Necatoriasis - Clinicals, Diagnosis, and Management

Infectious diseases

Clinicals - History

Fact Explanation
Ground itch- an intensely pruritic rash on the hands or feet. On penetrating the skin, significant numbers of L3 larvae perish, breaking down to release an extensive range of immunoreactive molecules which leads an immune reaction in the skin . Ground itch- an intensely pruritic rash on the hands or feet.
On penetrating the skin, significant numbers of L3 larvae perish, breaking down to release an extensive range of immunoreactive molecules which leads an immune reaction in the skin .
History of fever and cough. Cytokine, acute phase protein and eosinophil responses are initiated by the larvae migrating through the lungs giving rise to pneumonitis . History of fever and cough.
Cytokine, acute phase protein and eosinophil responses are initiated by the larvae migrating through the lungs giving rise to pneumonitis .
Vague abdominal pain, nausea and diarrhoea. These symptoms occur as the parasite matures into adult worms within the distal duodenum and proximal jejunum . Vague abdominal pain, nausea and diarrhoea.
These symptoms occur as the parasite matures into adult worms within the distal duodenum and proximal jejunum .
Lethargy, dyspnoea and palpitations. Following the attachment of parasites to the intestinal mucosa, there is release of active peptides that down regulate host inflammation, block the clotting of blood, prevent platelet aggregation, and degrade host connective tissue components resulting in continuous blood loss from capillaries and arterioles, which the parasite ruptures and degrades. This leads to anemia . Lethargy, dyspnoea and palpitations.
Following the attachment of parasites to the intestinal mucosa, there is release of active peptides that down regulate host inflammation, block the clotting of blood, prevent platelet aggregation, and degrade host connective tissue components resulting in continuous blood loss from capillaries and arterioles, which the parasite ruptures and degrades. This leads to anemia .

Clinicals - Examination

Fact Explanation
Conjunctival pallor, tachycardia and other clinical signs of anemia. Following the attachment of parasites to the intestinal mucosa, there is release of active peptides that down regulate host inflammation, block the clotting of blood, prevent platelet aggregation, and degrade host connective tissue components resulting in continuous blood loss from capillaries and arterioles, which the parasite ruptures and degrades. This leads to anemia . Conjunctival pallor, tachycardia and other clinical signs of anemia.
Following the attachment of parasites to the intestinal mucosa, there is release of active peptides that down regulate host inflammation, block the clotting of blood, prevent platelet aggregation, and degrade host connective tissue components resulting in continuous blood loss from capillaries and arterioles, which the parasite ruptures and degrades. This leads to anemia .
Generalized edema. Along with the blood loss, there will be loss of plasma proteins which would give rise to protein malnutrition. This protein losing enteropathy would lead to reduced colloid oncotic pressure within the blood vessels, thereby leading to edema . Generalized edema.
Along with the blood loss, there will be loss of plasma proteins which would give rise to protein malnutrition. This protein losing enteropathy would lead to reduced colloid oncotic pressure within the blood vessels, thereby leading to edema .
Features of vitamin deficiency. Presence of intestinal parasites is associated with a reduction in food intake, malabsorption and endogenous nutrient loss . Features of vitamin deficiency.
Presence of intestinal parasites is associated with a reduction in food intake, malabsorption and endogenous nutrient loss .
Erythematous, papular rash on the hands or feet. On penetrating the skin, significant numbers of L3 larvae perish, breaking down to release an extensive range of immunoreactive molecules which leads an immune reaction in the skin . Erythematous, papular rash on the hands or feet.
On penetrating the skin, significant numbers of L3 larvae perish, breaking down to release an extensive range of immunoreactive molecules which leads an immune reaction in the skin .
Pyrexia along with rhonchi and crepitations on auscultation of the lungs. Cytokine, acute phase protein and eosinophil responses are initiated by the larvae migrating through the lungs giving rise to pneumonitis and bronchitis . Pyrexia along with rhonchi and crepitations on auscultation of the lungs.
Cytokine, acute phase protein and eosinophil responses are initiated by the larvae migrating through the lungs giving rise to pneumonitis and bronchitis .

Investigations - Diagnosis

Fact Explanation
Direct microscopic examination of stool smears for ova (with thin colorless shells). Adult worms produce eggs within the intestinal lumen, which are deposited in the feces . Direct microscopic examination of stool smears for ova (with thin colorless shells).
Adult worms produce eggs within the intestinal lumen, which are deposited in the feces .
Features of iron deficiency anemia (eg: reduced mean corpuscular hemoglobin concentration) in full blood count. Anemia occurs due to the continuous blood loss associated with attachment of parasites to the intestinal mucosa . Features of iron deficiency anemia (eg: reduced mean corpuscular hemoglobin concentration) in full blood count.
Anemia occurs due to the continuous blood loss associated with attachment of parasites to the intestinal mucosa .
Eosinophilia in full blood count. The human immune responses to infection with hookworms are characterized by upregulation of the production of specific and nonspecific IgE as well as eosinophilia . Eosinophilia in full blood count.
The human immune responses to infection with hookworms are characterized by upregulation of the production of specific and nonspecific IgE as well as eosinophilia .
Diffuse alveolar infiltrates on chest radiography. The development and migration through the lungs, of N. americanus results in pneumonitis . Diffuse alveolar infiltrates on chest radiography.
The development and migration through the lungs, of N. americanus results in pneumonitis .

Management - Supportive

Fact Explanation
Iron and protein supplimentation. To combat the anemia and hypoproteinemia due to blood loss associated with hookworm infestation of the small intestine . Iron and protein supplimentation.
To combat the anemia and hypoproteinemia due to blood loss associated with hookworm infestation of the small intestine .
Vitamin supplimentation. To compensate for the poor intake of food due to nausea . Vitamin supplimentation.
To compensate for the poor intake of food due to nausea .

Management - Specific

Fact Explanation
Mebendazole (500mg single dose orally). It destroys the cytoplasmic microtubules in the hookworm's intestinal cells, thereby blocking the uptake of glucose and other nutrients, ultimately resulting in death of the parasite . Mebendazole (500mg single dose orally).
It destroys the cytoplasmic microtubules in the hookworm's intestinal cells, thereby blocking the uptake of glucose and other nutrients, ultimately resulting in death of the parasite .
Albendazole (400mg single dose orally). It inhibits tubulin polymerization in the hookworm and blocks glucose uptake. Therofore energy levels are reduced, resulting in death of the parasite . Albendazole (400mg single dose orally).
It inhibits tubulin polymerization in the hookworm and blocks glucose uptake. Therofore energy levels are reduced, resulting in death of the parasite .

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