Hookworm

• The hookworm is a parasites that lives in the small intestine of

its host, which may be a mammal such as a dog, cat, or human.
• Two species of hookworms commonly infect humans,
Ancylostoma duodenale and Necator americanus
• The distribution of each species significantly overlaps that of
the other.
• Necator americanus predominates in the Americas and
Australia, while only A. duodenale is found in the Middle East,
North Africa and southern Europe.
• Hookworms are thought to infect 800 million people worldwide.
• These worms are much smaller than the large roundworm,
Ascaris lumbricoides
• The most significant risk of hookworm infection is anemia
secondary to loss of iron and proteins
1. Adults: They look like
an odd piece thread and
are about 1cm. They are
white or light pinkish when
living. ♀is slightly larger
than♂.The male’s
posterior end is expanded
to form a copulatory bursa.
2. Eggs: 60×40 µm in size,
oval in shape, shell is thin
and colorless. Content is 2-
8cells.
Differences between two hookworms

Adults of A. duodenale Adults of N. americanus

• Scanning electron micrograph of the mouth
capsule of Ancylostoma duodenale, note the
presence of four "teeth," two on each side.
• Scanning electron micrograph of the mouth
capsule of Necator americanus. Note the
presence of two cutting teeth ( plates)
• Ancylostoma •Copulatory bursa
duodenale - copulatory of N. americanus(a
bursa and spines of side view)
male(a side view)
Left picture: Copulatory bursa and spines of N.
americanus(a side view);
Right picture: copulatory bursa of A. duodenale(a
top view)
• Morphologically it is
not possible to
differentiate between A.
duodenale and N.
americanus.
Interference contrast.
×400. Enlarged by 5.4.
 The Morphological Differences between Two species of
Hookworms
_____________________________________________________
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
____________________________________________________________
Copulatory circle in shape oval in shape
Bursa (a top view) (a top view)
____________________________________________________________
Copulatory 1pair with separate 1pair of which unite to form
spicule endings a terminal hooklet
_______________________________________________________
caudal spine present no
_______________________________________________________
vulva position post-equatorial pre-equatorial
_______________________________________________________
 Life Cycle

1. Final host: man

2. Inf. Stage: Larva 3 or filariform larva
3. Inf. Route: by skin
4. Food: blood and tissue fluid
5. Site of inhabitation: small intestine
6. Life span: Ad 15years, Na 3-7years
7. Blood-lung migration:
skin, blood vessel, right heart, lungs
Life cycle of hookworm
 Pathogenesis and Clinical Manifestations

• 1. Larval migration
(1) Dermatitis, known as "ground itch“. The larvae
penetrating the skin cause allergic reaction,
petechiae or papule with itching and burning
sensation. Scratching leads to secondary infection.
(2)pneumonitis (allergic reaction), Loeffier's
syndrome: cough, asthma, low fever, blood-tinged
sputum or hemoptysis, chest-pain, inflammation
shadows in lungs under X-ray. These
manifestations go on about 2 weeks.
2. Adults in small intestine
(1) Epigastric pain as that of a duodenal ulcer.
(2) A large worm burden results in microcytic hypochromatic
anemia. The symptoms are lassitude, edema, palpitation of the
heart. In severe case, death may result from cardiac failure or
physical exhaustion.
(3) Pica is due to the lack of trace element iron .
(4) A menorrhea, sterility, abortion may take place in women.
(5) Gastrointestinal bleeding
 Diagnosis
Criterion: 1. hemoglobin is lower than 120g/L in man, 110g/L in woman
2. find hookworm egg
Method:
1. saturated brine flotation technique
2. direct fecal smear
3. culture of larvae
V. Treatment
1. Albendazole 2. Mebedazole
VI. Epidemiology
worldwide distribution. 22-26OC is the optimal temperature for Ancylostoma duodenale
development, and it is mainly prevalent in north of China.
31-35OC is suitable for Necator americanus, it is mainly prevalent in south of China
VII. Prevention
Unified measures: 1. sanitary disposal of night soil, 2. individual protection, 3. health
education, 4. cultivate hygienic habits, 5. treat the patients and carriers.
Enterobius vermicularis

•Pin worm
•50% of
children in US
•Spread
–Fecal oral
route
–airborne
 Enterobius vermicularis
• The pinworms are one of the most common
intestinal nematodes.
• The adult worms inhabit the cecum and colon.
• Right after mating, the male dies. Therefore, the
male worms are rarely seen.
• The female worms migrate out the anus
depositing eggs on the perianal skin.
• Humans get this infection by mouth and by
autoinfection.
 Morphology
• 1. Adults:
– The adults look like a pin and are white in color.
– The female worm measures about 8 to 13 mm in size.
– The male adult is only 2-5mm, the tail of a male is curved.
They die right after mating, thus males are rarely seen.
– The anterior end tapers and is flanked on each side by
cuticular extensions called cephalic alae.
– The esophagus is slender, terminating in a prominent
posterior bulb , which is called esophageal bulb.
– The cephalic alae and esophageal bulb are important in
identification of the species.
• 2. Egg: 50 to 60m by 25 µm, persimmon seed-like,
colorless and transparent, thick and asymmetric
shell, contenting larva.
 Adult

