1. Hookworm Infection Brandy Kragness & Kerbe Norberg

2. Geographical Range • Necatoramericanus • Sub Saharan Africa • Southeast Asia • China • Indonesia • the Americas • Ancylostomaduodenale • Middle East • North Africa • India

3. Morphology • Necatoramericanus • “New World Hookworm” • Pair of dorsal and ventral cutting plates surrounding the buccal cavity • Also have subdorsal and subventral teeth near the rear of the buccal cavity • Males: • 7-9 mm long • Copulatory Bursa with needle-like spicules forming a distal hook • Females: • 9-11 mm long • Vulva located in middle of body • Produce 5,000-10,000 eggs per day (Life Span = 5 Years!) • Eggs: 65-75 μm by 36-40 μm, thin shelled

4. Necatoramericanus dorsal and ventral cutting plates

5. Morphology • Ancylostomaduodenale • “Old World Hookworm” • Two ventral cutting plates with two large teeth fused at their base • A pair of small teeth are located in the capsule as well • Males: • 8-11 mm long • Copulatory Bursa with needle-like spicules that are NOT fused distally • Females: • 10-13 mm long • Vulva located about 1/3 of the body length from the posterior end • Produce 10,000-30,000 eggs per day (Life Span= 1 year) • Eggs: 56-60 μm by 35-40 μm, thin shelled

6. Ancylostomaduodenale cutting plates with two large teeth fused

7. Transmission • Ancylostomaduodenale • Fecal Oral Route • Penetration of filariform larvae upon human skin • Transplacentally and through mother’s milk • Necatoramericanus • Penetration of filariform larvae upon human skin

8. Hosts • Definitive Host • Humans (Children more commonly than adults) • Paratenic Host • A. duodenalecan be transmitted through ingestion of undercooked meat (rabbit, pork, beef, lamb) • Pigs can serve as a transport host for N. americanus

10. Other Forms • Ancylostomacaninum • dogs, fox • intestinal • Ancylostomabraziliense • canines, felines • Cutaneous larval migrans • Humans act as accidental hosts for both species

11. Pathogenesis • Cutaneous Phase: • Occurs when the juvenile penetrates human skin • Ground Itch (“Creeping Eruption”) • Pulmonary Phase: • Occurs when juveniles break out of lung capillaries and into the throat • Usually asymptomatic • Dry coughing or sore throat may occur • Pneumonitis (Rare)

12. Pathogenesis • Intestinal Phase: • Occurs when worms reach the small intestine and attach themselves • Iron deficiency anemia: • N. americanuscan suck approximately 0.03 L of blood per day (1000 worms) • A. duodenalecan suck approximately 0.26 L of blood per day (100 worms) • Abdominal Pain • Loss of normal appetite • Cognitive Impairments

13. Diagnosis • Eggs or Worms in Feces • Must use concentration technique • Differentiating between N. americanus& A. duodenale: • Use PCR-RFLP method

14. Treatment & Prevention • Treatment: • Mebendazole- Drug of choice • Removes both species of Hookworm • Single dose therapy is efficient and cheap • Prevention: • Education • Persuasion of sanitary disposal of feces (use of latrines) • Avoid using nightsoil for fertilization • Mass Drug Administration (Distributing BenzimidazoleAnthelmintic Drugs)

15. Public Health Concern • Approximately 22.1 million DALY’s (Daily Adjusted Life Years) have been lost due to Hookworm Infection • Research: • Vaccines currently being clinically tested for targeting: • Larval worm stage • Adult worm stage

16. References • http://www.cdc.gov/ncidod/dpd/parasites/hookworm/factsht_hookworm.htm • https://health.google.com/health/ref/Creeping+eruption • Roberts, Larry S. and Jr. John Janovy. Foundations of Parisitology. 8th Edition. November 30th, 2008.