Hookworms by manoj

Hookworms by Mr.Manoj kumar Mehata

1. HOOKWORM Mr. sUbhASH L. KARN Dept. of microbiology u.c.m.s . Mr. Manoj kumar Mehata

2. TAXONOMICAL CLASSIFICATION Kingdom: Animalia Phylum : Nematode Class: secernentea Order: Strongiloidae Family: Ancylostomatidae Genus: Necator / Ancylostoma Species : A. duodenale and N. Americanus

3. EPIDEMIOLOGY I t is estimated that it affects 900 million people in the world .Hookworm disease is commonly throughout the tropics and subtropics region of the world . Do not live long in clay, dry, hard packed soils , or where temperatures are freezing , or are higher than 45  C Live long between 25  C and 35  C and a shady, sandy, or loamy soil for their larval development . The persistence of these worms favors Moist, shady, sandy, or loamy soil Larvae can survive for up to 6 weeks Spread of the parasite in population that does not wear shoes.

4. INTRODUCTION Hookworm is the second most c ommon human helminthic infection after ascariasis Two species of hookworms are human parasites First species Ancylostoma duodenale : ( Greek ankylos -hooked ; stoma - mouth ) was described by Dubini in 1843 in Italy and Life cycle described by Looss 1898 in Egypt – I t is predominant in S. Europe, N. Africa, western Asia, northern China, Japan and the west coast of America The second species Necator americanus was identified by Stiles in 1902 in specimens USA . The name literally means the‘American murderer’ ( Latin necator —murderer ) - It is predominant in sub-Saharan Africa, south Asia and the Pacific area and endemic in warm, moist tropical areas where people defecate in the soil.

5. Common name : Old world hookworm Habitat : Small intestine Definitive host : Huma n Route of infection : Filariform larvae penetrate the skin of human Infective stage : Third stage larvae ( filariform ) Diagnostic stage : Eggs in Stool Disease : Hookworm infection, Ancylostomiasis Life span : one year : A duodenale T hree- five year: N. americ anus INTRODUCTION

6. MORPHOLOGY Ancylostoma duodenale Females are 10-13 mm in length by 0.6 mm in breadth. Males are 8-11 mm by 0.4 mm breadth Posterior end has an umbrella-shaped bursa with riblike r ays in male but in female posterior end is straight. Two pairs of curved teeth on the ventral wall of its buc cal capsule Cylindrical , greyish white and slightly curved The anterior end is bent slightly in the same direction of the body curve and gives it name hookworm

7. Anclystoma adult Male Female

8. Necator americanus Females are 9-11 mm in length by 0.4 mm in diameter Males are 7-9 mm by 0.3 mm Smaller than A. duodenale A pair of semilunar cutting plates on the ventral wall of the buccal capsule MORPHOLOGY

9. MORPHOLOGY OF EGG Indistinguishable bewween A. Duodenale and Nector amircana Shape : oval with Clear space between segmented ovum & egg shell Size : 60 x 40 μm Shell : thin egg shell Color : colorless and transpa rent Contain : 4-8 blastomeres Nacl : Float on soln of Nacl Bile stained : Not bile stained Egg pass : Immature eggs pass in feces 20,000 eggs ⁄ day

10. RHABDITIFORM LARVA (L1, L2) Size: 250 x 15 μm Shape :- long, cylindrical Buccal cavity :- long Esophagus : bulbus shaped Genital primodium : small Tail : sharply pointed

11. FILARIFORM LARVA ( L3) Infective stage larva filariform larva size : 600-700 x 20-25 μm . Shape: long and slender Stage: Non-feeding Esophagus: elongates Tail : - sharply pointed tail

12. DIFFERENENCE BETWEEN A.DUODENALE AND N. AMERICANA A. duodenale N. americanus Size larger smaller Shape single curve, looks like C double curves, looks like S Mouth 2 pairs of ventral teeth 1peir of ventral cutting plates CopulatoryBursa circle in shape (a top view oval in shape(a top view Copulatory 1pair with separate spicule endings 1pair of which unite to form a terminal hooklet caudal spine present No vulva position post-equatorial pre- equatoria

13. Adults of A. duodenale Adults of N. americanus DIFFERENCES BETWEEN TWO HOOKWORMS

14. MODE OF TRANSMISSION Penetration of skin Ingestion of filariform larvae Breast milk from mother to infants Transplacental transmiss ion Most common Sites of skin penetration are : -Thin skin between toes - Dorsum of the feet - Inner side of the soles - Gardeners & miners – skin of hands

15. Adult worms live in the small intestine and female lay 5-10000 eggs a day over 5 years Eggs are passed with the feces Larvae develop outside the body and molt twice The filariform or L3 larvae move to the surface in search for a host If they come into contact with the host they penetrate the skin, enter blood vessels and leave the circulatory system into the alveoli The larvae move up the trachea into the esophagus, are swallowed and finally reach the intestine, where they molt twice more before they reach maturity LIFE CYCLE

