Hookworm

1. Pathophysiology
   1. Human Hookworm: Blood sucking Nematode
   2. Size of both species
      1. Length: 10-12 mm females, 6-8 mm males
      2. Eggs: 60-70 um
   3. Life cycle
      1. Eggs hatch into rhabditform larvae
      2. Ingest soil bacteria
      3. Molt into filariform larvae
      4. Larvae infect humans via pores, Hair Follicles, skin
      5. Larvae mature in blood
      6. Invade via alveolar capillaries into lung
      7. Ascend Bronchial tree to be swallowed
      8. Mature worm attaches to Small Intestine wall
      9. Worm feeds and lays eggs in Small Intestine
   4. Species
      1. Necator americanus (New World Hookworm)
         1. Predominates in Americas and Carribean
         2. Mouth with both dorsal and ventral cutting plates
      2. Ancylostoma duodenale (Old World Hookworm)
         1. Predominates in Asia, Africa and Europe
         2. Mouth with 2 pairs of cutting teeth
2. Epidemiology
   1. Second to Pinworm as most common US Helminth infection
   2. Widespread endemic areas
      1. Asia (China, India, Japan)
      2. Mideast
      3. Africa
      4. Southern Europe
      5. Caribbean
      6. Central America
      7. South America
3. Symptoms
   1. Initial (usually asymptomatic)
      1. Pruritic erythematous dermatitis
      2. Mild respiratory symptoms
   2. Later: Gastrointestinal (onset 6 weeks after infection)
      1. Symptoms related to Anemia (see below)
4. Complications
   1. Anemia due to blood loss
      1. Hookworm ingests 0.25 ml of blood per day
   2. Results of Anemia in Children
      1. Malnutrition
      2. Failure to Thrive
      3. Mental retardation
5. Labs
   1. Microscopy for Ova and Parasites exam
      1. Examine stool at room temperature
      2. Rhabditiform Larvae hatch
         1. Contrast with Strongyloides
   2. Complete Blood Count
      1. Hypochromic Microcytic Anemia
      2. Eosinophilia
6. Management
   1. Treat concurrent Iron Deficiency Anemia
   2. Eradication of Helminth infection
      1. Mebendazole 100 mg PO bid for 3 days
      2. Albendazole 400 mg PO for one dose
      3. Pyrantel pamoate 11 mg/kg up to 1 gram for one dose
7. Prevention
   1. Always wear shoes in endemic areas
   2. Ensure adequate sanitation system
8. References
   1. Kucik (2004) Am Fam Physician 69(5):1161-8