Hookworm is an intestinal parasite spread through contact with contaminated soil. It has a complex lifecycle involving eggs hatching in soil into larvae that penetrate human skin, traveling to the lungs and then intestines where they mature into adult worms, feeding on blood and causing anemia. Symptoms include abdominal pain, diarrhea, and protein deficiency. Diagnosis involves microscopic examination of stool samples. Treatment involves anthelmintic drugs like albendazole or mebendazole. Prevention focuses on improved sanitation and not walking barefoot in contaminated areas.

1. HOOKWORM
-LADI ANUDEEP
ISM-IUK

2. ETIOLOGY
• Hookworms are intestinal ,blood feeding, parasitic roundworms that
cause infections known as Helminthiases
• In humans hook worm infection caused by two main species of round
worm belonging to Ancylostoma duodenale and Necator americanus
• In other animals the main parasites are species of ancylostoma
brazilience and ancylostoma tubaeforme
• Wild cats are infected by ancylostoma pluridentatum
• Dogs are commlonly infected by ancylostoma caninum

3. EPIDEMIOLOGY
• Three conditions are important for transmission:
1) Human fecal contamination of soil
2) Favorable soil conditions for larva survival( moisture, warmth,
shade)
3) Contact of human skin with contaminated soil

4. Hookworm egg
The eggs are oval or elliptical, measuring
60 by 40 µm, colorless, not bile stained
and with a thin transparent hyaline shell
membrane.

5. LIFECYCLE
• The host is infected by larva not by eggs and usual route is skin
• Hookworm need moist soil, above 18c ,in order to hatch, they die if
exposed to direct sunlight or if they become dry
• First stage larva [L1]are noninfective ,feed on soil microorganism until
they moult into second stage larva[L2]
• First and second stage larva are in rhabditiform stage
• After feeding for seven days they moult into Third stage
larva[L3]known as filariform stage .This is nonfeeding ,infective stage`

6. • Common route of passage of larva is skin of bare foot walkers
• Once larva entered the host they travel in circulatory system to lungs ,
where they leave venules and enter alveoli
• Then they travel up trachea where they are coughed up, swallowed
and end up in small intestine
• In small intestine, larva moult into stage 4 adult worm
• It takes from 5-9 weeks from penetration to maturity in intestine
• Worms need 5-7 weeks to reach maturity and symptoms of infection

8. CLINICAL FEATURES
• They lead to combination of intestinal inflammation and progressive
iron deficiency anemia and protein deficiency
• Pulmonary manifestations: Cough, chest pain, pharyngeal irriation,
wheezing, fever result from severe infection
• GIT manifestations: Epigastric pain, indigestion, nausea, vomiting,
constipation, diarrhea, flatulence can occur in later stages
• Signs if advanced severe infection are protein deficiency anemia,
cardiac failure, abdominal distension with ascites

9. DIAGNOSIS
• Microscopic examination of stools with standard technique called KATO
KATZ technique
• Classification can be performed based on buccal cavity, space between oral
opening and esophagus: Hookworm rhabditiform larvae have long buccal
cavities
• Whereas strongyloides rhabditiform larvae have short buccal cavities
• Blood analysis shows eosinophilia(1350-3828 cells/microL)
• Recent research has focused on development of DNA based tools for
diagnosis of infection
• PCR assays could serve as a molecular approach for accurate diagnosis of
hookworm in the feces

10. TREATMENT
• Anthelminthic drugs: benzimidazoles( albendazole 400mg once on empty
stomach, mebendazole 100mg 2 times for 3 days)
• In some cases, levamisole and pyrantel pamoate(11mg/kg/day for 3 days) may be
used
• Efficacy of single dose treatment for hookworm infections is 72% for albendazole,
15% for mebendazole, 31% for pyrantel pamoate
• World Health Organization does recommend anthelmintic treatment in pregnant
women after the first trimester.
• It is also recommended that if the patient also suffers from anemia that ferrous
sulfate (200 mg) be administered three times daily at the same time as
anthelmintic treatment; this should be continued until hemoglobin values return
to normal which could take up to 3 months.
• Hookworm infection can be treated with local cryotherapy when the hookworm
is still in the skin.

11. • Triple therapy with albendazole 400mg, pyrantel pamoate 200mg/kg
and oxantel pamoate 20mg/kg showed cure rate of 84% when
compared with other combinations

12. PREVENTION
• Do not walk barefoot in known infected areas
• Do not use raw sewage as fertilizer in agriculture
• Do not defecate in open but rather in toilets
• School-based mass deworming
• Public health education
• Sanitation