By: Ns. Rizky Setiadi, S.Kep., MKM.

 Hookworms infect an estimated 1 billion people

worldwide, mostly in tropical and sub-tropical climates
 A. duodenale and N. americanus are the two hookworms
that infect humans
 A. duodenale is found in southern Europe, northern
Africa, India, China, the Middle East, and the Americas
 N. americanus can be found in the southeastern U.S. and
Australia
Hookworm
(Necator americanus, Ancylostoma duodenale)
Epidemiology: tropics/sub-tropics, SE USA, >1 billion

from Peters & Gillies, 1995

1. Adults: They look like an odd piece
thread and are about 1cm. They are
white or light pinkish when living. ♀is
slightly larger than♂.The male’s
posterior end is expanded to form a
copulatory bursa.
2. Eggs: 60×40 µm in size, oval in shape,
shell is thin and colorless. Content is 2-
8cells.
Differences between two hookworms

Adults of A. duodenale Adults of N. americanus

 Scanning electron micrograph of the mouth
capsule of Ancylostoma duodenale, note the
presence of four "teeth," two on each side.
 Scanning electron micrograph of the mouth capsule
of Necator americanus, another species of human
hookworm. Note the presence of two cutting "teeth“.
 Eggs are passed in the feces and hatch into rhabditiform
larvae in about 48 hours in the feces or in the soil

A. duodenale N. americanus

• Eggs are generally

57-76 µm by 35-47 µm and are
oval shaped with a thin shell
 Juveniles feed on feces for about 3 days then molt into 2nd
stage juveniles
 They molt again 5-10 days later into filariform larvae. Can
survive 3-4 weeks outside host.
  Infect humans by penetrating skin and then travel to the
heart and lungs where they penetrate the pharynx and are
swallowed. When they reach the small intestine they attach
to the intestinal wall and feed on blood.

Cutting plates
in N.
Cutting teeth americanus
in A.
duodenale
 Worms molt again two more times to reach
maturity
 A. duodenale adult males measure 8-11mm with females
being 10-13mm
 N. americanus adult males measure 7-9mm and females
measure 9-11mm
 Adult worms copulate and eggs appear in the feces
in about 6 weeks (females can produce sever
thousand eggs in one day)
 Cycle starts over again and adults live 1-2 years
Life cycle of hookworm
 Filariform juveniles wait in soil or feces and wave back
and forth to increase chances of finding a host
 Filariforms then penetrate the skin (usually hands or
feet)
 Children, elderly people and people who work about
contaminated soil are at high risk
 1. Larval migration
(1) Dermatitis, known as "ground itch" or "stool
poison".The larvae penetrating the skin cause allergic
reaction, petechiae 0r papule with itching and burning
sensation. Scratching leads to secondary infection.
(2) pneumonitis (allergic reaction), Loeffier's
syndrome: cough, asthma, low fever, biood-tinged
sputum or hemoptysis, chest-pain, inflammation
shadows in lungs under X-ray. These manifestations
go on about 2 weeks.
2. Adults in small intestine
(1) Epigastric pain as that of a duodenal ulcer.
(2) A large worm burden results in microcytic
hypochromatic anemia (character manifestation). The
symptoms are lassitude, edema, palpitation of the heart. In
severe case, death may result from cardiac failure or physical
exhaustion.
(3) Allotriophagy (orpica) is due to the lack of trace element
iron .
(4) Amenorrhea, sterility, abortion may take place in women.
(5) Gastrointestinal bleeding
(6) Infantile hookworm disease
Adults in intestinal mucosa
 Stool samples showing eggs or actual worms
 Watching for symptoms
 Scientist are trying to develop a vaccine
 In some countries, infections aren’t treated because
they are so common
 Drugs of choice are Albendazole, Mebendazole, and
Pyrantel Pamoate
 Wear shoes
 Monitor the disposal of humans feces
 Unified measures: 1. sanitary disposal of night
soil, 2. individual protection, 3. health education,
4. cultivate hygienic habits, 5. treat the patients
and carriers.