History

Fact Explanation
Ground itch (Cutaneous larva migrans). Due to percutaneous penetration and subsequent migration of larvae through the epidermis as a result of skin contact with fecal contaminated soil rich in hatched hookworm eggs [1]. It should be noted that there is no penetration in to the dermis in cutaneous larva migrans.
Cough and wheeze (Classic hookworm infection). After penetrating the dermis, larvae are transported via the lymphatics and venous system to the lungs. The migration of the larvae through the lung results in a hypersensitivity reaction [2].
Abdominal pain, nausea, anorexia, and diarrhea. Following migration to the trachea, larvae are swallowed and reach the intestine where they develop in to adult worms. Eosinophilic enteritis occurs as an allergic response of the gut mucosa to adult worms in the intestine [3].
Fatigue (Classic hookworm infection). Adult hookworms attach to and feed from the bowel mucosa of the infected host, resulting in intestinal blood loss, which often gives rise to iron deficiency and anemia [4].
References
  1. SHINKAR R M, STOCKS R, THOMAS E. Cutaneous larva migrans, creeping eruption, sand worm. Archives of Disease in Childhood [online] 2005 June, 90(10):998-998 [viewed 22 June 2014] Available from: doi:10.1136/adc.2005.073197
  2. SUCHARD JEFFREY R., MCLAREN CATHERINE J.. Clinicopathological Conference: A 38-year-old Man with Respiratory Failure—The Case of the Underground Illness. Acad Emergency Med [online] 2005 January, 12(1):71-78 [viewed 22 June 2014] Available from: doi:10.1111/j.1553-2712.2005.tb01482.x
  3. NGUI ROMANO, LIM YVONNE A. L., TRAUB REBECCA, MAHMUD ROHELA, MISTAM MOHD SANI, GEIGER STEFAN MICHAEL. Epidemiological and Genetic Data Supporting the Transmission of Ancylostoma ceylanicum among Human and Domestic Animals. PLoS Negl Trop Dis [online] 2012 February [viewed 22 June 2014] Available from: doi:10.1371/journal.pntd.0001522
  4. JONKER FEMKJE A. M., CALIS JOB C. J., PHIRI KAMIJA, BRIENEN ERIC A. T., KHOFFI HARRIET, BRABIN BERNARD J., VERWEIJ JACO J., VAN HENSBROEK MICHAEL BOELE, VAN LIESHOUT LISETTE, BRINDLEY PAUL J.. Real-time PCR Demonstrates Ancylostoma duodenale Is a Key Factor in the Etiology of Severe Anemia and Iron Deficiency in Malawian Pre-school Children. PLoS Negl Trop Dis [online] 2012 March [viewed 22 June 2014] Available from: doi:10.1371/journal.pntd.0001555.

