HOOKWORMS

BY: EMAN SAEED 2022

Introduction:
• Ankylostomiasis ( hook worm disease )
• One of small intestine nematodes
• Widely distributed in tropical & subtropical countries (South
America – Southern Africa Southern India –Pacific region
China and Jaban )
• Important cause of iron deficiency anemia
• Name; anterior end is bent
• They are two : Ankylostoma duodenale and Necator americanus
• The ancylostoma type (ankylos = hooked , stoma = mouth) in
Greek
• Geohelminthic
• Eggs of both can’t be differentiated by morphology
Ankylostoma duodenale
Dubini in 1843 described the
prasaite,
Arthur loss in 1898 described the
pathogenesis and mode of infection
Epidemiology
• Globally 900 million people infected causing
the loss of 9 million litres of blood overall each
day ,
• Hookworm infection is prevalent along
Mediterranean coast of Europe and Africa ,
India , China and Japan
• Males and young adults commonly affected
• Anemia sever in children and pregnant women
Morphology : adult and eggs

Male Female
• Smaller about 8-11mm in • Larger about 10-13mm in
length length
• Genital opens in cloaca • Genital opens at junction of
along with anus middle and posterior 1/3 of
• Posterior end expanded to the body
form copulatory bursa • Posterior end is tapering and
no bursa
Male and
female
A.duodenale
Np: Bursa for attachment
during copulation 3 lopes
13 rays for each.
Egg :
•Oval shaped , 60micro by 40micro
•Colourless , not bile stained
•Floats in saturated salt solution
•Excreted in feces 4-7 weeks after infection
•On their way from intestine to feces .. Its ovum develops
and becomes segmented with 4 or 8 blastomeres
•Surrounded by thin transparent hyaline shell-membrane
•Single female worm lays about 25,000 to 30,000 per day
Mode of transmission :
• Penetration of skin( barefooted) by
infective filariform larvae
• Filariform :
• -ve geotropism ( away from clay = upward
growth )
• +ve hygro-tropism ( water)
• +ve histo-tropism ( human tissues )
• +ve thermo-tropism
Microscopic
picture ; egg of
A.duodenale
- Hyaline shell
- Blastomeres
- Clear space
Life cycle of
hook worms

A.Duodenale &
Necator
Pathogenicity :
• Worms have the ability to suck blood from intestinal vessels …
into anemia
• Attaching & making cuts in intestinal wall by buccal capsule &
teeth
• Secreting hydrolytic enzymes
• Release anticoagulant substances
• Ingestion of extravasated blood
• Changing site of attachement
• A single female lays about (25.000 – 30.000 ) eggs per day
Life cycle
• habitat: mostly jejunum and less in duodenum
• Definitive host: man
• No intermediate host or R.H
• Infective form : 3rd stage filariform larva
• Mode of infection : penetration of skin ( skin
between toes and dorsum of foot & buccal
mucosa in case of drinking contaminated water )
• Diagnostic stage : immature egg
Clinical disease in hookworm infection
•Adult worm : •Migrating larva:
•Sucks blood leading to •Ground itch
microcytic hypochromic anemia
•Patient develops epigastric •Creeping eruption
pain ,vomiting ,diarrhea ,dyspeps ( cutaneous larva migrans
ia with reddish or black stool •Lesions in lungs
( melena / occult blood )
•Koilonychia (spoon nails) (bronchitis,
•Mental & physical retardation bronchopneumonia ,
•Malnutrition rarely loeffler S in 3
•Pica . intestinal nematodes )
 Ground itch
- Intense itching and
burning..erethyma and
edema of the area ..papular
and vesicular eruption
- Disappears 1-2 weeks
- Common with necator
Cutaneous larva
migrans

- Reddish itchy
papule
- Mostly in animals
- Human with
barefoot contacting
animal feces in soil
diagnosis
Laborator
y
diagnosis

Direct Indirect
method method

Stool Stool Blood&x-

exam culture ray
Direct method:
• Eggs: by direct wet microscopy or
concentration method or duodenal
aspirate
• Adult worms : in feces or duodenal
aspirate
• Stool culture : Harada-Mori method
Treatment
• ALBENDASOLE: most practical and effective
(400mg single dose)
• Mebendazole : 500mg once
• Pyrantel pamoate : used in pregnancy
• Thiabendazole : less effective
• Bephenium hydroxynaohthoate : ankylostoma only

• Don’t forget : correct anemia

before antihelminthic drugs
prophylaxis
• Diet rich with iron & protien
• Footwear & gloves to prevent entry of
larva
• Prevention of soil pollution
• Sanitary disposal of human excreta
• Mass Treatment of patients and carrier
Ankylostoma.D &Necator .A
Adult worm A.Duodenale Necator.A
More pathogenic Less pathogenic
Transplacenal& -----------
mammary (l3)
SIZE & Large and thick Small and slender
vulva Behind middle of the body In front of the middle of
body

Buccal capsule Large and oval Small and round

2 pairs of claw like teeth 1 pair (plates)

ant.end Binds in same direction of Against

body curvature

Post.end Spine in female worm No spine

Copulatory bursa Dorsal ray is single and Dorsal ray split from the
bifurcated base
13 rays 12 rays
Hook worms