Hook worms

Hook-like Ancylostoma duodenale Ancy: bent stoma: mouth present in Egypt

Necator americanus Necator: killer not present in Egypt

With a bursa at posterior end

With pointed posterior end

Ancylostomiasis Ancylostoma duodenale Definitive host: Man only Mouth opening (buccal capsule) Habitat: small intestine (jejunum) Cutting mucosa by teeth & plates
4 Teeth 2 lancets 2 Plates Buccal capsule
10 mm in length 12 mm in length

Cylindrical worms Adult worms attached to with bursa intestinal mucosa by their buccal capsule

Cylindrical worms with pointed end

Life Cycle of Ancylostoma duodenale

Infected human

Negative geotropism Positive hygrotropism Thermotropism Infective Rhabditiform Geohelminthic infection filariform larva larva 2nd 1st Develops on the ground moult moult

Diagnostic Stage
Egg in stool

Infective Stage
Filariform larve
Pointed tail

S S C C

60X40
Oval with rounded poles Thin-shelled

Filariform oesophagus filling anterior of larva

Ensheathed

Translucent Immature ovum with 4-cell stage

700 in length

Development of Ancylostoma duodenale inside the human body

Larva is swallowed

Pulmonary lesion

3rd moult Venous blood

Skin lesion
4th moult Filariform larva
jejunum

Adult Ancylostoma

Intestinal lesion

Pathogenesis and Clinical Picture

Skin lesion: at the site of entrance of larvae
Itching, erythema, vesicles, pustule

(ground itch)
Pulmonary lesion: due to passage of larvae
through the lungs causing:

- asthmatic bronchitis - minute haemorrhage - verminous pneumonitis - eosinophilia Fever, cough, haemoptysis, dyspnea Inflammatory cells

Plain X-ray of the lungs during migration stage

Normal lung

Lung shows scattered mottling Loefflers syndrome

Pathogenesis in small intestine

Adult worm attached to mucosa of small intestine
Fresh area
Inflamed tissue Inflammatory cells

Worm secretes anti-coagulant

Each worm sucks about 0.3 cc blood/day

Mucosa of small intestine

The adult Ancylostoma changes its site of attachment to mucosa to move away from inflamed tissue to fresh areas.

Pathogenesis and Clinical Picture

Intestinal lesion: due to adults cutting mucosa & feeding on blood. Plates This causes: Haemorrhage, minute ulcers Hypoproteinaemia Hypochromic microcytic anaemia Pallor, fatigue, dyspnea, tachycardia Due to anaemia

Subcutaneous oedema Due to hypoproteinaemia Diarrhoea, nausea, vomiting and melaena Black stool
Physical & mental retardation & Pica

Diagnosis
Stool examination for eggs. Determination of anaemia: Hypochromic microcytic anaemia Testing for occult blood ) ( in stool.

Treatment
Albendazole Iron supplement protein rich diet.

Epidemiology
Ancylostomiasis is prevalent in tropics, subtropics & some temperate zones. Widespread in areas where people defaecate on the ground, dont wear shoes and handle mud.

Suitable temperature, rainfall.

Prevention and Control

Sanitary disposal of human excreta.
Mass treatment. Health education.

Larvicides and disinfection of human excreta used as fertilizers.