Hook worms ‫ديدانخطافية‬

Hook-like
• Ancylostoma duodenale ‫ت شبه ا لخطاف‬
Ancy: bent stoma: mouth
present in Egypt

• Necator americanus ♀
Necator: killer ♂
not present in Egypt

With a bursa at With pointed

posterior end posterior end
 Ancylostoma duodenale Ancylostomiasis
Definitive host: Man only Mouth opening (buccal capsule)
Habitat: small intestine (jejunum)
Cutting mucosa by teeth & plates ♂ ♀
10 mm 12
4 Teeth in mm in
2 lancets length
2 Plates length
Buccal capsule

Cylindrical Cylindrical
♂worms ♀worms with
Adult worms attached to with bursa pointed end
intestinal mucosa by their
buccal capsule
 Life Cycle of Ancylostoma duodenale
Infected
human

Negative geotropism Positive hygrotropism

Thermotropism
Infective Rhabditiform Geohelminthic
filariform larva larva infection
2nd 1st
moult moult Develops on the ground
Diagnostic Stage Infective Stage
Egg in stool Filariform larve

Pointed tail

Filariform
oesophagus Ensheathed
S 60X40µ filling anterior
Oval with rounded poles ¼ of larva
S Thin-shelled
C Translucent 700µ in length

C Immature ovum
with 4-cell stage
 Development of Ancylostoma duodenale inside the
human body
Larva is swallowed Pulmonary
lesion

3rd
moult

Venous blood

Skin Adult
lesion Ancylostoma
4th moult Intestinal
Filariform larva jejunum lesion
 Pathogenesis and Clinical Picture
• Skin lesion: at the site of entrance of larvae
Itching, erythema, vesicles, pustule
(ground itch)
• Pulmonary lesion: due to passage of larvae
through the lungs causing:
- asthmatic bronchitis
- minute haemorrhage
- verminous pneumonitis
- eosinophilia
Fever, cough, haemoptysis,
dyspnea
Inflammatory cells
Plain X-ray of the lungs during migration stage

Normal lung Lung shows

scattered mottling
‫ب قع مبعثرة‬
Loeffler’s syndrome
 Pathogenesis in small intestine
Adult worm attached to Fresh area Inflamed tissue
Inflammatory cells
mucosa of small intestine

Worm secretes
anti-coagulant
Each worm sucks about
0.3 cc blood/day Mucosa of small intestine

The adult Ancylostoma changes it’s site of

attachment to mucosa to move away from
inflamed tissue to fresh areas.
 Pathogenesis and Clinical Picture
• Intestinal lesion: due to adults cutting
mucosa & feeding on blood. Plates

This causes:
Haemorrhage, minute ulcers
Hypoproteinaemia
Hypochromic microcytic anaemia
Pallor, fatigue, dyspnea, tachycardia Due to anaemia
Subcutaneous oedema Due to hypoproteinaemia
Diarrhoea, nausea, vomiting and melaena Black stool

Physical & mental retardation & Pica

 Diagnosis
• Stool examination for eggs.
• Determination of anaemia:
Hypochromic microcytic anaemia
• Testing for occult blood ‫ى‬
( ‫ )دم مختف‬in stool.

Treatment
Albendazole
Iron supplement
protein rich diet.
 Epidemiology
 Ancylostomiasis is

prevalent

in tropics,
 Widespread
subtropics & in areas
where people defaecate
some
on temperate zones.
the ground,
don’t wear shoes and
handle mud.
 Suitable temperature, rainfall.
 Prevention and Control

Sanitary disposal of human excreta.

Mass treatment.

Health education. X
Larvicides and disinfection of human excreta
used as fertilizers.
 Trichostrongylus colubriformis
Tricho: hair strongylus: cylindrical colubri: snake
formis: like
Geog. Distribution: cosmopolitan, esp. agricultural areas.
Final host: herbivorous animals and accidentally man.
Habitat: upper part of the small intestine,
may invade the biliary passages.
Diagnostic stage: egg in stool.

Infective stage: filariform larva

Mode of infection: ingestion
 Pathogenesis and Clinical Picture
Light infection: no symptoms.
Heavy infection: anaemia or signs of cholecystitis.
Diagnosis
Stool analysis
Or
Duodenal aspirate

Treatment
Thiabendazole
 Diagnostic Stage Infective Stage
Trichostrongylus Ancylostoma Trichostrongylus
Knob at
Egg filariform larva the end
in
stool
sheathed
Ingested
S 80X40µ 60X40µ Ancylostoma
Oval, thin-shelled filariform larva Pointed
SOne pole pointed 2 rounded tail
One pole rounded poles
C Translucent
sheathed
C Immature ovum
16- cell 4-cell Penetrates the skin
stage stage
 A Patient presenting with anaemia
Helminthic infections causing anaemia:
a- Schistosomiasis
b- Trichuriasis
c- Ancylostomiasis
Iron deficiency:
Due to blood loss
d- Diphyllobothriasis
Megaloblastic: Intestinal
Bladder
Due vit B12 deficiency wall
wall

Schistosomiasis
Due to hypersplenism
Trichuriasis Blood Blood
Due to toxic products of the worm in urine in stool
 Clinical Presentations of Intestinal Nematodes
Nematodes living in human small intestine: 6 worms
1- A.lumbricoides 2- A. duodenale 3-T.colubriformis

Adult Adult Adult

Abdominal pain, colic Nausea, vomiting,
nausea, vomiting diarrhoea, melaena No symptoms
Diarrhoea or Anaemia: pallor, Anaemia
constipation fatigue, dyspnea,
tachycardia Signs of
Dyspepsia, distension
Has complications Physical & mental cholecystitis
retardation
 Clinical Presentation of Intestinal Nematodes
Nematodes living in human large Intestine: 2 worms
1- Enterobius 2- Trichuris trichiura
vermicularis

♀ migrates
during
night
Adults
Adults
Nausea, vomiting, bloody
Pruritus ani especially at night diarrhoea & lower abdominal pain
Nervous irritability, Has complications: dysentery,
hyperactivity & insomnia rectal prolapse, appendicitis