This document provides information on hookworm, including its taxonomic classification, epidemiology, introduction, morphology, life cycle, modes of transmission, signs and symptoms, pathogencity, clinical diagnosis, laboratory diagnosis, prevention, control, and treatment. It discusses two main species of hookworm that infect humans - Ancylostoma duodenale and Necator americanus. Key details include that hookworm affects approximately 900 million people worldwide, living primarily in tropical and subtropical regions, and signs of infection include skin irritation, coughing, anemia, and iron deficiency.

1. HOOKWORM
Mr. sUbhASH L. KARN
Dept. of microbiology
u.c.m.s.
Mr.Manoj kumar Mehata

2. TAXONOMICAL CLASSIFICATION
• Kingdom: Animalia
• Phylum: Nematode
• Class: secernentea
• Order: Strongiloidae
• Family: Ancylostomatidae
• Genus: Necator/Ancylostoma
• Species: A. duodenale and N. Americanus

3. EPIDEMIOLOGY
 It is estimated that it affects 900 million people in the world.Hookworm disease is
commonly throughout the tropics and subtropics region of the world.
 Do not live long in clay, dry, hard packed soils, or where temperatures are freezing, or are
higher than 45C
 Live long between 25 C and 35 C and a shady, sandy, or loamy soil for their larval
development.
 The persistence of these worms favors Moist, shady, sandy, or loamy soil
 Larvae can survive for up to 6 weeks
 Spread of the parasite in population that does not wear shoes.

4. INTRODUCTION
Hookworm is the second most common human helminthic infection after ascariasis
 Two species of hookworms are human parasites
First species Ancylostoma duodenale: (Greek ankylos-hooked;stoma-mouth) was
described by Dubini in 1843 in Italy and Life cycle described by Looss 1898 in Egypt
–It is predominant in S. Europe, N. Africa, western Asia, northern China, Japan and the
west coast of America
The second species Necator americanus was identified by Stiles in 1902 in specimens
USA. The name literally means the‘American murderer’ (Latin necator—murderer)
- It is predominant in sub-Saharan Africa, south Asia and the Pacific area and
endemic in warm, moist tropical areas where people defecate in the soil.

5. Common name: Old world hookworm
Habitat: Small intestine
Definitive host: Human
Route of infection: Filariform larvae penetrate the skin of human
Infective stage: Third stage larvae ( filariform)
Diagnostic stage: Eggs in Stool
Disease: Hookworm infection, Ancylostomiasis
Life span:
one year : A duodenale
Three- five year: N. americanus
INTRODUCTION

6. MORPHOLOGY
Ancylostoma duodenale
 Females are 10-13 mm in length by 0.6 mm in breadth.
 Males are 8-11 mm by 0.4 mm breadth
 Posterior end has an umbrella-shaped bursa with riblike rays in male but in
female posterior end is straight.
 Two pairs of curved teeth on the ventral wall of its buccal capsule
 Cylindrical , greyish white and slightly curved
 The anterior end is bent slightly in the same direction of the body curve and
gives it name hookworm

7. MaleFemale

8. • Necator americanus
• Females are 9-11 mm in length by 0.4 mm
in diameter
• Males are 7-9 mm by 0.3 mm
• Smaller than A. duodenale
• A pair of semilunar cutting plates on the
ventral wall of the buccal capsule
MORPHOLOGY

9. MORPHOLOGY OF EGG
 Indistinguishable bewween A. Duodenale and Nector amircana
 Shape : oval with Clear space between segmented ovum & egg shell
 Size: 60 x 40 μm
 Shell: thin egg shell
 Color: colorless and transparent
 Contain : 4-8 blastomeres
 Nacl: Float on soln of Nacl
 Bile stained: Not bile stained
 Egg pass : Immature eggs pass in feces
20,000 eggs ⁄ day

10. RHABDITIFORM LARVA (L1, L2)
 Size: 250 x 15 μm
 Shape:- long, cylindrical
 Buccal cavity :- long
 Esophagus: bulbus shaped
 Genital primodium: small
 Tail: sharply pointed

11. FILARIFORM LARVA ( L3)
• Infective stage larva filariform larva
• size : 600-700 x 20-25 μm.
• Shape: long and slender
• Stage: Non-feeding
• Esophagus: elongates
• Tail: - sharply pointed tail

12. DIFFERENENCE BETWEEN A.DUODENALE AND N. AMERICANA
A. duodenale N. americanus
Size larger smaller
Shape single curve, looks like C double curves, looks like S
Mouth 2 pairs of ventral teeth 1peir of ventral cutting plates
CopulatoryBursa circle in shape (a top view oval in shape(a top view
Copulatory 1pair with separate spicule endings 1pair of which unite to form
a terminal hooklet
caudal spine present No
vulva position post-equatorial pre-equatoria

13. Adults of A. duodenale Adults of N. americanus
DIFFERENCES BETWEEN TWO HOOKWORMS

14. MODE OF TRANSMISSION
 Penetration of skin
 Ingestion of filariform larvae
 Breast milk from mother to infants
 Transplacental transmission
 Most common Sites of skin penetration are:
-Thin skin between toes
-Dorsum of the feet
- Inner side of the soles
- Gardeners & miners – skin of hands

15.  Adult worms live in the small intestine and
female lay 5-10000 eggs a day over 5 years
 Eggs are passed with the feces
 Larvae develop outside the body and molt
twice
 The filariform or L3 larvae move to the
surface in search for a host
 If they come into contact with the host they
penetrate the skin, enter blood vessels and
leave the circulatory system into the alveoli
 The larvae move up the trachea into the
esophagus, are swallowed and finally reach
the intestine, where they molt twice more
before they reach maturity
LIFE CYCLE