16. parasite lab by l.wafa menawi

17. LIFE CYCLE HOOKWORM

18. SIGN AND SYMPTOMS Skin Infection : - “ Ground itch ," a pruritic papule or vesicle, can occur at the site of entry of the larvae into the skin after 1-2 wks in primary infection - stinging , burning, itching, pruritus, papulovesicular rash - can last up to 2 wks Lung Infection P neumonia , Dry cough, wheezing rare and mild. Ingestion T hroat soreness, hoarseness, nausea, vomiting GI Infection : B loody stool from former attachment sites , abdominal pain , abdominal discomfort , anemia etc

19. SIGN AND SYMPTOMS Extreme pallor Anemia , iron deficiency,Eosinophilia Hypoproteinemia , edema . Inflammation Mental, physical, growth retardation . Immunocompromised . Failure to thrive, extreme fatigue IQ loss Complication in malaria and HIV patients

20. PATHOGNECITY Tissue damage and symptoms are caused by : Migrating larvae Adult worms Due to Migrating larvae; Symptoms produced in : 1 . Cutaneous phase 2. Pulmonary phase Due to adult worms; Symptoms produced in : 3. Intestinal phase

21. 1 .CUTANEOUS PHASE Creeping eruption A. PATHOLOGY CAUSED BY LARVA STAGE Lesions in the skin : -occurs due to filariform larva. -Larva penetrates the skin - maculopapules - erythema - heavy itching : ground itch/dew itch, dermatitis,water sore etc . - occurs at the site of entry -more common in necator , -lasts for 2 to 4 weeks Creeping eruption: - Reddish , itchy papule along the path traversed by filariform larvae larva migrans Dermatitis

22. 2.PULMONARY PHASE A. PATHOLOGY CAUSED BY LARVA STAGE Lesions in the lungs – B ronchitis & bronchopneumonia : In sensitive patient, larva carried in the circulation, may cause:Bronchitis / Pneumonitis Pneumonatit is : allergic reaction Loeffier's syndrome : cough, asthma, low fever, biood -tinged sputum or hemoptysis, chest-pain, inflammation shadows in lungs under X-ray . These manifestations go on about 2 weeks .

23. 3. INTESTINAL PHASE Hooked to the intestinal mucosal wall : -- abdominal pain, nausea, diarrhea, Gastrointestinal bleeding , e pigastric pain, during early phase of infection Absorbing 0.2-0.03 ml of blood/day/worm : -progressive anemia, hypochromic, microcytic type of Fe deficiency anemia – due to chronic blood loss Heavy anemia ( Hb may reach 2 gr % ) -Dyspnea , physical weakness, headache Rapid pulse beat, cardiac weakness Children : physical growth retardation, mental B,PATHOLOGY CAUSED BY ADULT WORM :

24. CLINICAL DIAGNOSIS Atrophic glossitis found with hypo chromic microcytic anemia, caused by heavy infection of hookworm T Patient with atrophic glossitis also show fingernail deformity ( koilonichia ) Fingernail becomes thin and concave with elevated ridge ongue surface become smooth and lacking of papillae

25. DEMOSTRATION OF EGG -BY MICROSCOPY DEMONSTRATION OF ADULT - IN FECES STOOL CULTURE -BY HARADAMORI METHOD BLOOD EXAMNATION OCCULT BLOOD TEST CHEST X-RAY INDIRECT METHODS DIRECT METHODS LABORATORY DIAGNOSIS OF HOOKWORM

26. STOOL EXAMINATION BY MICROSCOPY : N on bile stained egg, segmented DIRECT METHODS

27. DEMONSTRATION OF ADULT:- IN FECES Adult worm.of A . duodenale

28. STOOL CULTURE

29. Blood examination : - low erythrocyte counte -low haemoglobin level. -Increased no.of eosinophil count. Comment on Blood picture:. -Microcytic hypochromic Normochromic cause Iron deficiency anaemia – due to chronic blood loss: - A single ad ult hookworm sucks 0.2ml of blood/ day

30. Imaging methods BY CHEST X-RAY -Adult form of Ancyclostoma duodanale seen in case of heavy infection in lungs. And respiratory tract

31. LABORATORY DIAGNOSIS Occult blood in stool – P ositive If the blood or it’s products is not recognized in the feces, it is referred to Occult blood (hidden Blood Occult blood (hidden Blood) Seen in stool due to bleeding i the gastrointestinal tract . bleeding into the gastrointestinal tract Principle of the test: Hemoglobin + H 2 O 2 + Guaiac Oxidized guaiac+ H 2 O Pseudo-peroxidase O 2 Blue color

32. Proper sanitation measures & sewage disposal Personal hygiene Personal protection – wearing boots & gloves Simultaneous treatment of carriers & diseased with wholesale treatment of community PREVENTION & CONTROL

33. TREATMENT Hookworm infection is treated with albendazole , mebendazole , pyrantel pamoate Dosage is the same for children as for adults. Albendazole is not FDA-approved for treating hookworm infection DRUG DOSAGE FOR ADULTS AND CHILDREN Albendazole 400 mg orally once Mebendazole 100 mg orally twice a day for 3 days or 500 mg orally once Pyrantel pamoate 11 mg/kg (up to a maximum of 1 g) orally daily for 3 days

34. THANKYOU