Reference range:
The adult nematodes attach to the wall of the small intestine and suck blood. The hookworm life cycle also includes migration through the circulation to the heart and lungs, and into the oropharynx. Infection occurs when larvae from fecally-contaminated soil penetrate human skin. A. duodenale is widely distributed in the Mediterranean basin, India, China, Japan, and the Pacific coastal areas of South America
but is rare in the USA and equatorial Africa. N. americanus is the predominant hookworm of Central and South Africa, southern Asia, Melanesia, and Polynesia. It is widely distributed in the southern USA, on islands of the Caribbean, and on the Atlantic side of Central and South America. About 25% of the world’s population is infected with hookworms.
Hookworm infection is asymptomatic in most cases. Nutritional status, anemia, and iron stores should be evaluated in infected persons. During the acute phase, adult worms in the intestine may cause colicky epigastric pain, anorexia, flatulence, diarrhea, and weight loss. A pruritic papulovesicular rash (ground itch) may develop at the site of larval penetration. Migration of large numbers of larvae though the
lungs occasionally causes Löffler’s syndrome. Chronic infection may lead to iron-deficiency anemia and hypoproteinemia, causing pallor, dyspnea, weakness, tachycardia, lassitude, impotence, and edema.
A low grade eosinophilia often persists. Severe chronic blood loss may lead to growth retardation, cardiac failure, and anasarca.
Mebendazole is the drug of choice in the USA. A cure rate of > 99% has been reported after a course of 100 mg bid x 3 days. Natural agents include quassia, black walnut, garlic, and thyme.
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