Hookworm infection is a parasitic disease caused by nematodes (roundworms) that infect the small intestine. The two main species affecting humans are Ancylostoma duodenale and Necator americanus. It is one of the leading causes of iron-deficiency anemia worldwide, particularly in tropical and subtropical regions with poor sanitation.
Causes and Transmission
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Hookworm eggs are passed in human feces.
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In areas where sanitation is poor, these eggs hatch in soil into infective larvae.
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Transmission occurs through:
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Skin penetration: Infective larvae penetrate bare skin (usually feet).
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Oral route (less common): Ingestion of contaminated food or water.
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Once inside the body, larvae migrate via the bloodstream to the lungs, ascend the trachea, are swallowed, and then mature in the small intestine.
Symptoms
The severity of symptoms depends on the intensity of infection.
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Skin phase (entry site):
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Itchy rash ("ground itch") on the feet or exposed skin.
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Pulmonary phase (larval migration):
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Cough, wheezing, mild shortness of breath.
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Intestinal phase:
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Abdominal pain, bloating, diarrhea.
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Iron-deficiency anemia (pale skin, fatigue, weakness).
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Protein deficiency in heavy infections.
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Growth retardation and cognitive impairment in children with chronic infections.
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Diagnosis
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Stool microscopy: Identification of hookworm eggs in fecal samples.
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Complete blood count (CBC): Eosinophilia and anemia.
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Iron studies: To confirm iron-deficiency anemia.
Treatment
Anthelmintic drugs are the mainstay of therapy:
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Albendazole 400 mg orally as a single dose (first-line).
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Mebendazole 100 mg orally twice daily for 3 days, or 500 mg single dose.
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Pyrantel pamoate (alternative, especially in children) – dose 11 mg/kg (max 1 g), single dose.
Supportive treatment:
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Iron supplementation for anemia.
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Nutritional support for protein deficiency.
Contraindications
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Albendazole and mebendazole should be avoided during the first trimester of pregnancy.
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Caution in patients with significant liver disease.
Side Effects of Treatment
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Albendazole/Mebendazole: Abdominal pain, diarrhea, headache, rare liver enzyme elevation.
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Pyrantel: Nausea, dizziness, mild GI upset.
Precautions
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Pregnant women (especially in the first trimester) should avoid albendazole/mebendazole.
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Reinfection is common in endemic areas; preventive strategies are essential.
Drug Interactions
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Albendazole: May interact with cimetidine, dexamethasone, and praziquantel (increasing albendazole levels).
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Mebendazole: Levels can be increased by cimetidine.
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Pyrantel pamoate: Should not be given with piperazine, as they have opposing mechanisms.
Prevention
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Proper sanitation and disposal of human feces.
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Wearing footwear to avoid soil contact.
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Public health deworming programs in endemic regions.
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Health education about hygiene and food safety.
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