16. parasite lab
by l.wafa menawi

17. LIFE CYCLE HOOKWORM

18. SIGN AND SYMPTOMS
 Skin Infection:
- “Ground itch," a pruritic papule or vesicle, can occur at the site of
entry of the larvae into the skin after 1-2 wks in primary infection
-stinging, burning, itching, pruritus, papulovesicular rash - can last
up to 2 wks
 Lung Infection
• Pneumonia, Dry cough, wheezing rare and mild.
 Ingestion
• Throat soreness, hoarseness, nausea, vomiting
 GI Infection:
• Bloody stool from former attachment sites, abdominal pain,abdominal
discomfort ,anemia etc

19. SIGN AND SYMPTOMS
 Extreme pallor
 Anemia, iron deficiency,Eosinophilia
 Hypoproteinemia, edema. Inflammation
 Mental, physical, growth retardation.
 Immunocompromised.
 Failure to thrive, extreme fatigue
 IQ loss
 Complication in malaria and HIV patients

20. PATHOGNECITY
o Tissue damage and symptoms are caused by :
 Migrating larvae
 Adult worms
 Due to Migrating larvae; Symptoms produced in :
1. Cutaneous phase
2. Pulmonary phase
 Due to adult worms; Symptoms produced in :
3. Intestinal phase

21. 1.CUTANEOUS PHASE
Creeping eruption
A.PATHOLOGY CAUSED BY LARVA STAGE
Lesions in the skin:
-occurs due to filariform larva.
-Larva penetrates the skin - maculopapules -
erythema - heavy itching : ground itch/dew itch,
dermatitis,water sore etc. -occurs at the site of entry
-more common in necator,
-lasts for 2 to 4 weeks
 Creeping eruption:
-Reddish, itchy papule along the path traversed
by filariform larvae larva migrans
Dermatitis

22. 2.PULMONARY PHASE
A.PATHOLOGY CAUSED BY LARVA STAGE
• Lesions in the lungs
 – Bronchitis & bronchopneumonia: In sensitive patient, larva
carried in the circulation, may cause:Bronchitis / Pneumonitis
• Pneumonatitis: allergic reaction
Loeffier's syndrome: cough, asthma, low fever, biood-tinged sputum
or hemoptysis, chest-pain, inflammation shadows in lungs under X-
ray. These manifestations go on about 2 weeks.

23. 3. INTESTINAL PHASE
Hooked to the intestinal mucosal wall :
--abdominal pain, nausea, diarrhea,
Gastrointestinal bleeding ,epigastric pain,
during early phase of infection
 Absorbing 0.2-0.03 ml of blood/day/worm :
-progressive anemia, hypochromic,
microcytic type of Fe deficiency anemia–
due to chronic blood loss
 Heavy anemia (Hb may reach 2 gr %)
-Dyspnea, physical weakness, headache
Rapid pulse beat, cardiac weakness
Children : physical growth retardation,
mental
B,PATHOLOGY CAUSED BY ADULT WORM :

24. CLINICALDIAGNOSIS
 Atrophic glossitis found with hypo chromic microcytic anemia,
caused by heavy infection of hookworm
 TPatient with atrophic glossitis also show fingernail deformity
(koilonichia)
 Fingernail becomes thin and concave with elevated ridge
 ongue surface become smooth and lacking of papillae

25. DEMOSTRATION OF EGG
-BY MICROSCOPY
DEMONSTRATIO
N OF ADULT
- IN FECES
STOOL CULTURE
-BY HARADAMORI
METHOD
BLOOD EXAMNATION OCCULT BLOOD TEST
CHEST X-RAY
INDIRECT METHODS
DIRECT METHODS
LABORATORYDIAGNOSIS OF HOOKWORM

26.  STOOL EXAMINATION BY MICROSCOPY: Non bile stained egg, segmented
DIRECT METHODS

27. DEMONSTRATION OF ADULT:- IN FECES
Adult worm.of A. duodenale

28. STOOL CULTURE

29.  Blood examination:
-low erythrocyte counte
-low haemoglobin level.
-Increased no.of eosinophil count.
Comment on Blood picture:.
-Microcytic hypochromic Normochromic
cause Iron deficiency anaemia – due to
chronic blood loss:
-A single adult hookworm sucks 0.2ml of blood/ day

30. Imaging methods
BY CHEST X-RAY
-Adult form of Ancyclostoma duodanale
seen in case of heavy infection in lungs.
And respiratory tract

31. LABORATORY DIAGNOSIS
Occult blood in stool – Positive
• If the blood or it’s products is not recognized in the feces, it is referred to
Occult blood (hidden Blood
• Occult blood (hidden Blood) Seen in stool due to bleeding i the
gastrointestinal tract .
• bleeding into the gastrointestinal tract
• Principle of the test:
• Hemoglobin + H2O2 + Guaiac Oxidized guaiac+ H2O
Pseudo-peroxidase
O2
Blue color

32. Proper sanitation measures & sewage disposal
Personal hygiene
Personal protection – wearing boots & gloves
Simultaneous treatment of carriers & diseased
with wholesale treatment of community
PREVENTION&CONTROL

33. TREATMENT
 Hookworm infection is treated with albendazole, mebendazole, pyrantel
pamoate
 Dosage is the same for children as for adults.
 Albendazole is not FDA-approved for treating hookworm infection
DRUG DOSAGE FOR ADULTS AND CHILDREN
Albendazole 400 mg orally once
Mebendazole 100 mg orally twice a day for 3 days or 500 mg orally once
Pyrantel pamoate 11 mg/kg (up to a maximum of 1 g) orally daily for 3 days