PARASITOLOGY

Topic: Phasmids 2
Lecture by: Dr. Quiaoit

HOOKWORMS Filariform larvae:

 Necator americanus  The buccal spears of the N.
 Ancylostoma duodenale americanus filariform larva are
 Cutaneous larva migrans CONSPICUOUS and PARALLEL
o Ancylostoma braziliense throughout their lengths
o Ancylostoma caninum o There are conspicuous
o Ancylostoma ceylanicum transverse striations
 Strongyloides stercoralis present on the sheath in
the tail region
Necator americanus
Ancylostoma duodenale  In contrast, the filariform larva of A. duodenale has INCONSPICUOUS
 The hookworms that infect humans are Necator americanus and buccal spears and TRANSVERSE striations on the sheath in the tail
Ancylostoma duodenale, which are soil-transmitted helminths region
o They are blood-sucking nematodes that attach to the
mucosa of the small intestines Eggs:
o They are most commonly found in tropical and
subtropical countries where they occur as single or mixed
infections

Parasite Biology
 All hookworms have the MEROMYRIAN type of somatic muscle with
2 to 5 cells arranged per dorsal or ventral half
 It is quite difficult to distinguish the eggs of A. duodenale from those
N. americanus of N. americanus
 N. americanus adults are small,  The eggs have bluntly rounded ends and a single thin transparent
cylindrical fusiform, grayish-white hyaline shell
nematodes  They are unsegmented at oviposition
 Females (9-11 mm by 0.35 mm) are  They are in the two- to eight-cell stage of division when passed out
LARGER than males (5-9 mm by 0.30 with fresh feces
mm) NOTES from Lecture:
 The posterior end of the male has a Hookworms:
broad, membranous caudal bursa with rib-like rays, which are used  Hookworms  A misnomer (because they have no hooks)
for copulation o Hookworms are provided with plates/teeth
 The buccal capsule has a ventral PAIR of semilunar cutting PLATES  2 Genera:
 The head is curved opposite to the curvature of the body, which is o Necator
like a hook at the anterior end  N. americanus
o Ancylostoma
 A. duodenale
A. duodenale  A. braziliense
 The adult A. duodenale is slightly larger  A. caninum
than N. americanus  A. ceylanicum
 Each adult has single-paired male or
female reproductive organs Hookworms of Man:
 Unlike the N. americanus, the head of  N. americanus  New World
the A. duodenale adult continues in the  A. duodenale  Old World
same direction as the curvature of the
body Hookworms of Animals:
 The buccal capsule has TWO PAIRS of curved ventral TEETH  A. braziliense  Cat
 A. caninum  Dog
Rhabditiform larvae:  A. ceylanicum  Hamster
 Rhabditiform larvae of N. americanus
and A. duodenale are indistinguishable Morphology:
 They resemble those of Strongyloides  Size
stercoralis, but are somewhat LARGER, o Ancylostoma
more attenuated posteriorly, and have a  Male: 8-11 mm x 0.4-0.5 mm
longer buccal cavity  Female: 10-13 mm x 0.5-0.6 mm
 The genital primordium is SMALLER in o Necator
hookworms compared with S. stercoralis  Male: 6-8 mm x 0.2-0.3 mm
 Female: 10-12 mm x 0.2-0.5 mm

Continued next page…..

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 PARASITOLOGY
Topic: Phasmids 2
Lecture by: Dr. Quiaoit

