Good morning, everyone. I am Milky C. Tiongson and I will be tackling about Ancylostoma Duodenale.

For the topic outline, I will be discussing about:

Ancylostoma duodenale is
a human hookworm, which can cause parasitic infection to
countries with poor access to adequate water, sanitation, and hygiene..It is a parasitic
nematode worm and usually known as the Old World hookworm. Ancylostoma duodenale IS ONE OF
THE human hookworm species that are ordinarily examined as the reason for hookworm disease.
Ancylostoma duodenale is abundant all through the world. Habitat:
The adult worms live in
the small intestines of infected persons, mostly in the jejunum, less often in the
duodenum, and infrequently in the ileum.
Now lets move on to the taxonomic classfication
Taxonomic Classification

Kingdom: Animalia
Phylum: Nematoda
Class: Secernentea
Order: Strongiloidae
Family: Ancylostomatidae
Genus: Ancylostoma
Species: Ancylostoma duodenale

Short epidemiology

 AS said earlier, A. duodenale is prevalent throughout the world, this includes countries like
Southern Europe, North Africa, India, China, Southeast Asia, small areas of United States,
the Caribbean islands, and South America. This hookworm is well known in mines because
of the consistency in temperature and humidity that provides an ideal habitat for egg and
juvenile development. An estimated 1 billion people are infected with hookworms. For its
Mode of Transmission, it is by contact of skin with soil contaminated with larva or maybe
through ingestion of larvae. The way it enters the human body was understood in the 1880s,
after an epidemic of ancylostomiasis among miners working in the hot and humid Gotthard
Tunnel (Switzerland). The highest at-risk population to contract Ancylostoma infections
are the pre-school and school-aged children, this is because children are fond of
playing with the soil, and another at risk people are travelers who returned from
tropical countries. 
 People in close contact with dogs and cats are at risk to acquire zoonotic Ancylostoma
infection. 
  The incidence of Ancylostoma infection is tied to seasonal distribution where during the
summer-autumn period, the incidence is more prevalent. This is because the hookworm
thrives more in this temperature.
 Mixed infections with more than one Ancylostoma species are common in humans.

Morphology
Adult Worm
They are relatively stout cylindroidal worms.

 They are pale pink or greyish white, but may appear reddish brown due to ingested
blood.

 The body is curved with the dorsal aspect concave and the ventral aspect convex. The
anterior end is somewhat constricted and bent dorsally in the same direction of general
body curvature. This cervical curvature gave it the name hookworm

 The mouth is not at the tip but directed dorsally. The prominent buccal capsule,
reinforced with a hard chitin-like substance carries 6 teeth; 4 hook-like teeth ventrally, and
2 knob-like with a median cleft dorsally.

 The normal life expectancy of A. duodenale is one year.

Now, lets distinguish the differences between male and female ancylostoma duodenale.
As, you can see from the illustration, The male is smaller than the female with the sizw of 8-11
mm, the female is about 10-13 mm in length. For the copulatory bursa, this is a reproductive
organ where sperm is secreted. This is only present in male and absent for female. And then for
its genital opening, for the male, it opens in the cloaca, within the copulatory bursa, along with
anus, while the female, opens at the junction of the middle and posterior third of body.
The egg of hookworm is:

 Oval or elliptical, measuring 60 µm by 40 µm. micrometer

 Colorless, not bile stained.

 Surrounded by a thin transparent hyaline shell membrane.

 Floats in saturated salt solution.

 When released by the worm in the intestine, the egg contains an unsegmented ovum.

 During its passage down the intestine, the ovum develops. When passed in feces, the egg contains a
segmented ovum, usually with 4 or 8 blastomeres.
 refering to the picture, There is a clear space between the segmented ovum and the egg shell.

 A single female worm lays about 25,000–30,000 eggs in a day and some 18–54 million during its life
time.

Lifecycle
Life cycle of ancylostoma is completed in a single host (Fig. 18.3).

Definitive host: Humans are the only natural host. No intermediate host is required like other helminths.
Infective form: Third stage filariform larva.

