Introduction:
Hookworms are parasites that are typically spread using contaminated soil. They typically afflict the most vulnerable people in tropical and subtropical regions. The two primary species that cause infections in humans are Necator americanus and Ancylostoma duodenale. They can drain their host's blood and induce a persistent digestive tract infection, which almost always results in iron deficiency anemia. Additionally, the consequence of larval migration may result in pulmonary symptoms. Even though there are several drugs available to treat hookworm infections, problems can still be avoided by being proactive.
What Are the Risk Factors for Hookworm Infections?
Well-established risk factors for hookworm infection include inadequate sanitation, restricted access to clean water, poor financial status, and low educational attainment. International tourists, refugees, international adoptees, recent immigrants, and small children who come into contact with dirt or sand are among the high-risk groups.
An environment that is favorable to the development of hookworm illness exists. Environmental temperatures of 20 to 30° C are ideal for egg development, while A. Duodenale can withstand colder temperatures than N. Americanus. Warm, wet, well-aerated soil shaded from sunlight is also ideal. Because of these circumstances, which arise during the production of many agricultural products, hookworm infections are most common in rural regions. Under 13°C, larvae cannot grow, while temperatures below 6 to 8°C and beyond 45°C destroy fully developed eggs and new larvae. Additionally, drying and direct sunshine harm them.
What Is the Pathophysiology of Hookworm Infection?
The first stage of the hookworm life cycle is the transfer of hookworm eggs from human excrement into the soil. The first-stage larvae, rhabditiform L1 larvae, develop a few days after the hookworm eggs hatch in the soil. They undergo two molts to produce the infectious filariform L3, which is 0.5 to 0.6 mm long and, under ideal circumstances, can survive for three to four weeks. They penetrate human skin through hair follicles of the hand or feet, which requires around 30 minutes to a few hours. Ground itch, or local pruritic dermatitis, could result from the skin penetration.
In ten days, the larvae go through the dermis, enter the bloodstream, and go to the lungs. The larvae enter the alveoli and use the respiratory tract's ciliary activity to carry them to the glottis. The host may experience fever, sore throat, and cough during lung migration; these symptoms disappear once the worm enters the intestines. The larvae are swallowed at the glottis and transported to the small intestine, where they eventually end up.
Upon reaching the duodenum, the larvae undergo two transitions, transforming into L5 immature worms capable of attaching themselves to the intestinal mucosa of their host by means of their teeth or cutting plates lining their buccal capsule. In four to six weeks, worms reach adulthood and undergo sexual differentiation. The female reproduces up to 30,000 eggs a day after mating, and these eggs leave the host along with excrement, allowing the life cycle to continue.
What Are the Symptoms of Hookworm Infection?
Most cases of hookworm infection are asymptomatic. The host site and the stage of the parasite's development are typically related to the symptoms. A few symptoms are listed below:
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Usually, it begins as a localized reaction (ground itch) at the moment of skin penetration.
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Cough, sneezing, bronchitis (inflammation of the bronchi), hemoptysis (coughing up blood from the lungs), and eosinophilic pneumonia (a class of uncommon illnesses that impact the lungs) are possible manifestations of the infection during the pulmonary stage. These symptoms are typically self-limiting and do not require medical attention.
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After worms enter the small intestine, symptoms not specific to the stomach can appear, including diarrhea, concealed fecal blood, abdominal pain, and sometimes melena (black stools due to bleeding in the gastrointestinal tract). The main symptom of hookworm infection is iron deficiency anemia brought on by blood loss, which can occur via blood leaking into the intestine from the parasite attachment site or direct parasite taking in blood.
How to Diagnose Hookworm Infections?
The clinical manifestations of hookworm infections are typically vague and may be deceptive. A thorough comprehension of the epidemiology, clinical characteristics, and test results is essential for accurate diagnosis. Some of the tests to diagnose the condition are as follows:
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Although it has numerous shortcomings, stool microscopy is the primary diagnostic tool. It helps in the identification and measurement of hookworm eggs.
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Hospitals typically use egg concentration techniques in their labs.
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The IgG4 assay is still generalized but may be able to detect recent infection.
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Although non-specific, eosinophilia increases the possibility of a hookworm infection. When hookworm infections occur, systemic and mucosal eosinophilia are frequently seen. It becomes more prominent as mature worms penetrate the intestinal mucosa and can be found in the blood even before entering the intestinal tract.
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Although capsule endoscopy is seldom utilized to diagnose infection, it may reveal parasites.
What Are the Treatment Options Available to Treat Hookworm Infections?
Mebendazole and Albendazole are the two main medications used to treat hookworm infestations. Although each medication shows better cure and egg reduction rates when taken for three successive days, it is less practical for large-scale treatment programs. Patients with severe anemia may require blood transfusions. Nutritional supplementation and regular response monitoring are recommended for those who are badly impacted. Cutaneous larval migrans are typically self-contained and restricted to the skin. Oral Ivermectin or Albendazole works effectively for treating it, though therapy is occasionally required.
What Is the Prognosis of Hookworm Infection?
The prognosis is excellent with appropriate treatment. A proper anthelmintic treatment, along with iron and nutritional supplements, usually leads to full recovery from malnutrition and anemia in cases of classic hookworm disease, but some intellectual function abnormalities may continue. Reinfection in endemic locations is most likely the result of recurrent exposure; unless transferred to a place with much-improved hygiene, many individuals get reinfected within a few months.
How to Prevent Hookworm Infection?
One can avoid getting infected with hookworm by taking specific preventative steps. Among them are:
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Putting on shoes, particularly in contaminated settings, is a significant risk of infection.
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Applying a covering keeps the skin from touching the ground when seated.
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Staying away from unclean or dirt-contaminated food.
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Not eliminating waste in the ground or outside.
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Not applying human feces-derived fertilizer.
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Enveloping kids' sandboxes.
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Using safety measures during gardening, such as donning shoes and gloves.
Conclusion:
Hookworm illness is a prevalent parasitic infection. Most parasite cases are caused by barefoot walking in dirt contaminated with hookworm eggs. If not addressed, uncomfortable and risky symptoms may result. Typically, treating the illness only requires one round of medication that eradicates the parasites.
