10/17/2016

CDCDPDxHookworm

Hookworm
[Ancylostomabraziliense][Ancylostomacaninum][Ancylostomaduodenale][Necator
americanus]
ParasiteBiology

ImageGallery

LaboratoryDiagnosis

TreatmentInformation

Causal Agent
Thehumanhookwormsincludethenematodespecies,Ancylostoma
duodenaleandNecatoramericanus.Alargergroupofhookwormsinfecting
animalscaninvadeandparasitizehumans(A.ceylanicum)orcan
penetratethehumanskin(causingcutaneouslarvamigrans),butdonot
developanyfurther(A.braziliense,A.caninum,Uncinariastenocephala).
OccasionallyA.caninumlarvaemaymigratetothehumanintestine,
causingeosinophilicenteritis.Ancylostomacaninumlarvaehavealsobeen
implicatedasacauseofdiffuseunilateralsubacuteneuroretinitis.

Hookwormegginanunstained
wetmount.

Life Cycle
Intestinal Hookworm Infection

Anteriorendofanadult
ofAncylostomacaninum,adog
parasitethathasbeenfoundto
produceararehumaninfection
knownaseosinophilicenteritis.

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CDCDPDxHookworm

Eggsarepassedinthestool ,andunderfavorableconditions(moisture,warmth,shade),larvaehatchin1to2
days.Thereleasedrhabditiformlarvaegrowinthefecesand/orthesoil ,andafter5to10days(andtwomolts)
theybecomefilariform(thirdstage)larvaethatareinfective .Theseinfectivelarvaecansurvive3to4weeksin
favorableenvironmentalconditions.Oncontactwiththehumanhost,thelarvaepenetratetheskinandarecarried
throughthebloodvesselstotheheartandthentothelungs.Theypenetrateintothepulmonaryalveoli,ascend
thebronchialtreetothepharynx,andareswallowed .Thelarvaereachthesmallintestine,wheretheyreside
andmatureintoadults.Adultwormsliveinthelumenofthesmallintestine,wheretheyattachtotheintestinal
wallwithresultantbloodlossbythehost .Mostadultwormsareeliminatedin1to2years,butthelongevity
mayreachseveralyears.
SomeA.duodenalelarvae,followingpenetrationofthehostskin,canbecomedormant(intheintestineormuscle).
Inaddition,infectionbyA.duodenalemayprobablyalsooccurbytheoralandtransmammaryroute.N.
americanus,however,requiresatranspulmonarymigrationphase.

Cutaneous Larval Migrans

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Cutaneouslarvalmigrans(alsoknownascreepingeruption)isazoonoticinfectionwithhookwormspeciesthatdo
notusehumansasadefinitivehost,themostcommonbeingA.brazilienseandA.caninum.Thenormaldefinitive
hostsforthesespeciesaredogsandcats.Thecycleinthedefinitivehostisverysimilartothecycleforthehuman
species.Eggsarepassedinthestool ,andunderfavorableconditions(moisture,warmth,shade),larvaehatchin
1to2days.Thereleasedrhabditiformlarvaegrowinthefecesand/orthesoil ,andafter5to10days(andtwo
molts)theybecomefilariform(thirdstage)larvaethatareinfective .Theseinfectivelarvaecansurvive3to4
weeksinfavorableenvironmentalconditions.Oncontactwiththeanimalhost ,thelarvaepenetratetheskin
andarecarriedthroughthebloodvesselstotheheartandthentothelungs.Theypenetrateintothepulmonary
alveoli,ascendthebronchialtreetothepharynx,andareswallowed.Thelarvaereachthesmallintestine,where
theyresideandmatureintoadults.Adultwormsliveinthelumenofthesmallintestine,wheretheyattachtothe
intestinalwall.Somelarvaebecomearrestedinthetissues,andserveassourceofinfectionforpupsvia
transmammary(andpossiblytransplacental)routes .Humansmayalsobecomeinfectedwhenfilariformlarvae
penetratetheskin .Withmostspecies,thelarvaecannotmaturefurtherinthehumanhost,andmigrate
aimlesslywithintheepidermis,sometimesasmuchasseveralcentimetersaday.Somelarvaemaypersistin
deepertissueafterfinishingtheirskinmigration.

Geographic Distribution
Hookwormisthesecondmostcommonhumanhelminthicinfection(afterascariasis).Hookwormspeciesare
worldwideindistribution,mostlyinareaswithmoist,warmclimate.BothN.americanusandA.duodenaleare
foundinAfrica,AsiaandtheAmericas.NecatoramericanuspredominatesintheAmericasandAustralia,while
onlyA.duodenaleisfoundintheMiddleEast,NorthAfricaandsouthernEurope.

Clinical Presentation
Irondeficiencyanemia(causedbybloodlossatthesiteofintestinalattachmentoftheadultworms)isthemost
commonsymptomofhookworminfection,andcanbeaccompaniedbycardiaccomplications.Gastrointestinaland
nutritional/metabolicsymptomscanalsooccur.Inaddition,localskinmanifestations('grounditch')canoccur
duringpenetrationbythefilariform(L3)larvae,andrespiratorysymptomscanbeobservedduringpulmonary
migrationofthelarvae.
Themostcommonmanifestationofzoonoticinfectionwithanimalhookwormspeciesiscutaneouslarvamigrans,
alsoknownasgrounditch,wheremigratinglarvaecauseanintenselypruriticserpiginoustrackintheupper
dermis.Lesscommonly,larvaemaymigratetothebowellumenandcauseaneosinophilicenteritis.Insomecases
ofdiffuseunilateralsubacuteretinitis,singlelarvaecompatibleinsizetoA.caninumhavebeenvisualizedinthe
affectedeye.

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