Hookworm infects humans when third-stage filariform larvae penetrate the skin, particularly in
unprotected areas such as the feet. The filariform larvae migrate to the lymphatic and blood
systems once inside the body. The larvae are carried to the lungs by the blood, where they
penetrate the capillaries and enter the alveoli. The larvae continue to migrate into the
bronchioles, where they are coughed up to the pharynx, swallowed, and deposited in the
intestine. The larvae develop into adult hookworms in the intestine. The adults that result live
and multiply in the small intestine. Adult females produce 10,000 to 30,000 eggs per day. Many
of the resulting eggs are passed into the environment through the feces and reside on soil. When
deposited on warm, moist soil, a first stage rhabditiform larva rapidly develops in the
egg and hatches after 1 to 2 days. This rhabditiform larva moults twice in the soil and
becomes a skin-penetrating third-stage infective larva (filariform larva) within 5–10 days.
Then the infective larvae or filariform larva are able to sense vibrations in the soil, heat,
or carbon dioxide, and are able to use dendritic processes similar to cilia. They use
these processes as thermosensory, chemosensory, and mechanosensory receptors to
migrate towards a host for infection. [2] The filariform larvae can then penetrate the
exposed skin of another organism and begin a new cycle of infection.
Disease

 Ancylostomiasis-- also known as hookworm infection, is a rare parasitic disease caused

by the Ancylostoma hookworms. Also known as miners anaemia, tunnel disease,
brickmaker’s anaemia, and Egyptian chlorosis. As you can see, this disease has a lot
of names because this is based from the country, like the miners anemia it is from France,
and Egyptian chlorosis is from Egypt.
 Infection occurs when a worm larvae enters the body, usually through contact of broken
skin on the feet with contaminated soil, and travelling through the bloodstream to the
lung and intestine, where they begin to multiply.
 Produce an iron deficiency anemia by sucking blood from the host’s intestinal walls.

 For its signs and symptoms,

 Itching of skin as a result of penetration of larvae
 Rash at the site of larval entry
 Congestion in lungs in heavy infection
 A person with light infection may have no symptoms
 A person with heavy infection may experience abdominal pain, diarrhea, loss of appetite,
weight loss, fatigue, and anemia.
  The physical and cognitive growth of children can be affected

 Unchecked ancylostomiasis infection may lead to fatty degeneration of heart, liver and
kidneys, ending in death.

Diagnosis (techniques and tools)

Direct methods
 Demonstration of characteristic oval segmented eggs in feces by direct
wet microscopy or by formalin-ether concentration methods with
stool sample is the best method of diagnosis. The stool should be
examined within several hours after defecation. In stool samples
examined 24 hours or more after collection, the eggs may have
hatched and rhabditiform larvae may be present.
 Egg counts give a measure of the intensity of infection. Modified Kato-
Katz smear technique is a useful method for quantitative
estimation of eggs in the stool.
 Stool cultures (fecal sample smear on moistened filter paper in a closed
tube for a few days)(Harada-Mori technique) to demonstrate third-
stage filariform larvae A. duodenale larvae have long buccal cavities
and smaller genital primordium, whereas Strongyloides have short
buccal cavities.
Indirect methods 
 Blood examination reveals microcytic, hypochromic anemia, and
eosinophilia.
 Stool examination may show occult blood and Charcot -Leyden
crystals
 Chest X-ray may show pulmonary in infiltrates in the migratory phase. .

Management (Drug of choice and preventive measure

Effective drugs: A single

dose of albendazole(400mg)  or mebendazole(500mg). pyrantel
pamoate((11 mg/kg × 3 days)  is also effective and can be used in
pregnancy.
  For kids, pregnant women, or others who develop anemia as a result of
hookworm infection, health care providers will often prescribe an iron
supplement to overcome hemoglobin due to anemia.

Preventive measures
 Preventing unhygienic defecation. Then, avoid direct skin contact with the soil (eg, wearing
shoes do not walk bare footed because larva may enter through the skin of the foot, wear
gloves when handling soil especially for farmers and gardeners, and using barriers when
seated on the ground), because this may be contaminated with feces from human, dogs,
cats, and other animals. We need also to treat dogs and cats for hookworm to prevent
them from spreading from spreading animal hookworms to people.
 Prevention of soil pollution with feces and proper disposal of night soil and use of sanitary
latrines. as much as possible do not defecate outside to avoid polluting the soil with feces.
Practice proper disposal of feces
  Treatment of patients and carriers, preferably all at the same time, limits
the source of infection.