted nematodes Necator americanus and Ancylostoma duodenale is one of the most common parasitic infections worldwide.[ncbi.nlm.nih.gov]
Ancylostoma Duodenale
  • The most common hookworm species are Ancylostoma duodenale and Necator americanus. In this report we present a case of overt gastrointestinal bleeding because of hookworm infection.[ncbi.nlm.nih.gov]
  • The study was carried out in 37 Nigerian patients with hookworm infection (Necator americanus and Ancylostoma duodenale and 17 healthy Nigerians as controls.[ncbi.nlm.nih.gov]
  • Hookworm infection caused by the soil-transmitted nematodes Necator americanus and Ancylostoma duodenale is one of the most common parasitic infections worldwide.[ncbi.nlm.nih.gov]
  • Both Necator americanus and Ancylostoma duodenale were identified, although the former species predominated.[ncbi.nlm.nih.gov]
  • Ancylostoma duodenale produces more blood loss than Necator americanus. More anemia comes about with the infection of the Ancylostoma duodenale.[coursera.org]

Treatment

  • The impact of anthelmintic treatment is greatest when albendazole is co-administered with praziquantel.[ncbi.nlm.nih.gov]
  • The percent reduction in hookworm egg counts from baseline to 3 months post-treatment was 40.8%. Praziquantel treatment did not decrease the infection intensity of STHs.[ncbi.nlm.nih.gov]
  • The intensity of hookworm infection, egg counts, results of treatment by anthelminthic drugs, observations on new infections and reinfections following treatment throughout the year and the density of nematode larvae in soil in the study area were investigated[ncbi.nlm.nih.gov]
  • The sudden introduction of this treatment combines with the cross-area differences in pre-treatment infection rates to form the basis of the identification strategy.[ncbi.nlm.nih.gov]
  • The diarrhea and eosinophilia subsided after this treatment. Copyright 2011. Published by Elsevier B.V.[ncbi.nlm.nih.gov]

Prognosis

  • What Is the Prognosis? Proper treatment of hookworm infections results in a high recovery rate. How Is the Diagnosis Made? Reinfection is common. Wearing shoes prevents the larvae from entering the body through the feet.[healthychildren.org]
  • Outlook (Prognosis) You will have a complete recovery if you get treated before serious complications develop. Treatment gets rid of the infection.[ufhealth.org]
  • Prognosis The prognosis for patients with hookworm disease is generally good. However, reinfection rates are extremely high in countries with poor sanitation.[medical-dictionary.thefreedictionary.com]

Etiology

  • Worldwide, N. americanus is the predominant etiology of human hookworm infection, whereas A. duodenale occurs in more scattered focal environments [ 3 ].[doi.org]

Epidemiology

  • Our epidemiological understanding of hookworm has improved through the development of mathematical models of transmission dynamics, which coupled with decades of field research across multiple epidemiological settings, have shown that certain population[ncbi.nlm.nih.gov]
  • This paper investigates the epidemiology of parasitic infections in 460 pre-school children who were part of a larger case-control study of severe malaria in Kilifi on the Kenyan coast.[ncbi.nlm.nih.gov]
  • Our aim was to identify environmental factors that might serve to predict infection and thus guide control efforts when epidemiologic information is insufficient.[ncbi.nlm.nih.gov]
  • METHODOLOGY: A cross-sectional epidemiological survey was carried out in a rural part of south-central Côte d'Ivoire.[ncbi.nlm.nih.gov]
  • Predictions are compared with observed post-treatment epidemiological patterns.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • University Tropical Parasitology: Protozoans, Worms, Vectors and Human Diseases This course provides students an understanding of important human parasitic diseases, including their life cycles, vectors of transmission, distribution and epidemiology, pathophysiology[coursera.org]
  • Trichostrongyles are related to hookworms in terms of transmission mode, morphology, and pathophysiology.[doi.org]

Prevention

  • Treating in this way is called preventive treatment (or "preventive chemotherapy").[web.archive.org]
  • Specifically, we found that while preventive chemotherapy appeared to dramatically reduce hookworm infection, WASH was associated with infection intensity.[ncbi.nlm.nih.gov]
  • Treating in this way is called preventive treatment (or “preventive chemotherapy”).[cdc.gov]
  • These patterns form the framework for subsequent advice on prevention and control.[who.int]

References

Article

  1. Hotez PJ, Brooker S, Bethony JM, et al. Hookworm infection. N Engl J Med. 2004 Aug 19. 351(8):799-807.
  2. Nacher M, Singhasivanon P, Traore B, et al. Short report: hookworm infection is associated with decreased body temperature during mild Plasmodium falciparum malaria. Am J Trop Med Hyg 2001;65:136-7
  3. Anyaeze CM. Reducing burden of hookworm disease in the management of upper abdominal pain in the tropics. Trop Doct 2003;33:174-5.
  4. Hotez PJ, Brooker S, Bethony JM, et al. Hookworm infection. N Engl J Med. 2004 Aug 19. 351(8):799-807.
  5. Gilles HM, Williams EJ, Ball PA. Hookworm infection and anaemia: an epidemiological, clinical, and laboratory study. Q J Med 1964;331:1-24.
  6. Heukelbach J, Feldmeier H. Epidemiological and clinical characteristics of hookworm-related cutaneous larva migrans. Lancet Infect Dis. 2008 May. 8(5):302-9.
  7. Brooker S, Bundy DAP. Soil-transmitted Helminths (Geohelminths). Cook GC, Zumla AI, eds. Manson’s Tropical Diseases. 22nd ed. Philadelphia, PA: WB Saunders; 2009. 1515-48.
  8. Stoltzfus RJ, Albonico M, Tielsch JM, Chwaya HM, Savioli L. Linear growth retardation in Zanzibari school children. J Nutr. 1997 Jun. 127(6):1099-105.
  9. Stoltzfus RJ, Chwaya HM, Tielsch JM, Schulze KJ, Albonico M, Savioli L. Epidemiology of iron deficiency anemia in Zanzibari schoolchildren: the importance of hookworms. Am J Clin Nutr 1997;65:153-9.
  10. Gasser RB, Cantacessi C, Loukas A. DNA technological progress toward advanced diagnostic tools to support human hookworm control. Biotechnol Adv. 2008;26(1):35-45.
  11. Olatunde BO, Onyemelukwe GC. Immunosuppression in Nigerians with hookworm infection. Afr J Med Med Sci 1994;23:221-5.
  12. Loukas A, Prociv P. Immune responses in hookworm infections. Clin Microbiol Rev 2001;14:689-703.

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Last updated: 2018-06-22 05:26