PHASMIDS 2- HOOKWORMS

HOOKWORMS of Man
Misnomer NO HOOKS (plates and teeth only)
Hangs in the intestine

Necator americanus/ ancylostoma

duodenale

Necator americanus (NEW WORLD)

Ancyclostoma duodenale (OLD WORLD)

HABITAT
MORPHOLOGY

SMALL INTESTINE

ADULT

White or Pink worms are quite large

With SMOOTH striated muscles
On each side of the worm is a faint
LONGITUDINAL LINE
Separate sexes
Differentiated by buccal cavity

LARVA

N.americanus- no teeth/ buccal plate

A.duodenale- 2 even pairs
A.braziliense- 2 uneven pairs
A.caninum- 3 pairs
A.ceylanicum- 2 pairs in pile
RHABDITIFORM
Non infective
Feeding larvae
Short and stout
Directly hatches from the egg

TRANS BY: LOMJA TRANS BY: LOMJA

Cutaneous Larva Migrans

Caused by:
- A. braziliense(CAT)
- A.caninum(DOG)
- A.ceylanicum(HAMSTER)

CREEPING ERUPTION

SUBCUTANEOUS LAYER

Strongyloides stercoralis
Cochin China diarrhea
SIMILARITIES with HOOKWORM:
-life stages, forms of larva, infective stage, MOT,
habitat in man
DIFFERENCES:
Buccal cavity: no teeth nor plates
Life cycle: 4x MOLTING
Population affected: ADULT, institutionalized
SMALL INTESTINE

RHABDITIFORM: stouter
FILARIFORM: pointed

EGGS

L1
FILARIFORM
Infective
Thin and long
Adult form
Never survive in the soil
L3

Ovoid
Yellowish
Thin shelled
SKIN PENETRATION
PATHOGENESIS
- erythema
- itchiness
- reddish pinpoint lesions
VASCULAR/LYMPHATIC PENETRATION
-70% of parasite will look for this site
PULMONARY(ALVEOLAR)
-for N.americanus ONLY
-dyspnea/ dry cough/ chest pain/ back pain
-alveolar rupture release of larva mix with
secretions larynx pharynx
swallowed(tonsilopharyngeal area)
bloodstreaked due to ruptured
capillaries(sputum)
-minute hemorrhages/ inflammatory infiltrates
GIT(MUCOSA)
-maturation/ differentiation/ sexual
reproduction
-erosion/ ulceration/ hemorrhages/ abd. Pain/
nausea/ diarrhea
PATHOLOGY:
INTESTINAL
-sucking blood: A. duodenale >> N.americanus
SYSTEMIC
-anemia (RBC with halo: no iron/ no hemog/
hypochromic)
*apathy/ fatigue/ palor/ puffiness face/
dyspnea/ palpitation/ syncope/generalized
edema
-dyspnea
TRANS BY: LOMJA TRANS BY: LOMJA

Skin lesions MAPLIKE

Erythematous
Itchy
With pinpoint lesions

Autoreinfection/hyperinfection

ACUTE

-focal erythema
-edema
-urticaria
-petechiae
-migration to lungs, brochi, trachea throat
irritation

CHRONIC

-9external perianal autoinfection

-GIT:
*diarrhea
*abdominal pain
*bloody mucoid stools
*anorexia
*nausea/vomiting
*flatulence pruritus ani
-PULMONARY
*dry cough/ wheezing
-INCREASING INTENSITY
*fever
*weakness
*dyspnea
*malaise
URINARY PROBLEMS
*nocturia
*incontinence

HYPERINFECTION(Not common
sa hookworms)

DIAGNOSIS

TREATMENT
INFECTIVE
STAGE
DIAGNOSTIC
STAGE

-loss of appetite
-easy fatigability,pale
PROTEIN LOSS
-liver reduced capacity of producing albumin
-combined loss of rbc, plasma, tissue fluid
CLINICAL MANIFESTATION:
CUTANEOUS LESION GROUND ITCH
SPUTUM
-eosinophils/ charot leydin crystals
HAIR
-fine/ sparse
WAKANA DISEASE
INTESTINAL TRACT
-anorexia/ flatulence/ diarrhea/ vague/ abd
discomfort and burning pain (relieved by food
intake)
ANEMIA
OTHERS
-deformed nails/ pica/ cardiac murmurs/ signs
of high output failure
SKIN DEPIGMENTATION
-kwashiorkor
CHRoNIC INFECTION
-delayed puberty/ stunted growth/ loss of
mental faculty
PREGNANCY
-inc. mortality
Eggs in FECES
Direct fecal smear
Kato-katz method
Barium meal exam
ALBENDAZOLE
MEBENDAZOLE
PYRANTEL PAMOATE

-increased intestinal worm burden

-intense dessimination of larva to lungs
-Depressed host immunity, malnourished
(Immunosuppresants)
-malabsorption/ protein losing enteropathy
-bronchitis/ pneumonia/ pleural effusion/
dyspnea/ cough
COMPLICATION:
-gram (-)negative bacteremia/ pericarditis/
bacterial pneumonia and effussion

Skin slit biopsy

Stool exam
Duodenal fluid exam
Sputum exam (charot leydin and eosinophils)

THIABENDAZOLE
IVERMECTIN

THIABENDAZOLE
IVERMECTIN
Altx: Mebendazole/ pyrivium pamoate

L3 filariform larvae (2x molt)

L3 filariform larvae

L3 filariform larvae (4x molt)

Egg

filariform

Egg/ rhabditiform larvae/ adult

TRANS BY: LOMJA TRANS BY: LOMJA