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Hookworm Disease - Causes, Symptoms and Treatment
What is Hookworm Disease?
Also known as uncinariasis, hookworm disease is an infection of the upper intestine caused by Ancylostoma duodenale (found in the eastern hemisphere) or Necator americanus (in the western hemisphere). Sandy soil, high humidity, a warm climate, and failure to wear shoes all favor its transmission.
In the United States, hookworm disease is most common in the southeast. Although this disease can cause cardiopulmonary complications, it's seldom fatal, except in debilitated people and infants under age 1.
What are the Causes of Hookworm Disease?
Both forms of hookworm disease are transmitted to humans through direct skin penetration (usually in the foot) by hookworm larvae in soil contaminated with feces that contain hookworm ova. These ova develop into infectious larvae in 1 to 3 days.
Larvae travel through the lymphatic's to the pulmonary capillaries, where they penetrate alveoli and move up the bronchial tree to the trachea and epiglottis. There they are swallowed and enter the GI tract. When they reach the small intestine, they mature, attach to the jejunal mucosa, and suck blood, oxygen, and glucose from the intestinal wall. These mature worms then deposit ova, which are excreted in stools, starting the cycle anew. Hookworm larvae mature in about 5 to 6 weeks.
What are the Signs and Symptoms of Hookworm Disease?
Most cases of hookworm disease produce few symptoms may be overlooked until worms are passed in stools. The earliest signs and symptoms include irritation, pruritus, and edema at the site of entry, which are sometimes accompanied by secondary bacterial infection with pustule formation.
When the larvae reach the lungs, they may cause pneumonitis and hemorrhage with fever, sore throat, crackles, and cough. Finally, intestinal infection may cause fatigue, nausea, weight loss, dizziness, melena, and uncontrolled diarrhea.
In severe and chronic infection, anemia from blood loss may lead to cardiomegaly (a result of increased oxygen demands), heart failure, and generalized massive edema.
Treatment for Hookworm Disease
The usual treatment for hookworm infection includes administering an anthelmintic, such as mebendazole, albendazole, levamisole, or pyrantel, and providing an iron-rich diet or iron supplements to prevent or correct anemia. Stool examinations are repeated in 2 weeks. The patient may be retreated if indicated.
Special Considerations and Prevention Tips for Hookworm Disease
Below are some of the Tips which will help you control the disease and prevent it from getting serious:
- Obtain a complete history, with special attention to travel or residency in endemic areas. Note the sequence and onset of symptoms. Interview the family and other close contacts to see if they too have any symptoms.
- Carefully assess the patient, noting signs of entry, lymphedema, and respiratory status.
- Wash your hands thoroughly after every patient contact.
- For severe anemia, administer oxygen at a low to moderate flow rate. Make sure the oxygen is humidified because the patient may already have upper airway irritation from the parasites.
- Encourage coughing and deep breathing to stimulate removal of blood or secretions from involved lung areas and to prevent secondary infection.
- Allow frequent rest periods because the patient may tire easily.
- If anemia causes immobility, reposition the patient often to prevent skin breakdown.
- Closely monitor intake and output. Note the quantity and frequency of diarrheal stools. Dispose of stools promptly, and wear gloves when doing so.
- To help assess nutritional status, weigh the patient daily.
- To combat malnutrition, emphasize the importance of good nutrition, with particular attention to foods high in iron and protein. If the patient receives iron supplements, explain that they will darken stools.
- Administer anthelmintics on an empty stomach but without a purgative.
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