Anterior part of E. vermicularis. Note cephalic alae and

esophageal bulb .
 Egg

Egg: 50 to 60m by 25 µm,

persimmon seed-like, colorless
and transparent, thick and
asymmetric shell, contenting a
larva
Anal smear showing
large numbers of
Enterobius eggs under
the lower power. In the
background are also
two Ascaris eggs.
cellophane tape method
 Life Cycle

1. site of inhabitation: cecum and colon

2. infective stage: embryonated egg
3. infective route: by mouth
4. without intermediate host and reservoir host
5. life span of female adults: 1-2 months
Life Cycle of Enterobius Vermicularis
 Symptomatology
1. About one-third of pinworm-infected persons are
asymptomatic
2. The adult worms may cause slight irritation of the
intestinal mucosa.
Major symptom is anal pruritus, which associates
with the nocturnal migration of the gravid females
from the anus and deposition of eggs in the perianal
folds of the skin.
Restlessness, nervousness, and irritability probably
resulting from poor sleep associated with anal
pruritus.
In young girls, migration of the worms may produce
vaginitis and salpingitis or granuloma of the
peritoneal cavity.
Adult Pinworms on the perianal skin
 Diagnosis
Diagnosis depends on recovery of the
characteristic eggs. The eggs and the female
adults can be removed from the folds of the skin
in the perianal regions by the use of the
cellophane tape method. The examination
should be made in the morning, before the patient
has washed or defecated
 Treatment and prevention
Since the life span of the pinworm is less than two months, the
major problem is reinfection. Albendazole is the drug of
choice. Repeated treatment may be necessary for a radical
cure.
Prevention: 1. treat the patients and carriers 2. individual
health 3. public health 4. health education and hygienic habits
• VI. Epidemiology
Geographical distribution—cosmopolitan in temperate
zones with about 30 to 50% of the population infected. It is
more prevalent in children than adults. Enterobiasis is most
common where people live under crowded conditions such as
orphanages, kindergartens, and large families.
 Strongyloides stercoralis
• Strongyloides stercoralis is an
intestinal nematode commonly
found in warm areas, although it
is known to survive in colder
climates. The geographic range
of Strongyloides infections tends
to overlap with that of Hookworm.
• S. stercoralis grows to the size of
the hookworm (2 mm for female,
slightly smaller for male). More
invasive than the male, the
female imbeds herself in mucosa
of the small intestine, leading to
systemic eosinophilia in the
usually asymptomatic host.
• The life cycle of S. stercoralis is a complex one and it has
three phases;
• 1. The non infective first stage or rhabditiform larvae
develop into free living adults in the soil and produce
infective third stage or filariform larvae which can
penetrate exposed skin. This phase is common in moist,
warm tropical countries.
• 2. The non infective rhabditiform larvae which are excreted
in the faeces, develop into infective filariform larvae in the
soil. These infective larvae penetrate exposed skin. There
is no development of free living adult worms and this
phase is common in temperate zones.
• 3. The non infective rhabditiform larvae develop into
infective filariform larvae while passing down the small
intestine. Autoinfection occurs when the larvae reinfect
the host by penetrating the intestinal mucosa or the
perianal or perineal skin. The larvae migrate to the lungs
via the circulatory system and then return to the intestine.
 Clinical disease
• Disease associated with infections due to S. stercoralis is
varied, ranging from some patients being totally asymptomatic
to the hyperinfection syndrome. There are 3 areas of
involvement in Strongyloides infections; skin, lungs and
intestine.
• 1. Initial skin penetration of the filariform larvae usually causes
very little reaction, and or may has hypersensitive reaction
• 2. The migration of larvae through the lungs may stimulate an
immune response which can result in a cough, wheezing and
fever.
• 3. Symptoms associated with intestinal strongyloidiasis may
mimic a peptic ulcer due to ulceration of the intestinal mucosa.
• In heavy infections, the intestinal mucosa may be severely
damaged resulting in malabsorption. There may also be lower
gastrointestinal bleeding. Eosinophilia may be high.
• Laboratory diagnosis
• Laboratory diagnosis depends on finding larvae
in stool, sputum or duodenal aspirates.
• Rhabditiform larvae of S. stercoralis in wet
mounts after fixation in formalin
10%. Diagnostic characteristics: length 200 to
250 µm (up to 380 µm); buccal cavity short, and
prominent genital primordium.

•
•
•
•
• In an old specimen,
rhabditiform larvae of S.
stercoralis must be
differentiated from
those of hookworm
which have a longer
buccal cavity.
• The third stage or
filariform larva is
approximately 500 
long and has a notched
tail compared with that
of hookworm which is
sheathed and has a
long slender tail.
• Strongyloides larvae may
be present in the stool in
very small numbers and
culture methods may be
needed to encourage the
rhabditiform larvae to
develop into filariform
larvae and migrate from
the sample.
• The method currently
employed at the Hospital
for Tropical Diseases is
the charcoal culture
method.
Filariform larvae (L3) of
Strongyloides stercoralis
• Eggs are rarely
found in the stool as
they hatch in the
intestine. They are
oval and thin
shelled, resembling
those of hookworm
but are smaller
measuring 50 - 58
by 30 - 34 microns