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It is common in the moist tropics and subtropics. It affects about 1 billion people worldwide.

In developing nations, the disease leads to the death of many children by increasing their risk for infections that their bodies would normally fight off. It is a condition caused by roundworms that affects the small intestine and lungs. There is very little risk of getting the disease in the United States because of advances in sanitation and waste control. Hookworm is a leading cause of maternal and child morbidity in the developing countries of the tropics and subtropics. In susceptible children hookworms cause intellectual, cognitive and growth retardation, intrauterine growth retardation, prematurity, and low birth weight among newborns born to infected mothers. In developed countries, hookworm infection is rarely fatal, but anemia can be significant in a heavily infected individual. Causes The disorder is caused by infestation with the roundworms:

Necator americanus Ancylostoma duodenale Ancylostoma ceylanicum Ancylostoma braziliense The first two roundworms affect humans only. The last two types also occur in animals. Necator can only be transmitted through penetration of the skin whereas Ancylostoma can be transmitted percutaneously, orally, and probably transplacentally. Disease Transmission Transmission of this infection is similar to other soil-transmitted helminths in which the individual walks barefoot or plays on soil or sand when the eggs or baby worms are present there. Proper disposal of animal feces will lessen the risk of human infection as pets such as dogs and cats can acquire hookworm infection and deposit the eggs in soil. The larvae (immature form of the worm) get into the skin. The larvae move to the lungs via the bloodstream and enter the airways. The worms are about 1/2 inch long. After traveling up the windpipe, the larva are swallowed. After the larvae are swallowed, they infect the small intestine. They develop into adult worms and live there for 1 or more years. Adult worms and larvae are released in the feces.

Life Cycle Stages The life cycles of hookworms species are similar. Parasites are dioecious, with male and female organs in separate individuals. They mate in host's small intestine and the females produce eggs. Following copulation, female lays her eggs.

EGGusual

daily output of eggs for single female hookworm is between 10,000 and 30,000 eggs; eggs are passed to the environment with feces
RHABDITIFORM LARVA

RHABDITIFORM LARVA 1 (L1)rhabditiform

microorganisms

larvae hatch from eggs in a warm soil (~48 hours); it feeds on bacteria and other

RHABDITIFORM LARVA 2 (L2)rhabditiform larvae first stage molt to rhabditiform larvae second stage by third day

(L3)rhabditiform larva second stage molts to filariform larva (L3); this is infectious nonfeeding stage of the hookworm; the larvae migrate to the grass blades and "stand up" on their tails ready to stick to the passing host; the larvae survive for several week without feeding until they exaust their metabolic reserves; they adhere to the host on contact and penetrate skin causing so-called "ground itch" IMMATURE ADULTswept by blood stream L3 larvae in about 10 days after entry reach the heart and then, lungs, where they rupture capillaries and ascend the alveoli, bronchioles, bronchi, and trachea; the host coughs up the larvae and swallows them; when the larvae reach the small intestine, they settle, start feeding, and undergo two additional moltings
FILARIFORM LARVA

after 2 moltings the parasites mature into adults and mate; intestinal blood loss begins just before egg production and continues for the life of the worm (up to 5 years); to ensure blood flow, adults release anticlotting agents (the agents were isolated and applied in therapeutics to block blood coagulation in several diseases); adult females: 10 to 13 mm (A. duodenale), 9 to 11 mm (N. americanus); adult males: 8 to 11 mm (A. duodenale), 7 to 9 mm (N. americanus)
MATURE ADULT

NOTE: Adult hookworms reside in the human small intestine, where they attach themselves by gripping intestinal lining with their mouths. They ingest blood and cause bleeding at the attachment site. Symptoms

Abdominal discomfort Blood in the stool Bloody sputum ( COUGHING OF BLOOD) Cough Diarrhea Fatigue Fever Itchy rash Loss of appetite Nausea, vomiting Pale skin Most people have no symptoms once the worms enter the intestines. Treatment

Treat complications of anemia (Taking in iron supplement or rich in iron foods) Improve nutrition If the number of hookworm eggs in your intestines is large enough more than 2,000 eggs per gram of stoolyour healthcare provider will assume that the infection may cause anemia and start treating you. Parasite-killing medications such as albendazole, mebendazole, or pyrantel pamoate are usually prescribed. Ivermectin, used for other worm infections, does not work for hookworm infections. Possible Complications

Iron deficiency anemia caused by loss of blood

Nutritional deficiencies When to Contact a Medical Professional Call for an appointment with your health care provider if symptoms of hookworm infection develop. Prevention and Control Hookworm vaccine are given If in an area where hookworm disease is common, or where human feces may be in the soil or sand, you: Should not walk barefoot on the soil or sand Should not touch the soil or sand with your bare hands. Health Education on proper excretion disposal Animals should also have a proper way of excretion as much as possible. Vegetables should not be eaten raw. Improvement in sanitation measure Note: In chronic (lasting a long time) hookworm infections, if the number of parasites becomes great enough, you can develop serious anemia (low red blood cell count). This is due to blood loss from the worms attaching themselves to the intestines and sucking the blood and tissue juices. When this situation is combined with poor nutrition, pregnancy, or malaria, the anemia can be severe.

The incubation period is 40 to 100 days or two to eight weeks. Also it is largely dependent on the number of hookworm parasites with which an individual is infected References: Kazura JW. Nematode infections. In: Goldman L, Ausiello D, eds.Cecil Medicine . 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 378. Maguire JH. Intestinal nematodes (roundworms). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Disease . 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 287.

Genus and species Common name

Necator americanus New world hookworm

Ancylostoma duodenale Old world hookworm

Etiologic agent of Infective stage Definitive host

Necatoriasis, Filariform larva Human Usually via skin penetration rather than ingestion Skin > mouth Small intestine (jejunum, ileum) L3 Larva
[59]

Ancylostomiasis,

Portal of entry

Usually via ingestion rather than skin penetration Mouth > skin Small intestine (duodenum, jejunum)

Mode of transmission Habitat


[59]

Pathogenic stage Maturation time in host (days) Mode of attachment Mode of nutrition 4956

53

Oral attachment to mucosa by sucking Sucking and ingesting of blood Larva ground / dew itch, creeping eruption

Pathogenesis Adult IDA Microcytic, Hypochromic Anemia Laboratory diagnosis Treatment Length of adult hookworm (mm)
[60]

Concentration methods and direct fecal smear Albendazole, Mebendazole, or Pyrantel Pamoate 59 for males; 911 for females Head curved opposite to curvature of body, giving a hooked appearance to anterior end 811 for males; 1013 for females Head continuous in same direction as the body

Shape

[60]

Egg output per female worm per [59] day Blood loss per worm per day (ml)
[59]

5,00010,000

10,00025,000

0.03

0.150.23

Temperature at which 90% of eggs [59] hatch (C) Diagnostic feature adult

2035

1535

Semi-lunar cutting plate; bipartite dorsal ray

Male Tripartite dorsal ray