10/7/2021
There are two species of human hookworms
- Necator americanus ( SL )
- Ancylostoma duodenale
They differ from each other
- Distribution
- Morphology
- Life cycle
- Transmission
a). Name the pathogenic intestinal nematodes found in man.
b). Name the common habitat of hookworm.
c). Describe the mode of infection .
d). Outline the stages in the life cycle .
e). Describe the clinical consequences of these stages in man.
f). Identify the adult worms.
g). Make feacal smears in iodine and saline to demonstrate
hookworm ova .
h). Identify the ova on a slide.
i). Describe the method of diagnosis.
j). Describe the preventive measures applicable to hookworm.
1
10/7/2021
Introduction
Life cycle & Morph – Infective stage
Adult Necator americanus
– Mode of Tx
– Track inside
– Diagnostic stage
Pathophysiology – Natural track
– Ectopic track/s
Clinical features
Lab diagnosis
Treatment
Prevention
• No intermediate or reservoir host
Adult Ancylostoma duodenale
• There are certain other animal
hookworms, which can infect man
• Adult male and female worms are
found in small intestines (upper part).
• Mainly jejunum.
• Shape - cylindrical
• Colour - creamy white
• Cuticle - finely striated transversely
• Anterior end
- bent dorsally like a hook
• Consist of the mouth or the buccal
capsule
- Continues as the GIT
- The organ of the attachment
2
10/7/2021
Life cycle
Hookworm larvae
I - Eggs • In old faeces samples -
eggs contain mass of cells
Size - 60 x 40 µm (morula stage)
Shape - Oval • When the cell division takes place the
Shell - thin transparent or colorless clear space gradually reduces.
Ovum - segmented (4-8 segments) • When deposited in -
Warm
- Clear space
Shady
Moist
Sandy soil
EGGS
The larvae rapidly develop in the egg and
hatches after one or two days later
This larva is called;
First stage rhabditiform larva (L1)
Muscular pharynx
A prominent posterior bulb
(Moult 1 ) – in 3 days
3
10/7/2021
• No moults in lungs
2ndstage rhabditiform larva(L2) • They passively carried or crawls upwards
Moult 2 - in 5 days Trachea
Larynx
Epiglottis Swallowed
Filariform larva (L3)
Infective stage Duodenum – Third - moult (Feed & Grow)
Forth – moult
Non feeding/ non growing
After forth – moult
No muscular pharynx
Very active Young Adult
• Incubation Period – 42 days
Protective layer – sheathed Symptoms & Signs
Rapidly killed by freezing, desiccation, sunlight, (Hookworm disease )
Infection is acquired in,
and chemicals.
Infancy
In suitable environment it can survive for several Later childhood
months. Adults
New comers to endemic areas
When it comes in contact with human skin mainly
in the interdigital spaces.
L3 penetrate the skin
Migrate through the venous system
Superficial venules
Right ventricle
Lungs
Alveoli
Airway System
4
10/7/2021
1. Migratory Period
rare when compared to Ascaris
• The time, onset of these symptoms
lung reactions occur very rarely in
varies according to the above factors
A.duodenale
• Usually the symptoms of anaemia
2. Maturation stage manifest before that of hypoprotenaemia
abdominal pain
diarrhoea
eosinophilia
The main clinical features of the disease are
due to Symptoms
• Unable to work
• Anaemia
• Lassitude
• Hypoalbuminaemia • Shortness of breath
• Swelling of legs
• Loss of normal skin colour
This occurs as a effect of blood loss.
• Anorexia
• Aching pain in the thighs / calves
BLOOD LOSS
Signs
Loss of red cells Loss of plasma
Hb proteins · Severely anaemic
· Increase pulse pressure
Anaemia hypoprotenaemia · pale
Iron deficiency
microcytic
hypochromic
5
10/7/2021
This course clinically demonstrable morbidity
with the negative effect of ,
Diagnosis
• Chronic infections on growth
• Finding the characteristic eggs
• Nutritional status
• If anaemia (+) → estimate the worm load
• Physical fitness
• Serology – not practical (cross reactions)
• Physical activity
• School performance of children
• Mainly in the tropics
Adult worm attached to the villi
• Environmental conditions are ideal for the development of the
- Suck blood eggs.larvae
- Produce tiny ulcers • Soil type sandly moist soil
(Clay soil not good)
- Frequent change of sites (8 /day)
• Mode & extent of faecal pollution use of human faeces as fertilizer
- Seepage of blood to the vicinity • At risk → poor
• Bare footed population
• Agricultural population than town people
N . americanus 0.03 – 0.05 ml/day worm
• Mode & extent of contact between the infected soil, skin or mouth
A . duodenale 0.13 – 0.15 ml/day/worm
Treatment
➢ They get O2 / nutrients from blood Mebendazole (Vermox)
Dose → 100mg bd X 3 days or
➢ Their main source of nourishment is plasma
proteins 500mg stat
Advantages
➢ And the red cells pass into the lumen of No dietary restrictions
the intestines
• Act against most of the intestinal nematodes
Iron absorption as it takes place in the • Therefore stool examination not necessary
duodenum and upper jejunum • Mass treatment difficult
6
10/7/2021
Pyrantel (Pyrantin/Combantrin)
• 10mg/kg/day
• single dose treatment
•These are other broad spectrum anti-helminthics,
which are not commonly used, but available in the
market.
Albendazole (Zentel)
• Single dose 400g (80% - Reduction)
Levamisole (Ketrax)
• Single dose 3mg/kg/body weight
• Other than these drugs iron therapy in anaemics
• Ferrous sulphate 200mg X TDS with deworming
• Even without deworming the Hb % will improve with
iron therapy alone
• But once Fe therapy is discontinued again
Patient will become anaemic
• So Anti-helminthic treatment is important