Life Stages:
 Eggs
o Ovoid
o Yellowish
o Thin shelled
Similar in all hookworms

 Larva
o Rhabditiform
 NON-INFECTIVE
 Feeding larva
 Short and stout
 Directly hatches from eggs
 L1
o Filariform
 INFECTIVE
 Thin and long
 Adult form
 Never survive in soil
 L3 Eggs are passed in the stool (1) , and under favorable conditions (moisture, warmth, shade),
Similar in all hookworms larvae hatch in 1 to 2 days and become free-living in contaminated soil. These released
Molting stage: L2 rhabditiform larvae grow in the feces and/or the soil (2) , and after 5 to 10 days (and two
molts) they become filariform (third-stage) larvae that are infective (3) . These infective
larvae can survive 3 to 4 weeks in favorable environmental conditions. On contact with the
 Adult
human host, typically bare feet, the larvae penetrate the skin and are carried through the
o Separate sexes blood vessels to the heart and then to the lungs. They penetrate into the pulmonary alveoli,
o Female > Male (size) ascend the bronchial tree to the pharynx, and are swallowed (4) . The larvae reach the
o Not similar in all hookworm jejunum of the small intestine, where they reside and mature into adults. Adult worms live
o Differentiated by: in the lumen of the small intestine, typically the distal jejunum, where they attach to the
 Buccal cavity intestinal wall with resultant blood loss by the host (5) . Most adult worms are eliminated in
 Presence of plates/teeth 1 to 2 years, but the longevity may reach several years
 Number of teeth
Some A. duodenale larvae, following penetration of the host skin, can become dormant
 Arrangement of teeth
(hypobiosis in the intestine or muscle). These larvae are capable of re-activating and
 Buccal Cavity establishing patent, intestinal infections. In addition, infection by A. duodenale may
o N. americanus – buccal plates probably also occur by the oral and the transmammary route. A. ceylanicum and A.
 Teeth caninum infections may also be acquired by oral ingestion. A. caninum-associated
o A. duodenale – 2 even pairs eosinophilic enteritis is believed to result following oral ingestion of larvae, not
o A. braziliense – 2 uneven pairs percutaneous infection. N. americanus does not appear to be infective via the oral or
transmammary route
o A. caninum – 3 pairs
o A. ceylanicum – 2 pairs in pile
Pathogenesis & Clinical Manifestations
Life Cycle  The pathology of hookworm infection involves:
o The skin at the site of entry of the filariform larvae
 The hookworm life cycle is direct and begins with the ADULT worms
o The lung during larval migration
copulating while attached to the mucosa of the SMALL INTESTINES
o The small intestine, the habitat of the adult worms
 Female worms oviposit into the intestinal lumen and the eggs are
 Penetration of the filariform larvae through the skin produces
passed out with human feces
maculopapular lesions and localized erythema
 In the soil, the embryo within the egg develops rapidly and hatches
Itching is often severe, and it is known as “ground itch” or “dew
after 1 to 2 days into the rhabditiform larva
itch,” as it is related to contact with soil, especially on a dewy
 After 7 to 10 days, the larva undergoes TWO stages of molting and
morning. Itching, edema, erythema, and later papulovesicular
transforms into the non-feeding filariform larva (L3), the infective
eruptions can last for 2 weeks
stage of the parasite
 Filariform larvae penetrate the skin and enter venules
 If the larvae migrating through the lungs are ABUNDANT, bronchitis
 They migrate to the heart and lungs, and then into the alveoli
or pneumonitis may result
 The larvae then ascend to the trachea and are finally swallowed, and
 In the course of migration, these larvae produce minute
passed down to the small intestine where the worms become
hemorrhages with eosinophilic and leukocytic infiltration, but these
sexually mature and the female will start laying eggs
manifestations seem to be RARE in the tropics
 In the stage of maturation of the worm in the intestine, there is:
o Abdominal pain
o Steatorrhea
o Sometimes diarrhea with blood and mucus
o Eosinophilia
 Hookworm infection is usually CHRONIC, hence patients often show
no acute symptoms

