hookworm infection

community medicine presentation on "hookworm infection" and its medical management. 2nd year nursing

1. HOOKWORM INFECTION Presented by MS. ANJALI (Bsc. Hons . Nursing 2 nd year)

2. INTRODUCTION Hookworm infection is an infection of the intestines that can cause an itchy rush, respiratory and gastrointestinal problems and eventually iron deficiency anemia due to ongoing loss of blood. People can become infected when walking barefoot because hookworm lives in the soil and can penetrate the skin. Eggs are passed in the feces of an infected person. If the infected person defecates outside(near bushes, in a garden/field) or if the feces of an infected person are used as fertilizers, eggs are deposited on soil.

3. DEFINITION Hookworms  are intestinal, blood-feeding, parasitic roundworms that cause types of infection known as helminthiases .  Hookworm  infection is common in countries with poor access to adequate water, sanitation, and hygiene

4. MORPHOLOGY Hookworm is the second most common human helminthic infection after ascariasis . ANCYLOSTOMA DUODENALE It is a Greek term referring ‘ankylos-hooked’ and ‘stoma-mouth ’. The anterior end is bent slightly in the same direction of the body curve and hence gives it the name hookworm. Cylindrical, white and slightly curved. Two pairs of curved teeth on the ventral wall of its buccal capsule. FEMALE MALE

5. NECATOR AMERICANUS MALE FEMALE

6. Difference between the two species of hookworm CHARACTERISTICS ANCYLOSTOMA DUODENAL NECATOR AMERICANUS SIZE larger Smaller SHAPE Single curve looks like C Double curves looks like S MOUTH 2 pairs of ventral teeth 1 pair of ventral cutting plate VULVA POSITION Post-equatorial Pre-equatorial

7. LIFE CYCLE OF HOOKWORM

8. TRANSMISSION Three conditions are most important for transmission Human fecal contamination of soil Favorable soil conditions for larvae survival (Moist, warm and shade ) Contact to human skin with contaminated soil

9. PATHOPHYSIOLOGY Eggs hatch and release rhabdiform larvae [L1] L1 converts into filariform larvae [L3] Comes into contact with human skin and initiate an infection usually takes Cutaneous penetration usually goes unnoticed but sometimes cause ground itch. Larvae produces proteolytic enzymes and crack dermal integrity and penetrates

10. Travel through blood stream to lungs, then to alveoli and finally from bronchial tree to the pharynx coughed or swallowed into small intestines and use their teeth to get fixed into mucosa of gut. Worms mature in 4-6 weeks and get sexually differentiated. After mating, female produces 30,000 eggs per day, existing in host feces to continue the life cycle hemoglobin may reach 9mL/day in sever cases because of 2 causes :- (i) consumption of the parasite (ii) Blood loss due to leakage from attachment site

11. SKIN MANIFESTATION Ground itch : observed after 7-10 days around feet. Intense itching, edema, erythema and rash

12. RESPIRATORY MANIFESTATIONS Mild cough and chest pain Pharyngitis Dyspnea : occurs when worm enters the lung alveoli Hemoptysis Bronchitis Pneumonia with pulmonary consolidation

13. INTESTINAL MANIFESTATION Anaemia Nausea/ vomiting Diarrhea Abdominal discomfort 5. Bloody stool from former attachment site 6. Abdominal pain and discomfort

14. OTHER MANIFESTATION Extreme pallor Anaemia edema inflammation mental and physical growth retardation IQ loss complications in malaria and HIV patients.

15. PATHOGENECITY Tissue damage and symptoms are caused by :- MIGRATING LARVAE ADULT WORMS

16. 1.CUTANEOUS PHASE Pathology caused by larva stage Lesions in the skin occurs due to filariform larva. They penetrate in skin – maculopapules – erythema – heavy itching dermatitis, water sore etc. occurs at the site of entry More common in necator and lasts for 2-4 weeks creeping eruption may include reddish, itchy papule along the path traversed by filariform larvae.