Examination

Fact Explanation
Erythema of the skin with papules and pustules. Pruritic folliculitis occurs in areas of larval skin penetration following contact with fecal contaminated soil rich in larvae following hatching of eggs [1].
Rales heard on auscultation of the lung. After penetrating the dermis (in classic hookworm infection), larvae are transported via the lymphatics and venous system to the lungs. The migration of the larvae through the lung results in a hypersensitivity reaction [2].
Pallor. Following migration to the trachea, larvae are swallowed and reach the intestine where they develop in to adult worms. Adult worms attach to and feed from the bowel mucosa of the infected host, resulting in intestinal blood loss, which often gives rise to iron deficiency and anemia [3].
Edema. Due to hypoalbuminemia occurring as a result of chronic intestinal blood loss [4].
Creeping eruption (serpiginous burrows). This occurs in cutaneous larvae migrans. Created by larvae migrating in the epidermis [4].
References
  1. MALVY DENIS, EZZEDINE KHALED, PISTONE THIERRY, RECEVEUR MARIE-CATHERINE, LONGY-BOURSIER MAITE. Extensive Cutaneous Larva Migrans With Folliculitis Mimicking Multimetameric Herpes Zoster Presentation in an Adult Traveler Returning From Thailand. J Travel Medicine [online] 2006 July, 13(4):244-247 [viewed 22 June 2014] Available from: doi:10.1111/j.1708-8305.2006.00040.x
  2. SUCHARD JEFFREY R., MCLAREN CATHERINE J.. Clinicopathological Conference: A 38-year-old Man with Respiratory Failure—The Case of the Underground Illness. Acad Emergency Med [online] 2005 January, 12(1):71-78 [viewed 22 June 2014] Available from: doi:10.1111/j.1553-2712.2005.tb01482.x
  3. JONKER FEMKJE A. M., CALIS JOB C. J., PHIRI KAMIJA, BRIENEN ERIC A. T., KHOFFI HARRIET, BRABIN BERNARD J., VERWEIJ JACO J., VAN HENSBROEK MICHAEL BOELE, VAN LIESHOUT LISETTE, BRINDLEY PAUL J.. Real-time PCR Demonstrates Ancylostoma duodenale Is a Key Factor in the Etiology of Severe Anemia and Iron Deficiency in Malawian Pre-school Children. PLoS Negl Trop Dis [online] 2012 March [viewed 22 June 2014] Available from: doi:10.1371/journal.pntd.0001555.
  4. HOTEZ PETER J., BROOKER SIMON, BETHONY JEFFREY M., BOTTAZZI MARIA ELENA, LOUKAS ALEX, XIAO SHUHUA. Hookworm Infection. N Engl J Med [online] 2004 August, 351(8):799-807 [viewed 22 June 2014] Available from: doi:10.1056/NEJMra032492

Differential Diagnoses

Fact Explanation
Scabies. Intense pruritus with papules and burrows are associated with a similar history in family members or close contacts [1].
Pneumonia. It also presents with cough and wheezing but is also associated with fever, pleuritic chest pain and sputum production [2].
Hemolytic anemia. Features of anemia are also associated with jaundice and splenomegaly [3].
Tropical pulmonary eosinophilia. It presents with paroxysmal cough and dyspnea [4].
References
  1. CHOSIDOW OLIVIER. Scabies. N Engl J Med [online] 2006 April, 354(16):1718-1727 [viewed 22 June 2014] Available from: doi:10.1056/NEJMcp052784
  2. JASTI H., MORTENSEN E. M., OBROSKY D. S., KAPOOR W. N., FINE M. J.. Causes and Risk Factors for Rehospitalization of Patients Hospitalized with Community-Acquired Pneumonia. Clinical Infectious Diseases [online] 2008 February, 46(4):550-556 [viewed 23 June 2014] Available from: doi:10.1086/526526
  3. OPFELL RW, LORKIN PA, LEHMANN H. Hereditary non-spherocytic haemolytic anaemia with post-splenectomy inclusion bodies and pigmenturia caused by an unstable haemoglobin Santa Ana-beta-88 (F4) leucine--proline. J Med Genet [online] 1968 Dec, 5(4):292-297 [viewed 23 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1468682
  4. BOGGILD A. K., KEYSTONE J. S., KAIN K. C.. Tropical Pulmonary Eosinophilia: A Case Series in a Setting of Nonendemicity. Clinical Infectious Diseases [online] 2004 October, 39(8):1123-1128 [viewed 24 June 2014] Available from: doi:10.1086/423964

Investigations - for Diagnosis

Fact Explanation
Stool examination for eggs of the worm. Adult female worms produce eggs which are excreted in feces [1].
Eosinophilia in full blood count. Growing and moulting worms provide a major stimulus for the eosinophil response which is the hallmark of parasitic infection [2].
References
  1. ALBONICO M. Epidemiological evidence for a differential effect of hookworm species, Ancylostoma duodenale or Necator americanus, on iron status of children. [online] 1998 June, 27(3):530-537 [viewed 23 June 2014] Available from: doi:10.1093/ije/27.3.530
  2. GARSIDE PAUL, BEHNKE JERZY M., ROSE RICHARD A.. The immune response of male DSN hamsters to a primary infection with Ancylostoma ceylanicum. JHL [online] December [viewed 23 June 2014] Available from: doi:10.1017/S0022149X00009068

