Ancylostoma duodenale and Necator

americanus co-infection as a cause of severe

anemia in elderly patient: a case report
Ahmad Fariz 1
M. Z. Zein , Amanah 2

1Department of Internal Medicine, Faculty of Medicine, Universitas Swadaya Gunung Jati - Waled General Hospital,
Cirebon, West Java, Indonesia
2Department of Immunology & Tropical Disease, Faculty of Medicine, Universitas Swadaya Gunung Jati , Cirebon, West
Java, Indonesia

Introduction Fig. 1
Hookworms are the most common nematode causing intestinal infestation in the world.

Case Illustration
A 63-year old male patient with fatigue. No comorbidity. Physical examination showed
pale conjunctivae, epigastric tenderness, and no organomegaly. Complete blood count
showed severe anemia and eosinophilia. No specific finding in fecal analysis. Upper Fig. 2
gastrointestinal (GI) endoscopy was performed. The gastric mucosa was erythematous.
There were also hookworm infestation in the duodenum (Fig.1 & Fig. 2) and some were
easily lifted off the mucosa with the standard biopsy forceps. The histologic finding of
the worms revealed both A. duodenale (Fig. 3 & Fig. 4) and N. americanus (Fig. 5). The
histopathologic finding revealed nonspecific chronic gastritis. The management of this
case encompassed the administration of PPI iv, the administration of pyrantel pamoate,
and blood transfusion. He was hospitalized for 10 days.

Fig. 3

Discussion
We presented a case of an elderly male with chronic fatigue and severe anemia, with an
incidental finding of hookworms infestation during upper GI endoscopy. Two species of
hookworm, A. duodenale and N. americanus, are found exclusively in human and causing
long-term iron deficiency anemia.
The definite diagnosis is usually made by repeated fecal examination for finding the
eggs. In our case, we could not find them. The endoscopic finding showed hookworm Fig. 4
infestation and further the histologic finding of worms were A. duodenale and N.
americanus. The available drug of choice in this case for hookworms elimination was
pyrantel pamoate 10mg/kg once, which is inferior to albendazole but superior to
mebendazole and levamisole.

Keyword: Ancylostoma duodenale, Necator americanus, co-infection, severe

anemia, elderly
Fig. 5

Corresponding author:
Ahmad Fariz Malvi Zamzam Zein
Department of Internal Medicine, Faculty of Medicine, Universitas Swadaya Gunung Jati – Waled Hospital
Jalan Taman Pemuda 2 Kesambi, Cirebon, West Java, Indonesia 45132
Email address: fariz_zein_dr@yahoo.com