17. 2.PULMONARY PHASE Pathology caused by larva Lesions in the lungs, in sensitive patient, larva carried in the circulation, may cause : bronchitis which is allergic reaction Loffler's syndrome : cough and asthma, low fever, blood tinged sputum, chest pain, inflammation in lungs, diagnosed by x-rays. These manifestations go on about 2 weeks.

18. 3.INTESTINAL PHASE Pathology caused by adult worm Hooked to the intestinal mucosal wall : abdominal distress, nausea, diarrhea, gastrointestinal bleeding, epigastric pain during early phase of infection. Absorbing 0.2-03ml of blood/day/worm causing progressive iron deficiency anaemia due to chronic blood loss. Heavy anaemia hemoglobin may reach 9gm/ dL causing dyspnea, weakness, headache, pallor, rapid pulse beat and in children physical and mental growth retardation may occur.

19. DIAGNOSTIC EVALUATION HOOKWORM DIAGNOSIS DIRECT METHOD INDIRECT METHOD Demonstration of egg by microscopy Chest x-ray Demonstration of adult worm in feces Occult blood test Stool culture - harada mori method Blood examination

20. Harada mori stool culture method incubated for 10 days at temperature above 21℃. The larvae then concentrate into liquid at the bottom and hence the liquid examination confirms the presence of larvae in the stool. Stool culture can only detect larvae presence after 6 weeks because only after 6 weeks of infection, the adult worms produce egg that further develops into larvae. FILTER PAPER STOOL MIXED WITH VERMICULTURE AND ACTIVATED CAHRCOAL CONTAINER WATER

21. MEDICAL MANAGEMENT Hookworm infections are treated with albendazole, mebendazole pyrantel pamoate . Dosage is same for children and adults. Albendazole : 400mg orally once Mebendazole : 100mg orally twice for 3 days/500mg orally once Pyrantel pamoate : 11mg daily for 3 days Hookworm infection can be treated with cryotherapy when the hookworm is still in the skin

22. MASS DEWORMING 10 TH

23. NURSING INTERVENTION Acute pain related to mucosal irritation Ineffective tissue perfusion related to blood loss Impaired skin integrity related to persistent scratching Deficient knowledge related to disease condition

24. Don’t walk barefoot in known infected areas. Don’t use raw sewage as fertilizers in agriculture Don’t defecate in open out rather in toilets School based mass deworming Public health education Sanitation and proper sewage disposal Personal hygiene PREVENTIONS

25. HEALTH EDUCATION During abdominal distress, rest and sleep Induce tissue perfusion by transfusing blood if indicated Provide albendazole empty stomach Protect skin integrity by applying sterile dressing as indicate Proper sanitization and public hygiene Prevent walking barefoot.

26. SUMMARY Hookworm is a parasitic infection cause by hookworm. They are of 2 species Ancyclostoma duodenale and necator americanus Egg – rahbdiform larve – filariform larve – penetrate into skin (cutaneous phase) – reach to lungs (pulmonary phase) – reach to small intestine (intestinal phase) – mature and lay eggs that futher causes infection. Albendazole 400mg once
Mebendazole 100mg twice for 3 days
Pyrantel pamoate 11mg for 3 days
And prevention should b performed.

27. WHICH OF THE FOLLOWING IS NOT IMPORTANT FOR TRANSMISSION Weak immunity Larva in soil Contact of human skin with infected Soil

28. CUTANEOUS PENETRATION CAUSES Ground itch Chest pain Inflammation of GI tract

29. ADULT WORM CAUSE Cutaneous phase Pulmonary phase Intestinal phase

30. TRUE/ FALSE Chest x-ray is direct method of diagnosis Stool culture is direct method Cryotherapy can be used when hookworm is still in skin Larvae cause intestinal distress/ phase

31. RHABDIFORM LARVAE DEVELOP INTO FILARIFORM LARVAE 6 days 10 days 7 days

32. NATIONAL DEWORMING DAY 5 th march 10th February 16 december