HookwormPathophysiology
HookwormPathophysiology
Pathophysiology,
Clinical
Manifesta:ons
and
Treatment
Hookworm:
Pathophysiology
• 2
geohelminths
associated
with
hookworm;
Ancyclostoma
duodenale
and
Necatur
americanus
• Differences:
Ancyclostoma
can
infect
through
the
skin
and
by
inges:on,
but
Necatur
can
only
infect
through
the
skin;
Necatur
larvae
can
grow
in
the
lungs
but
Ancyclostoma
larvae
cannot
Hookworm:
Pathophysiology
• Primary
infec:on
occurs
through
skin
(soles
or
palms)
following
exposure
to
soil
contaminated
with
human
feces
• Vesicular
or
pustular
erup:on
may
occur
at
entry
site
• Ancyclostoma
larvae
migrate
to
the
lungs
via
the
bloodstream,
where
they
mature
and
travel
uo
the
trachea,
down
the
esophagus,
and
seJle
in
the
small
intes:ne
• In
the
small
intes:ne
they
produce
suc:on
impulses
120-‐200
:mes/
minute,
removing
serum
and
blood
from
the
host
• Worm
produces
an:coagulant
to
con:nue
serum
and
blood
availability
Hookworm:
Pathophysiology
Hookworm:
Clinical
Manifesta:ons
• Vesicular
or
pustular
erup:on
at
skin
entry
point,
many
are
asymptoma:c
• Necatur
migrates
through
the
lungs;
lungs
may
develop
alveolar
hemorrhage
and
eosinophilic
and
leukocy:c
infiltrates
and
pa:ents
may
complain
of
cough,
fever
and
asthma
• Small
intes:ne
(distal
duodenum,
jejunum
and
proximal
ileum)
become
infested
with
worms;
pa:ents
may
complain
of
abdominal
pain
which
is
relieved
by
ea:ng
• Pa:ents
may
note
altered
taste,
pica
or
melena
Hookworm:
Clinical
Manifesta:ons
• Severity
of
disease
related
to
anemia;
profound
anemia
may
cause
fa:gue,
dyspnea,
pallor,
palpita:ons,
syncope
and
depression
• Anemia
may
result
in
conges:ve
heart
failure
• Generalized
edema
from
hypoproteinemia
and
CHF
Hookworm:
Laboratory
Findings
and
Diagnosis
• Microcy:c
anemia
common
due
to
iron
deficiency
• Hypoproteinemia
• During
Necatur
larval
lung
infec:on,
peripheral
eosinophilia
may
be
seen
• Diagnosis
made
from
iden:fica:on
of
eggs
in
stool;
number
of
eggs
may
correlate
with
number
of
worms
Hookworm:
Treatment
• Albendazole
is
the
preferred
op:on
• Mebendazole
is
also
effec:ve
• Important
to
provide
iron
and
folate
supplements
Hookworm:
Case
History
• 13
yo
boy
presented
with
dyspnea,
hearing
his
pulse
and
abdominal
pain
• On
exam
he
is
tachycardic,
pale
and
has
generalized
edema.
On
abdominal
exam
he
has
epigastric
tenderness.
• Hemoglobin
5.3,
MCV
64
• Stool
exam
reveals
Necatur
eggs
• Receives
treatment
with
albendazole,
iron
and
folate,
and
he
recovers
well