Investigations - Fitness for Management

Fact Explanation
Low hemoglobin levels on full blood count. Adult worms attach to and feed from the bowel mucosa of the infected host, resulting in intestinal blood loss, which often gives rise to iron deficiency and anemia [1].
References
  1. JONKER FEMKJE A. M., CALIS JOB C. J., PHIRI KAMIJA, BRIENEN ERIC A. T., KHOFFI HARRIET, BRABIN BERNARD J., VERWEIJ JACO J., VAN HENSBROEK MICHAEL BOELE, VAN LIESHOUT LISETTE, BRINDLEY PAUL J.. Real-time PCR Demonstrates Ancylostoma duodenale Is a Key Factor in the Etiology of Severe Anemia and Iron Deficiency in Malawian Pre-school Children. PLoS Negl Trop Dis [online] 2012 March [viewed 22 June 2014] Available from: doi:10.1371/journal.pntd.0001555.

Management - General Measures

Fact Explanation
Iron therapy. Adult worms attach to and feed from the bowel mucosa of the infected host, resulting in intestinal blood loss, which often gives rise to iron deficiency and anemia [1].
High protein diet which includes all essential nutrients. Due to hypoalbuminemia occurring as a result of chronic intestinal blood loss [2].
Advice on use of sanitary latrines for excretory functions. Fecal pollution of the soil, with subsequent hatching of deposited eggs and larval development results in increased likelihood of transmission of infection to humans [3].
Use of protective footwear. To protect feet from contact with contaminated soil [3].
References
  1. JONKER FEMKJE A. M., CALIS JOB C. J., PHIRI KAMIJA, BRIENEN ERIC A. T., KHOFFI HARRIET, BRABIN BERNARD J., VERWEIJ JACO J., VAN HENSBROEK MICHAEL BOELE, VAN LIESHOUT LISETTE, BRINDLEY PAUL J.. Real-time PCR Demonstrates Ancylostoma duodenale Is a Key Factor in the Etiology of Severe Anemia and Iron Deficiency in Malawian Pre-school Children. PLoS Negl Trop Dis [online] 2012 March [viewed 22 June 2014] Available from: doi:10.1371/journal.pntd.0001555.
  2. HOTEZ PETER J., BROOKER SIMON, BETHONY JEFFREY M., BOTTAZZI MARIA ELENA, LOUKAS ALEX, XIAO SHUHUA. Hookworm Infection. N Engl J Med [online] 2004 August, 351(8):799-807 [viewed 22 June 2014] Available from: doi:10.1056/NEJMra032492
  3. STOLTZFUS REBECCA J., DREYFUSS MICHELE L., CHWAYA HABABUU M., ALBONICO MARCO. Hookworm Control as a Strategy to Prevent Iron Deficiency. [online] 2009 April, 55(6):223-232 [viewed 24 June 2014] Available from: doi:10.1111/j.1753-4887.1997.tb01609.x

Management - Specific Treatments

Fact Explanation
Albendazole. 400mg - single dose. It acts by binding to parasite beta-tubulin, inhibiting its polymerization and impairing glucose uptake [1].
Mebendazole. 100mg twice daily for 3 days. It acts by binding to parasite beta-tubulin, inhibiting its polymerization and impairing glucose uptake [1].
Pyrantel pamoate. dose- 11 mg/kg. It acts on the parasite neuromuscular pathways and paralyses them [2].
References
  1. VENKATESAN P. Albendazole. [online] 1998 February, 41(2):145-147 [viewed 23 June 2014] Available from: doi:10.1093/jac/41.2.145
  2. HORTON J.. Albendazole: a review of anthelmintic efficacy and safety in humans. Parasitology [online] December [viewed 23 June 2014] Available from: doi:10.1017/S0031182000007290