ANCYLOSTOMA

DUODENALE
 HISTORICAL
Disease induced by hookworms

….. was never suspected to be

a disease at all

….. the people who had it were labeled as lazy

and were despised

….. they were made fun of, when they should

have been pitied
---Mark Twain
SPECIES OF HOOKWORMS

 Two principal species that infect man

 Necator americanus
 American killer
 The new world hookworm

 Ancylostoma duodenale
 The old world hookworm
HABITAT
 Adult worms live in the Small intestine
--- more often in the Jejunum
--- less often in the Duodenum
--- rarely in the Ileum

 Female worm lays 5-10000 eggs a day over

5 years
MORPHOLOGY

1. Adult Worms

2. Eggs
Adult
3. Larva

Rhabditiform
larva

Egg
1. ADULT WORM
General characters
 Small, cylindrical worms
 Greyish white in color
 Appears reddish brown when freshly passed due to
ingested blood
 Anterior end is bent dorsally into a hook – ( name)
 Bend is in the same direction of the general body
curvature
 Oral aperture has a buccal capsule
 Buccal capsule
∞ lined by a hard substance
∞ has six teeth
> Two knob like …. on the dorsal surface
> Four hook like …. on the ventral surface

 Digestive system …. has five glands

 Eosophageal gland secretes an enzyme which

prevents clotting of blood
 Gender differences
MALE FEMALE
1 Short and narrow Long and broad

2 Posterior end has a No copulatory bursa

copulatory bursa
~ Umbrella shaped
~ Has three lobes
~ 13 chitinous rays

3 Genital opening At the junction of middle

---Posterior 1/3rd and posterior 1/3rd of
the body
During copulation …..Y - - Shaped structure
2. EGGS
Oval / elliptical in shape
Size --- 65 x 49 microns
Surrounded by a transparent hyaline shell membrane
Segmented ovum with 4 – 8 blastomeres
Clear space between the ovum and the shell
membrane
Colourless; not bile stained
Light; float in saturated salt solution
Not infective to man
NOTE

 The eggs are first laid in an unsegmented stage

 During their passage through the bowel

… ovum develops 4 blastomeres
3. LARVA

A) Rhabditiform larva
¤ Has a long and narrow buccal chamber
¤ Flask shaped / double bulb eosophagus
¤ Not infective to man

B) Filariform Larva
¤ Short eosophagus; no posterior bulb
¤ Infective to man
 LIFE CYCLE
 Host : Man
 Infective forms : Filariform Larvae
 Mode of Infection : Penetration through unbroken soft
skin
 Persons walking bare feet
 Thin skin between the toes
 Dorsum of the foot
 Inner side of the soles
 Gardeners and miners
 Site of entry …. Skin of the hands
Stages of Life Cycle
Passage of eggs from the infected host
 Eggs containing segmented ova with 4 blastomeres
 Passed out into the faeces
Development in the soil
 Rhabditiform larva hatches out in the soil from the egg
 This takes 24 hours
 It moults twice; on the third and fifth day
 Develops into a filariform larva …. Infective form
Entrance into a new host
 The filariform larvae cast off their sheaths
 Gain entrance into the body by penetrating the skin
Migration
 Larvae reach the subcutaneous tissues
 Enter the lymphatics or small venules
 They are carried to the right side of the heart and into
the pulmonary capillaries
 Here they break through the capillary walls and enter
into the alveolar spaces
Migration ….. contd
 They migrate to the bronchi, trachea, larynx
 Crawl over the epiglottis
 To the back of the pharynx and are swallowed
 On entering the eosophagus … a third moulting takes
place
 A terminal toothless buccal capsule is formed
 Time taken … 10 days
Localisation and laying of eggs
 The growing larvae settle down in the SI
 Undergo a fourth moulting
 Develop into adolescent worms
 The toothless buccal capsule is cast off
 A buccal capsule with teeth is formed
 The worms become sexually mature in 3 – 4 weeks
 The male fertilizes the female worm
 The gravid worm then lays eggs
LIFE CYCLE
 PATHOGENICITY
EFFECTS PRODUCED BY LARVAE

A. Lesions in the skin B. Lesions in the lungs

i) Ankylostome dermatitis / Ground itch
 At the site of entry of larvae (Necator)
 Generally disappears in 1 -2 weeks

ii) Creeping Eruption

…..next page
ii) Creeping Eruption
Species involved
 Ancylostome species not adapted to man eg. A.
caninum, A. braziliense
 India … seen with N. americanus in Tea garden
coolies

Genesis
 The larvae cannot reach the SI after penetrating
the skin
 The larvae wander aimlessly through the skin
for several weeks to months (2 years)
 Finally the larvae die
Site
 Skin, in a serpiginous tunnel
 Roof … stratum granulosum
 Floor … stratum corium

Speed of movement
 slowly and irregularly
 1 – 2 cms per day
 Hence called ‘Larva migrans’

Clinical features
 The larvae produce a reddish itchy papule along

the path
EFFECTS PRODUCED BY LARVAE

B. Lesions in the lungs

i) Bronchitis

ii) Bronchopneumonia

 These occur when the larvae break through the

pulmonary capillaries and enter the alveolar
spaces

 Associated with marked Eosinophilia

LESIONS PRODUCED BY THE ADULT WORM

Progressive anaemia
 Microcytic / Hypochromic type
 Causes
1. Chronic blood loss due to …
 Haemorrhage at the puncture sites
 Parasite withdraws blood for its food
 0.03 – 0.2 ml per day
 Loss of hemoglobin for 12 worms
could be 1 percent
 Plasma is the main source of
nutrition
2. Nutritional defficiency in the diet…
 type of anemia may vary
 Defficiency of iron
 Microcytic anaemia
 Defficienct of Folic Acid and Vitamin B12
 Macrocytic anaemia
Clinical features of adult worm infestation

1. Gastrointestinal
 dyspepsia, epigastric tenderness
 appetite for mud, lime … Pica / Geophagy
 constipation
 steatorrhoea … fatty diarrhoea

2. Effects of Anaemia
 skin appears light yellow, pallor, dry lustreless hair
 puffiness of face
 koilonychia
 protuberant abdomen
LABORATORY DIAGNOSIS

DIRECT METHOD

A) Examination of stool
 Macroscopic Examination for Adult Worms

 Microscopic Examination for eggs (conc. methods)

B) Examination of duodenal aspirate

 may reveal adult worms or eggs
INDIRECT METHOD

 Examination of Blood
  Anaemia

 Eosinophilia

 Examination of stool
 Occult blood

 Charcot Leyden crystals