HOOKWORM

Mr. Chaula S. A
BSc.hls, MSc. PE
 Introduction
Disease: Hookworm Infection
1. Ancylostomiasis,
2. Necatoriasis
 Infectious agents:
Two species of hookworm :
1. Ancylostoma duodenale
2. Necator americanus
Reservior: Humans for the two species above
Systematic Classification

CLASS SUPERFAMILY FAMILY GENUS SPECIES

Secernentea Ancylostomatoid Ancylostomatida Ancylostoma A. duodenale

ea e Necator N. americanus
 Geographical distribution
Necator americanus occurs in North America,
South America, Asia,Africa Southern Pacific.
A.duodenale is found in Europe, Asia,
Africa,North and South America
Hookworm are highly prevalent in Tanzania and
are most prevalent in the coastal belt where sand
soil, shade and moisture are particularly
favorable for survivors of hookworm larva.
Poor sanitation: Promiscuous defecation
Epidemiology
Hookworms are of worldwide distribution;
widely endemic in tropical and subtropical
countries where improper disposal of human
faeces is practised
Poor sanitation and proper environment for
worms is critical
Proper soil moisture and temperature increases
transmission worms must contact the skin
Individual infections increase soil contamination
 Morphology

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Adult
Small less than 1.5 cm
 Curved anteriorly (hook like) but do not
have hooks.
N. americanus closely resembles A.
duodenale, but there are features that
distinguish them.
Adult female & male hookworms
Rhabditiform and Filariform larvae
 Egg

Oval or elliptical in shape,

colourless,
transparent shell
 segmented ovum
Eggs of N. americanus and A. duodenale are
indistinguishable
 Hookworm Egg

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 Ancylostoma duodenale
A. duodenale is a cylindrical white, grey or
reddish – brown from ingested blood thread like
worm.
Both male and female worms have a buccal
capsule containing two pairs of teeth for attaching
to the small intestinal mucosa.
The female is slightly larger and has the body
cavity occupied by the ovary and coiled uterine
tubes packed with eggs
The maximum, egg out put occurs 15-18
months after infection. The interval between
infection and final disappearance of eggs from
the stool with death of he worm average six
years.
The female produces about 10,000eggs each
day and some 18-54 million during its life time
The eggs are elliptical with transparent shell
and when freshly laid contain two to four
segments (blastomeres).
Necator americanus
Necator americanus
N. americanus closely resembles A. duodenale
but it is shorter and slender and can be
distinguished from A. duodenale by the position
of the vulva in the female which is anterior third
of the body and the buccal capsule which is
smaller than that of N. americanus has cutting
plates instead of teeth. The egg is slightly larger
than that of A. duodenale.
The female N. americanus lays 5000-10,000 eggs
daily and has a life duration an average of five
years.
The hookworm attach themselves to the mucosa of
he small intestine by their buccal capsules. The
favorite site is upper small intestine; but in heavy
infections the worms may be present as far as the
lower ileum an anticoagulating secretion facilitate
blood sucking.
As much as 0.026 to 0.200 ml of blood may be
withdrawn by a worm in 24 hours(N.americanus-
0.003ml; A.duodenale-0.15-0.26ml)
A. duodenale infections may persist for 6 to 8
 Transmission
Infection is normally acquired via skin or mouth)
from filariform (infective) larvae in the soil
contaminated by human faeces.
The larvae leave the faeces and bury themselves in
moist damp soil. These larva are called
rhabditiform and are not infective before they have
changed into the sheathed filariform stage (about 5
days)
The filariform larvae may attach themselves to
grass or hide in the soil. As soon they are touched
by something, they attach themselves to it when
this happens to be a human leg or foot they
penetrate actively through the skin and the cycle
starts.
Orally via the ingestion of contaminated food.
However other methods of transmission which
are comparatively unimportant have been
suggested:
Through eating uncooked meat containing
the larvae of A. duodenale which have
migrated into the muscles of the animal,where
they can survive for 26-34 days.
Via milk (A. caninum in puppies)
The migrating infective filariform larvae of A.
duodenale migrate to the mammary gland,
where they are excreted in the milk and infect
the child.
Third stage infective filariform larvae of the
infected mothers was found to have infected
babies.
 Life cycle
The eggs are deposited into the lumen of the
intestine containing two, four or eight blastomeres
and are passed out in the faeces where, if
deposited in damp shade soil they hatch into
rhabditiform (first stage larva) which are free
living. The larvae molts on the third day, it then
move away from faeces into the soil and molt to
form filariform (infective) larvae. The larva moves
towards oxygen and cannot survive in water.
When the filariform larva comes into contact
with the skin of the host it penetrate it and enters
the blood stream, reaching the lungs on third
day. Breaking through the alveoli it enters the
bronchioles, moves up the trachea, down the
oesophagus to the stomach and small intestine.
During the migration the third molt takes
place and the buccal capsule is formed. It
arrives in the intestine on the seventh day and
a fourth molt takes place, the buccal capsule
assumes the adult form and the worm attaches
to the mucosa of the small intestine, where it
can be seen at post-mortem as a small thread-
like structure containing a red lining of
ingested blood.
In about four to five weeks it becomes
sexually mature and the female produces
fertile eggs. Adult worm live for 1 to 9 years
and produce 10,000-20,000 eggs per day
(Necator 9000 eggs daily)
The life cycles of Ancylostoma and Necator
are similar except that:
A. duodenale can infect by ingestion as well
as via the skin
N. americanus infects only through the skin
The larvae are most numerous in the upper
2.5 cm of soil but can ascend from deeper
layers. Protected from desiccation they can
live in warm damp soil for 2 years. Direct
sunlight, drying or salt water are fatal.
LIFE CYCLE
 Signs/symptoms
Abdominal pain
Loss of appetite
Lung passage cause coughing
Eosinophilia
Sometimes diarrhea in heavy infections and
diarrhea is mixed with blood.
 Pathology
Pathology depends on three factors:
1. Worm burden
2. Species of hookworm
3. Nutritional state of infected person
The majority of N. americanus disappear within 2
years, others live 4 to 5 years.
 Egg output per day
N. americanus 10,000
A. duodenale 20,000
 Pathology cont….
The main pathology of disease is anaemia
The anaemia is typically iron deficiency anaemia
and respond very well to iron therapy.
Hookworm cause loss of iron
A. duodenale daily blood loss 0.2ml
N. americanus daily blood loss 0.03ml
Ground itch – on the place where the larvae
penetrate the skin. Most common between the
toes and on the back of the feet
 Laboratory diagnosis

Based on finding characteristics eggs in faeces

- Species eggs are identical
 Eggs in faeces may hatch
- Rhabdiform larvae may be seen
- Very similar to Strongyloides larvae.
Worm load can be estimated by an egg count.
Hookworm Egg
Hookworm egg
 Treatment
Albendazole – This is effective against both A.
duodenale and N. americanus
Albendazole is also highly effective against other
intestinal nematodes and is therefore suitable for
mass treatment.
Mebendazole 100mg twice daily for 3 days is
highly effective against both A. duodenale
Iron deficiency:
Anaemia is treated with Iron orally (Ferrous
sulphate for two months)
A high protein diet is necessary to replace
protein loss dietary supplements)
De-worming is indicated when the worm load
is severe that treating the anaemia only will not
give results or when reinfection is unlikely to
occur.
Prevention
Provision of proper sanitary facilities for the
sanitary disposal of human faeces.
Wearing shoes will prevent infection but
usually shoes are not worn during shamba work.
It is the shamba that the infection is acquired.
Mass chemotherapy
Health education.
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