Hookworm
Hookworm
Introduction
3
Epidemiological determinants
Environment
Agent Host
4
Agent factor
• Agent: Adult worms live in the small intestine, mainly jejunum where they
attach themselves to the villi.
• Measures: - male - 8 to 11 mm
female - 10 to 13 mm with dorsally curved anterior end.
• Eggs - are passed in faeces in thousands
- one female of Ancylostoma duodenale produces about 10,000 –
30,000 eggs
- one female of
Necator americanus
produces about
5000- 10,000 eggs per
day
Life cycle of hookworm
6
• Reservoir - Man is the only important reservoir of
human hookworm infection.
• Infective material
- Faeces containing the ova of hookworms.
- Immediate source of infection is soil
contaminated with infective larvae.
• Period of infectivity – As long as the person
harbours the parasite.
Host factors
• Age : All age groups; In endemic area, highest incidence in 15-
25 years
• Sex: Both sexes
• Nutrition: Malnutrition
• Host- parasite balance:
In endemic area,
Inhabitants develop a host parasite balance
Worm load is limited
Harbours parasite without manifesting clinical signs and
symptoms
Infection rate may be 100 percent
Some may have light infection but some proportion are
heavily infected
• Occupation: agricultural workers than town workers.
9
Environmental factors
• Soil : damp, sandy or friable soil with decaying vegetation.
• Temperature: 24 to 32 °C favorable for larval development;
egg doesn’t develop below 13°C ; larva killed at 45-50°C.
• Oxygen
• Moisture and Rainfall
• Shade
• Human habits: Open field defecation, barefoot walking,
untreated sewage disposal
10
Mode of transmission:
• Through skin penetration of feet
• Oral route(direct ingestion of infective larva), via contaminated
foods and vegetables.
Incubation period:
• Necator americanus: 7 weeks
• Ancylostoma duodenale: unpredictable; ranging from 5 weeks
to 9 months.
11
Effect of the disease
Individual:
• Chronic blood loss and iron deficiency anemia.
• Low birth weight babies, Abortion, Still births
• Hypoalbuminemia
• Decrease exercise tolerance
12
Laboratory Diagnosis
• Demonstration of the eggs in faeces by direct
microscopy or by concentration methods is the
diagnostic test.
• In stool samples examined 24 hours or more after
collection, the eggs may have hatched and
rhabditiform larvae may be present.
• These have to be differentiated from strongyloides
larvae. Egg counts give a measure of the intensity of
infection.
• Adult hookworms may sometimes be seen in feces.
• Eggs are oval or elliptical, measuring 60 μm by 40
μm, colourless, not bile stained, with a thin
transparent hyaline shell membrane.
• segmented ovum, usually with 4 or 8 blastomeres.
The eggs float in saturated salt solution.
Ascariasis 16
PROBLEM STATEMENT
Ascariasis 17
Geographic Distribution and Prevalence of
Ascariasis
Ascariasis is the most common helminthic infection, with an
estimated worldwide prevalence of 25% (0.8-1.22 billion people).
The reported prevalence rate ranged from less than 15.0% to over
75.0%.
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Host Environment
Ascariasis 20
Agent Factors
Agent: Ascarias lumbricoides
Habitat (Adult worm): Small Intestine ( 85%: Jejunum, 15%:
ileum)
Sex: Separate
Morphology:
Cylindrical, with tapering ends
Pale pink or flesh colored
Mouth at anterior
Male end has 3 finely toothedFemale
lips
Smaller than female, 15-30 cm in length Larger than male, 20-40 cm in length
and 2-4 mm in thickness and 3-6 mm in thickness
Posterior end: Curved ventrally to form a Posterior end: Straight and conical,
hook and carries 2 copulatory spicules
Vulva is situated mid- ventrally, near the
junction of anterior and middle thirds of
body
Ascariasis 21
Figure showing Male and Female Ascarias lumbricoides
Ascariasis 22
Lifecycle of Ascarias lumbricoides
Ascariasis 23
Lifecycle of Ascarias lumbricoides
Start Here
Ascariasis 24
Host Factors
Ascariasis 25
Environmental Factors
Soil transmitted infection.
Ascariasis 26
Period of communicability: Until all fertile females are destroyed
and stools are negative.
Ascariasis 27
Prevention and Control: Primary Prevention
Most effective in interrupting transmission.
These are:
Sanitary disposal of human excreta to prevent or reduce
faecal contamination of soil
Provision of safe drinking water, food hygiene habits
Health education of community in use of sanitary latrines,
personal hygiene and changing behavioral patterns
Measures of personal protection such as wearing protective
footwear and making use of health facilities for diagnosis
and treatment
These are:
Piperazine
Mebendazole
Levamisole
Pyrantel Pamoate
Albendazole:
Dose for adults and children >2 yr.: 400 mg single dose
Contraindicated in children <2 yr. and in pregnancy
Mebendazole:
Usual dose: 100 mg twice daily for 3 days for all ages
above 2 yrs. Ascariasis 29
Prevention and Control: Secondary Prevention
(Contd.)
Levamisole:
Levorotatory form of Tetramisole
More active than Tetramisole
For many years remained as Drug of choice
Dose: Single oral dose of 2.5 mg/kg of body weight
(maximum 150 mg recommended)
Used successfully in mass treatment
Pyrantel Pamoate:
Effective dose: Single dose of 10 mg/kg of body weight
with maximum of 1 g.
Ascariasis 30
Prevention and Control: Secondary Prevention
(Contd.)
Mass Treatment:
Ascariasis 31
Prevention and Control: National
Nutrition programs implemented by CHD’s Nutrition Section
(1993–2016)
Ascariasis 33
Prevention and Control: National
Ministry of Health achievement of nutrition in emergency in 14
earthquake affected districts (2015/16): Children aged 12-59
months received deworming tablets
Target Population: 418, 544 Children not Receiving
Tablets, 12.00%
Beneficiaries reached: 368, 223
% of target reached: 88%
Children Receiving
Tablets, 88.00%
1200000
1251879
1000000
800000
600000 395687
313516
249138 168799412475 124739
400000 326541
268061
189165
200000 134710
0
EDR CDR WDR MWDR FWDR National
Girls Boys
Source: Annual Health Report (2072/73), Department of Health Services, Ministry
ofAscariasis
Health 35
<5 yr. children received Deworming tablet
(Biannual)- 2016
3500000
3246970
3000000
2500000
2000000
1500000
1175970
1000000
615716 693449
500000
463759
298076
0
EDR CDR WDR MWDR FWDR National
Source: Annual Health Report (2072/73), Department of Health Services, Ministry
ofAscariasis
Health 36
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