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 PARASITOLOGY
Topic: Phasmids 2
Lecture by: Dr. Quiaoit
Pathogenesis & Clinical Manifestations continued…..
 Studies have shown GREATER blood loss per worm per day in A.
duodenale infection compared with N. americanus infection
 Chronic moderate or heavy hookworm infection results in a
progressive, secondary, microcytic, hypochromic ANEMIA of the
iron-deficient type, due primarily to continuous loss of blood
 Hypoalbuminemia is another manifestation of hookworm infection
There is low level of albumin due to combined loss of blood,
lymph, and protein
 Other symptoms are:
o Exertional dyspnea, weakness, dizziness, and lassitude,
while signs include rapid pulse, edema, and albuminuria
 Unlike in ascariasis, the complications in hookworm infection are
quite MILD, and remedial measures are readily applied
 In general, the prognosis of hookworm infection is GOOD
 Cellular immune response is primarily mediated by:
o Eosinophils
o Mast cells
o Th2 cells
 Despite all of these, there has been no clear evidence that the host
develops perpetual immunity against hookworm infection; however,
polyvalent IgE antibodies have been suggested to provide some
protective roles
Diagnosis
 Final diagnosis depends on the identification of parasite ova in the
feces
 The following techniques are INEXPENSIVE and can be applied to
both INDIVIDUAL and MASS screening:
1. Direct fecal smear
 Is of value only when the infection is quite
heavy
 It may NOT detect the parasite in light
infections (i.e., egg count of <400 eggs per
gram feces)
2. Kato thick or Kato-Katz method
 May INCREASE detection rates since more
stools are examined using these techniques
 The latter technique (Kato-Katz method) may
also provide quantitative diagnosis by
determining the intensity of infection in
terms of number of helminth eggs per gram of
feces
 The disadvantage of these methods is the
RAPID CLEARANCE of hookworm eggs after
30 to 60 minutes with the use of glycerine as
a clearing agent
3. Concentration methods like Zinc sulfate centrifugal
flotation and the Formalin-ether/ethyl acetate
concentration method
 Use GREATER quantity of stool that may
contribute to the increase in sensitivity
 FLOTAC, which is also a centrifugal flotation
method, has been shown to have a HIGHER
sensitivity for the diagnosis of soil-transmitted
helminths compared with multiple
examinations of Kato-Katz smears
4. Culture methods like the Harada-Mori
 Allow hatching of larvae from eggs on strips of
filter paper with one end immersed in water
 Culture methods are recommended for
SPECIES IDENTIFICATION
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 Molecular approaches have also been developed:
o PCR-based detection of hookworm DNA in feces
o Enzyme-linked immunosorbent assay (ELISA) for the
detection of secretory/excretory coproantigens
Treatment
 All diagnosed cases of hookworm infections should be treated
HOWEVER, where the risk of reinfection is high, mass screening
before treatment may be impractical
 As with other soil-transmitted helminth infection control, the WHO
recommends mass drug administration among school-age children
at least ONCE a year for communities with cumulative STH
prevalence greater than or equal to 20%
 Treatment of other high-risk groups such as preschool children,
women of childbearing age, including pregnant women in the second
and third trimesters and lactating women, should also be considered
 Albendazole
o The drug of choice, is larvicidal and ovicidal against N.
americanus and A. duodenale
o It is given as a 400 mg single dose for adults and children
over 2 years old
o Chewable tablets or suspension preparations are
available
 Mebendazole
o For children and adults  given as a 500 mg single dose
These drugs are both BENZIMIDAZOLE derivatives that block the
uptake of glucose by most intestinal and tissue nematodes
Adverse Effects:
 Rare, and are usually mild and transient
 Epigastric pain, diarrhea, headache, and dizziness
 Iron Supplementation & adequate diet
o Addresses anemia and hypoproteinemia
 Important Parameters in Drug monitoring:
o Cure rates
o Egg reduction
o Rates
o Reinfection rates
Epidemiology
 About 576 to 740 million people in tropical and subtropical
countries are estimated to be infected with either A. duodenale or
N. americanus
 Associated anemia causes at least 50,000 deaths annually
 Geographical distribution of the two human hookworms used to be
relatively distinct
A. duodenale was prevalent in Europe and Southwestern Asia
N. americanus was prevalent in tropical Africa and the Americas
 But now, both species have become widely distributed throughout
the tropics and subtropics, and rigid demarcations are no longer
present
 In the Philippines, local studies on speciation of human hookworms
revealed that out of 1,958 samples positive for hookworm in
cultures, 97% were identified as N. americanus, 1% as A. duodenale,
and 2% were mixed infections
 The local distribution of human hookworm infection is greater in
AGRICULTURAL areas
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 PARASITOLOGY
Topic: Phasmids 2
Lecture by: Dr. Quiaoit

