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Hookworm Infection: Transmission, Symptoms, Diagnosis & Prevention

Hookworm (Ancylostoma duodenale, Necator americanus) infects ~500 million globally, causing iron-deficiency anemia and protein malnutrition.

Life Cycle & Transmission

  1. Eggs passed in feces → hatch in warm, moist soil → rhabditiform larvae → molt to infective filariform larvae (L3).
  2. Penetration: L3 penetrate intact skin (usually feet/hands) → enter circulation.
  3. Lung Migration: Heart → pulmonary capillaries → alveoli → coughed up → swallowed.
  4. Intestinal Maturation: Duodenum/jejunum → attach to mucosa → feed on blood (0.03–0.2 mL/worm/day) → produce eggs (5,000–30,000/day).
  5. Prepatent period: 5–9 weeks.

    6. Clinical Manifestations

    • Cutaneous: "Ground itch" at entry site (papules, vesicles).
    • Pulmonary: Loeffler-like syndrome (cough, eosinophilia) during migration.
    • Intestinal: Epigastric pain, diarrhea, anorexia.
    • Chronic: Microcytic hypochromic anemia, hypoproteinemia, growth/cognitive stunting in children.

    Diagnosis

    • Stool O&P (Kato-Katz quantitative) — eggs: oval, thin-shelled, 4–8 cell stage.
    • CBC: eosinophilia, anemia.

    Treatment

    • Albendazole 400 mg single dose or Mebendazole 100 mg BID x 3 days (cure rates 85–95%).
    • Iron supplementation for anemia.

    Prevention (WASH + One Health)

    • Sanitation: latrines, sewage treatment — prevent soil contamination.
    • Footwear: shoes/boots in endemic areas.
    • Hygiene: handwashing, food washing.
    • Periodic deworming (school-age children, pregnant women 2nd/3rd trimester) per WHO.
    • Animal reservoir control (dogs/cats for A. caninum).

    Endemic in tropical/subtropical regions with poor sanitation. Travelers: avoid barefoot contact with soil/sand.

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