Necator americanus

Common Name: New World hookworm

Cause: Hookworm infection
Disease: Necatoriasis1
Lifespan: 1-2years

Morphology
Egg:
Shape: Oval or elliptical
Size:
Length: 60-75 μm
Width: 35-40 μm
Embryonic cleavage: Two-, four-, or eight-cell stage
Shell: Thin, smooth colorless1

Infective Stage:
L3 or the 3rd stage of larva
Diagnostic Stage:
Unembryonated eggs (pass in feces)

Rhabditiform Larva:
Size: Newly hatched 270 by 15 µm
5 days old: 540-700 µm long
Other features: Long buccal cavity; small genital primordium

Filariform Larva:
Length of esophagus: Short
Tail: Pointed

Adult worm:
Color: Grayish-white to pink
Cuticle: Somewhat thick
Anterior end: Conspicuous bend, hook1

Characteristics
Female Adults
Size 9-12 mm long, 0.25-0.50 mm wide
Male Adults
5-10 mm long, 0.2-0.4 mm wide
Anterior end:
Bent lightly dorsally
Buccal Capsule: contains pair of cutting plates
Posterior end:
 Male:
o Expanded in umbrella like fashion
o Bursa
 Dorsal ray, deep cleft, bifid tips, spicules fused and barbed
 Female:
o Tapering, with no expanded bursa

Genital Opening:
Male: Opens posteriorly with the cloaca
Female: Situated at the junction of posterior and middle 3rd of
body

Habitat
Hosts:
Definitive Host: Human beings
Soil (eggs)
Intermediate Host: None

Transmission:
Via fecal-dermal route (filariform larva penetrates through the skin)2

Life Cycle:
Human Cycle
 Lungs Stage
 Intestinal Stage
External Environment Cycle2
Human Cycle
 Filariform larva penetrate the skin (usually feet or legs)
 They are carried by blood to the lungs
Lung stage:
 Migrate into alveoli & up the bronchi, trachea
 Then are swallowed3
Intestinal Stage:
 Develop into adults in the small intestine
 Attaching to the wall with cutting plates
 Feed on blood from capillaries of the intestinal villi
 Thousands of eggs are passed per day in feces3
External Environment Cycle:
 Eggs become embryonated in warm, moist soil
 Eggs first develop into noninfectious, feeding (rhabditiform) larva
 Then into 3rd stage, infectious nonfeeding (filariform) larva
 Penetration of larva in the skin completes the cycle3

Pathogenesis:
 Loss of blood (0.1 to 0.3ml/worm)
 Blood is consumed by the worms
 Blood oozes from the site

Epidemiology:
  North and South America
 This species is also known to exist in China, India, and Africa.4

Clinical Findings:
 Mostly asymptomatic
 Anemia
 Weakness
 Pallor
 Ground itch
 Cutaneous larva migrans
 Pneumonia4

Lab Diagnosis:
 Direct Fecal Smear
 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.

Treatment:
Drugs of Choice
 Albendazole 400 mg orally as a single dose
 Mebendazole 100 mg orally BID for 3 days or 500 mg as a single dose
Alternative Drug
 Pyrantel pamoate 11 mg/kg (maximum dose of 1 g) orally OD for 3 days

Prevention:
 Proper disposal of human feces
 Avoid walking barefoot (wear shoes)4
 Public Health Education

Prognosis:
With proper treatment, the prognosis is excellent