 Farmers are prone to the infection because they work in rice fields CUTANEOUS LARVA MIGRANS
and vegetable gardens, and they are not properly protected from  Cause by A. braziliense, A. caninum, A. ceylanicum
contact with infective soil  Never leave the skin
 In other high-risk groups, the prevalence of hookworm infection  “Creeping eruption”
remains relatively high:
o Pregnant women  5.5% Pathogenesis:
o Adolescent females  2.8%  Transmitted through dog feces at the soil  eggs hatch 
o Military and para-military personnel  46.9% rhabditiform larva  man walks on infected soil  penetration 
o Indigenous people communities (Davao del Norte)  erythema & itchiness
13.6% of school children were infected
o Food handlers  22.7% in Metro Manila Pathology:
14.8% in Cebu  Skin lesions (map-like)
 Factors that contribute to the distribution and transmission of  Erythematous
hookworms are  Itchy
a) Suitability of the environment for eggs or larvae: damp,  With pinpoint lesion
sandy or friable soil with decaying vegetation, and
temperature of 24 to 32°C Life Cycle:
b) Mode and extent of fecal pollution of the soil (through  Filariform larva only
open defecation or the use of night soil as fertilizer)
c) Mode and extent of contact between infected soil and Treatment
skin or mouth
 Thiabendazole, Ivermectin
 Method of human infection in Necatoriasis is purely percutaneous
 Method of human infection in Ancylostomiasis, it is BOTH Mode of Transmission:
percutaneous and through the oral route  Penetration
The latter occurs upon eating raw vegetables contaminated with
infective larvae and probably also through ingestion of raw or Diagnostic Stage:
insufficiently cooked infected meat, although it is not clear  Filariform (end of the map); entry point: point lesion
whether infection through eating raw meat occurs in humans
Diagnosis:
 A. duodenale may remain DORMANT in the intestines or in the  Slit skin biopsy
muscles, resulting in a prolonged incubation period and creating
problems in treatment Strongyloides stercoralis
 Transmammary transmission has also been reported  Common name: Threadworm
 “Cochin China diarrhea”
Animal Hookworms:
 It is characterized by free-living rhabditiform and parasitic filariform
 Ancylostoma braziliense (cat hookworm)
stages
 Ancylostoma caninum (dog hookworm)
 Strongyloides stercoralis or threadworm is the only species of this
That can infect humans causing “creeping eruption” also known as genus which is naturally pathogenic to humans
cutaneous larva migrans (CLM) o Several species have been reported in mammals and in
birds
Prevention & Control
 Regular mass drug administration in schools  decrease in the Parasite Biology
prevalence of soil-transmitted helminths among school children Filariform:
However, coverage of deworming is limited to preschool- and  The parasitic or filariform female is 2.2 mm by 0.04 mm, colorless,
school-age children, leaving other high-risk groups vulnerable semi-transparent, with a finely striated cuticle
 It has a slender tapering anterior end and a short conical pointed tail
 In the Philippines, the WASHED approach is being advocated for a  The short buccal cavity has FOUR indistinct lips
more comprehensive control of STH infections  The long slender esophagus extends to the anterior fourth of the
This approach refers to improvement in access to clean water and body, and the intestine is continuous to the subterminal anus
sanitation, promotion of hygiene education, and regular  The vulva is located one-third the length of the body from the
deworming. posterior end
 The uteri contain a single file of 8 to 12 thin-shelled, transparent,
 Highlighting behavior change among the people and promotion of segmented ova, 50 to 58 µm by 30 to 34 µm
sustainable sanitation through community-led total sanitation 
may result in greater impact on helminth control Free-living:
 Open defecation should be discouraged  The free-living female measures 1 mm by 0.06 mm and is smaller
 Sanitary disposal of human feces than the parasitic female
 Wearing of shoes, slippers, and boots  It has a muscular double-bulbed esophagus, and the intestine is a
 A vaccine against a secretory antigen of hookworm had undergone a straight cylindrical tube
Phase I clinical trial on human volunteers  The free-living male, measuring 0.7 mm by 0.04 mm, is smaller than
 There were also on-going feasibility studies on the possibility of the female, and has a ventrally curved tail, two copulatory spicules, a
administering the vaccine along with anthelminthic drugs, Vitamin A, gubernaculum, but no caudal alae
and micronutrients, as an intervention package for school children o Parasitic males have not been reliably identified

