Ancylostomiasis overview

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Ancylostomiasis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

CT

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalpana Giri, MBBS[2]

Overview

Ancylostomiasis is a hookworm infection, soil-transmitted helminths (STH) occurs predominantly in countries with low socioeconomic status located in tropical and subtropical areas of the world. Common symptoms of ancylostomiasis include: anorexia, flatulence, diarrhea, weight loss, pallor, dyspnea, weakness, generalized edema, melena, hematemesis, dizziness, syncope, cough, sneezing, hemoptysis, nausea, vomiting, pharyngeal irritation, itchy, erythematous, serpiginous skin lesions. The mainstay of treatment for ancylostomiasis is anti-helminthic therapies are recommended among patients with ancylostomiasis.

Historical Perspective

Ancylostomiasis was first discovered by Dubini, an Italian physician, in 1838.

Classification

Ancylostomiasis may be classified according to the species into two groups: Human hookworm: Ancylostoma and Necator Americanus and Zoonotic hookworm: Ancylostoma braziliense, Ancylostoma caninum, Ancylostoma ceylanicum and Uncinaria stenocephala.

Pathophysiology

Ancylostomiasis is a hookworm infection, soil-transmitted helminths (STH) occurs predominantly in countries with low socioeconomic status located in tropical and subtropical areas of the world. The life cycle of hookworm include: human hookworm and zoonotic hookworm. Mature females released eggs in the host’s small intestine and these eggs are passed in the feces. Under appropriate conditions, each eggs hatch in soil, and develops into an infective filariform (L3) stage larva. It enter the body either through a skin or oral ingestion then enters the bloodstream, and reach the lungs and migrate across the alveoli. Then they ascend from the bronchial tree to the pharynx and reach the small intestine where they mount into fourth-stage larvae and mature into blood-feeding adults male or female.

Causes

Common causes of ancylostomiasis include: Ancylostoma duodenale, Necator americanus, Ancylostoma ceylanicum, and less common organisms include: Ancylostoma braziliense, Ancylostoma caninum, Ancylostoma ceylanicum, and Uncinaria stenocephala.

Differentiating ancylostomiasis from Other Diseases

Ancylostomiasis must be differentiated from contact dermatitis, scabies infection, migratory myiasis, and cercarial dermatitis for cutaneous manifestations, and portal hypertension, meckel’s diverticulum, inflammatory bowel disease and nonsteroidal anti-inflammatory drug-induced small bowel disease, angiectasias, adenocarcinoma, leiomyoma, and lymphoma for GI bleeding.

Epidemiology and Demographics

The incidence rate of hookworm infection was 7.5/100 person-years. Prevalence of ancylostomiasis is approximately 1 billion people worldwide. People of all ages are susceptible to ancylostomiasis, commonly affects children and women of childbearing age. Mortality rate of hookworms in the tropics is approximately 50-60,000 deaths per year. Men are more commonly affected by ancylostomiasis than women.

Risk Factors

Common risk factors of ancylostomiasis include: exposure to soil where filariform larvae, the infective stage, live in and penetrate human skin, poor sanitation, low socioeconomic status, low educational attainment.

Natural History, Complications, and Prognosis

The majority of the infected patients remain asymptomatic. The symptoms of ancylostomiasis typically develop by direct contact of the skin with contaminated soil and the fecal-oral route. The most common complications include: iron deficiency anemia, in child: intellectual and cognitive development, in pregnant women: severe anemia, impaired growth, severe anemia, premature birth, neonatal anemia. Prognosis is generally excellent with proper treatment.

Diagnosis

Diagnostic Study of Choice

The diagnostic test of ancylostomiasis is the microscopic detection of hookworms eggs in stool.

History and Symptoms

The majority of patients with ancylostomiasis are asymptomatic. Common symptoms of ancylostomiasis include: anorexia, flatulence, diarrhea, weight loss, pallor, dyspnea, weakness, generalized edema, melena, hematemesis, dizziness, syncope, cough, sneezing, hemoptysis, nausea, vomiting, pharyngeal irritation, itchy, erythematous, serpiginous skin lesions.

Physical examination

Physical examination include: pallor, fatigue, dizziness, serpiginous, erythematous, and palpable plaque associated with edema, abdominal distension.

Lab Findings

Lab findings include: decreased hemoglobin, eosinophilia, presence of several live and motile worms in upper gastrointestinal endoscopy.

X Ray

There are no x-ray findings associated with ancylostomiasis.

CT

There are no CT findings associated with ancylostomiasis.

Other Diagnostic Studies

Other diagnostic studies for ancylostomiasis include upper gastrointestinal endoscopy, which demonstrates live and motile worms in GI tract.

Treatment

Medical Therapy

Anti-helminthic therapies are recommended among patients with ancylostomiasis. Efficacy of treatment varies according to the severity of infection, geographical distribution, and age groups. Multiple blood transfusion, iron supplements are also be given in severe cases.

Surgery

Surgical intervention is not recommended for the management of ancylostomiasis.

Primary Prevention

Effective measures for the primary prevention of ancylostomiasis include periodic mass anthelminthic treatment of at-risk populations, avoid gardening barefooted, patient education on proper hygiene and sanitation.

References

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