Hookworm infestation is a parasitic disease of humans caused by one of the two organisms- Ancylostoma duodenale and Necator americanus. It is the second most common helminthic infection in developing world. Hookworms are found in soil contaminated by human feces. The transmission of infection occurs when the following conditions are met:

• Contamination of soil by infected human feces
• Warm, moist soil that is favourable for larval hatching and survival
• Contact of human skin, usually foot, with the contaminated soil and penetration by larvae

After entering the human body, these larva reach bloodstream and ultimately reach the lungs. These larvae are coughed up from the lungs and swallowed into the gastrointestinal tract. They finally reach the intestine and get attached to the intestinal lining.

Risk Factors

If you walk barefoot or with open slippers in contaminated soil, the hookworm might penetrate your skin and cause infection. If you live in endemic areas or you are a traveler to such areas, then you are at risk of acquiring the hookworm infection.

Symptoms

Mild hookworm infestation may not produce any symptoms. Symptoms occur where the larvae penetrate skin, lungs or infest intestine:

• Itchy skin rash at the skin entry site
• Respiratory symptoms like cough, difficulty breathing and coughing up blood
• Nausea and intermittent vomiting
• Abdominal pain and increased flatulence
• Symptoms of iron deficiency anemia like pallor, fatigue, dizziness etc
• Generalised swelling from anemia and malnutrition
• The heavy infection leads to impaired nutrition and growth retardation.

Diagnosis

Diagnosis is confirmed by demonstration of eggs in human feces.

The history of skin exposure to contaminated soil and the symptoms can suggest hookworm infestation. Examinations may show pallor due to anemia, swelling due to low albumin or growth retardation in children.

Blood test: One of the white blood cells: Eosinophils are increased in blood suggesting persistent attachment of the worms in intestine. However this alone does not establish the diagnosis.

Chest X-ray is done when respiratory symptoms during the lung penetration phase.

Treatment Options

• Treatment with Albendazole is the most effective therapy. Mebendazole is alternative treatment.
• Iron tablets are given when there is anemia.
• In impaired nutritional status, the antihelminthic therapy helps in improving growth and cognitive function.

Prevention

• Make a habit of wearing shoes, do not walk barefooted in contaminated soil.
• Maintain environmental sanitation, defecate only in toilets.
• Avoid using human excreta as fertilizers in agriculture.
• Regular deworming of children and women of childbearing age may be beneficial.
• Improvement of socioeconomic status, sanitation, education can control the infection in community.