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 PARASITOLOGY
Topic: Phasmids 2
Lecture by: Dr. Quiaoit
Parasite Biology continued…..
Rhabditiform Larva:
 The rhabditiform larva measures 225 µm by 16 µm
 It has an elongated esophagus with a pyriform posterior bulb. This
species differs from the hookworm in being slightly smaller and less
attenuated posteriorly
 It also has a shorter buccal capsule and a larger genital primordium
Infective Filariform Larva:
 The infective filariform larva is nonfeeding, slender, and about 550
µm in length
 It is similar to the hookworm filariform larva but is usually SMALLER,
with a distinct cleft at the ip of the tail
Eggs:
 Eggs have a clear thin shell and are similar to those of hookworms
except that they measure only about 50 to 58 µm by 30 to 34 µm
 Free-living forms of Strongyloides are found in the soil
 The female worm lays embryonated eggs, which develop into
rhabditiform larvae after a few hours
 These larvae feed on organic matter and transform into free-living
adults
 When conditions in the soil become unfavorable, rhabditiform larvae
develop into filariform larvae, which are infective to humans
Life Cycle
 The parasitic life cycle begins when filariform larvae infect humans
through the skin
 The parasites enter the circulation, pass through the lungs, and
migrate to the larynx where they are subsequently swallowed
 Larvae develop into adults in about a month while in the duodenum
 Females generally reproduce by parthenogenesis
 They invade the intestinal mucosa where they deposit their eggs
 Eggs hatch into rhabditiform larvae, migrate into the lumen, and pass
out in the feces
 Autoinfection occurs when rhabditiform larvae pass down the large
intestine and develop into filariform larvae
Being the infective stage, these filariform larvae may invade the
mucosa and enter the circulation to start another parasitic cycle
without leaving the body of the host
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The Strongyloides stercoralis life cycle is complex, alternating between free-living and
parasitic cycles and involving autoinfection. In the free-living cycle: Rhabditiform larvae are
passed in the stool of an infected definitive host (1) , develop into either infective filariform
larvae (direct development) (6) or free-living adult males and females (2) that mate and
produce eggs (3) , from which rhabditiform larvae hatch (4) and eventually become
infective filariform (L3) slarvae (5) . The filariform larvae penetrate the human host skin to
initiate the parasitic cycle (see below) (6) . This second generation of filariform larvae cannot
mature into free-living adults and must find a new host to continue the life cycle
Parasitic cycle: Filariform larvae in contaminated soil penetrate human skin when skin
contacts soil (6) , and migrate to the small intestine (7) . It has been thought that the L3
larvae migrate via the bloodstream and lymphatics to the lungs, where they are eventually
coughed up and swallowed. However, L3 larvae appear capable of migrating to the intestine
via alternate routes (e.g. through abdominal viscera or connective tissue). In the small
intestine, the larvae molt twice and become adult female worms (8) . The females live
embedded in the submucosa of the small intestine and produce eggs via parthenogenesis
(parasitic males do not exist) (9) , which yield rhabditiform larvae. The rhabditiform larvae
can either be passed in the stool (1) (see “Free-living cycle” above), or can cause
autoinfection (10)
Rhabditiform larvae in the gut become infective filariform larvae that can penetrate either
the intestinal mucosa or the skin of the perianal area, resulting in autoinfection. Once the
filariform larvae reinfect the host, they are carried to the lungs, pharynx and small intestine
as described above, or disseminate throughout the body. The significance of autoinfection
in Strongyloides is that untreated cases can result in persistent infection, even after many
decades of residence in a non-endemic area, and may contribute to the development of
hyperinfection syndrome
NOTES from Lecture:
Similarities with Hookworms:
 Life stages
o Egg
o Larva
o Adult
 Forms of larva
o Rhabditiform
o Filariform
 Infective stage  Filariform (L3)
 MOT  Penetration
 Habitat  Small intestine
Differences with Hookworms:
 Buccal cavity:
o No teeth nor plates
 Life cycle
o 4x molting
o Pulmonary circulation
o Exhibits autoinfection
o Manifests hyperinfection
 Diagnostic stage  Egg + Rhabditiform larva (L1)
 Population affected  Adult, institutionalized
Pathogenesis & Clinical Manifestations
 There are three phases of acute infection in strongyloidiasis:
a) Invasion of the skin by filariform larvae
b) Migration of larvae through the body
c) Penetration of the intestinal mucosa by adult FEMALE
worms
 The migration of larvae through the body and penetration of
intestinal mucosa by adult females may occur simultaneously,
particularly in hyperinfection
 In the first phase of acute infection, larval invasion of the skin
produces erythema, and pruritic elevated hemorrhagic papules
 During the larval migration phase, the lungs are destroyed causing
lobar pneumonia with hemorrhage
Cough and tracheal irritation may also occur, mimicking
bronchitis
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 PARASITOLOGY
Topic: Phasmids 2
Lecture by: Dr. Quiaoit
 In the third phase, adult female worms may be found in the intestinal
mucosa from the pylorus to the rectum, but the greatest numbers
are found in the duodenal and upper jejunal regions
 Light infection DOES NOT cause intestinal symptoms
 Moderate infection causes diarrhea alternating with constipation
 Heavy infection produces intractable, painless, intermittent diarrhea
(Cochin China diarrhea) characterized by numerous episodes of
watery and bloody stools
 Hyperinfection
o Is a syndrome of accelerated autoinfection which usually,
but not invariably, occurs in the immunocompromised
o It manifests with exacerbation of gastrointestinal and
pulmonary symptoms and increased numbers of larvae in
the stool and/or sputum
 Chronic strongyloidiasis is often asymptomatic
o However, intermittent vomiting, diarrhea, constipation,
and borborygmi may be observed
o Anal pruritus, urticaria, and larva currens rashes are also
common
o Recurrent asthma and nephritic syndrome have also been
reported in cases of chronic infection with S. stercoralis
 Complications include:
o Ddema, emaciation, loss of appetite, anemia, lobar
pneumonia, ileus, intestinal obstruction, gastrointestinal
bleeding, and malabsorption leading to cachexia
 Disseminated infection occurs among patients with cancer,
malnutrition, HIV/AIDS, HTLV-1, or those using immunosuppressive
drugs after organ transplantation
Prognosis:
 Prognosis is good in light infections
 Moderate and heavy infections have high mortality rates due to the
massive invasion of tissues by adults and larvae
Diagnosis
 The finding of unexplained eosinophilia in a patient may be a clue
pointing to strongyloidiasis
 The application of repeated concentration techniques, like the
Baermann funnel gauze method, usually leads to detection of the
infection
 Harada-Mori culture is considered one of the most successful
methods in parasite identification
 At present, using the nutrient agar plates is also recommended
 Other laboratory methods that can be done are Beale’s string test,
duodenal aspiration, and small bowel biopsy
 In disseminated strongyloidiasis, larvae may be found in sputum or
urine
 Serology may not be useful in filariasis endemic areas since there are
cross-reactions between Strongyloides and filarial worm antigens
 The culture technique is practical, low-cost, and suited for mass
screening as well as individual diagnosis
 The modified Harada-Mori culture method makes use of
polyethylene plastic bags or tubes instead of glass tubes
Plastic bags and tubes are unbreakable, lighter to transport, and
do not occupy much space. These are therefore recommended
for use in the field
 On the other hand, the main advantage of serologic testing is the
rapidity and ease of performance of the procedure
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Treatment
 All infected individuals should be treated
 Treatment was previously based on albendazole or thiabendazole.
However, recent studies show that IVERMECTIN also provides the
best results in chronic uncomplicated strongyloidiasis with
regard to efficacy and tolerability
 Higher doses given for longer periods may be necessary
 Strongyloides stercoralis is quite sensitive to the ovicidal and
larvicidal actions of the drugs
 Albendazole, thiabendazole, and ivermectin have been used to treat
hyperinfection or disseminated disease singly or in combination, but
data are limited to case reports or case series
Albendazole and thiabendazole are CONTRAINDICATED in
pregnant women and in those with known HYPERSENSITIVITY to
the drugs
Adverse Effects:
 Thiabendazole may give rise to:
o Dizziness, gastrointestinal irritation, drowsiness, pruritus,
and headache lasting for several hours
 Adverse reactions with albendazole are:
o Transient gastrointestinal discomfort and headache
 Egg reduction rate cannot be determined because eggs are NOT
passed out in the feces but are oviposited in the intestine and other
tissues of the host
 Reinfection rate is difficult to calculate because of autoinfection
Epidemiology
 Strongyloides stercoralis is found throughout the world and follows a
distribution pattern similar to hookworm in the tropics and
subtropics, as well as in Europe and the USA
 Some 50 to 100 million people are estimated to be infected with this
parasite
 Strongyloides is a soil-transmitted helminth
 In the Philippines, strongyloidiasis is relatively rare
 The factors that affect transmission include:
o Poor sanitation
o Indiscriminate disposal of human feces that may contain
Strongyloides larvae
 Autoinfection explains how some people remain infected for more
than 30 years even after leaving the endemic area
This phenomenon has been seen in American veterans who
returned from the Korean and Vietnam wars
Prevention & Control
 Prevention and control measures for this disease are similar to those
for hookworm infection
 Both worms use the soil for further development and maintain their
endemicity in areas where environmental sanitation is poor and
human feces is deposited indiscriminately in the soil by infected
people
 Infection is acquired by individuals who usually walk barefoot
 There is a need to provide health education on personal, family and
community hygiene to change behavior and practices
 Infected individuals should be treated in order to prevent morbidity
and mortality
 People with cancer, debilitating diseases like pulmonary tuberculosis,
and malnutrition, and those about to undergo organ transplantation
should be cleared of Strongyloides infection