Ankilostomiasis

By: Ns. Rizky Setiadi, S.Kep

 Some Facts….
• Hookworms infect an estimated 1 billion people worldwide,
mostly in tropical and sub-tropical climates
• A. duodenale and N. americanus are the two hookworms
that infect humans
• A. duodenale is found in southern Europe, northern Africa,
India, China, the Middle East, and the Americas
• N. americanus can be found in the southeastern U.S. and
Australia
Hookworm
(Necator americanus, Ancylostoma duodenale)
Epidemiology: tropics/sub-tropics, SE USA, >1 billion

from Peters & Gillies, 1995

 Morphology

1. Adults: They look like an odd piece

thread and are about 1cm. They are
white or light pinkish when living. ♀is
slightly larger than♂.The male’s posterior
end is expanded to form a copulatory
bursa.
2. Eggs: 60×40 µm in size, oval in shape,
shell is thin and colorless. Content is 2-
8cells.
Differences between two hookworms

Adults of A. duodenale Adults of N. americanus

• Scanning electron micrograph of the mouth capsule
of Ancylostoma duodenale, note the presence of
four "teeth," two on each side.
• Scanning electron micrograph of the mouth capsule of
Necator americanus, another species of human
hookworm.  Note the presence of two cutting "teeth“.
 Life Cycle and Reproduction
• Eggs are passed in the feces and hatch into rhabditiform
larvae in about 48 hours in the feces or in the soil

A. duodenale N. americanus

• Eggs aregenerally 57-76 µm by 35-47 µm and are

oval shaped with a thin shell
Rhabditiform Larvae (wet mount)
 Life cycle continued
• Juveniles feed on feces for about 3 days then molt into 2nd
stage juveniles
• They molt again 5-10 days later into filariform larvae. Can
survive 3-4 weeks outside host.
 Life Cycle
• Infect humans by penetrating skin and then travel to the
heart and lungs where they penetrate the pharynx and are
swallowed. When they reach the small intestine they attach
to the intestinal wall and feed on blood.

Cutting plates
in N.
Cutting teeth americanus
in A.
duodenale
 Life Cycle
• Worms molt again two more times to reach
maturity
– A. duodenale adult males measure 8-11mm with females
being 10-13mm
– N. americanus adult males measure 7-9mm and females
measure 9-11mm
• Adult worms copulate and eggs appear in the feces
in about 6 weeks (females can produce sever
thousand eggs in one day)
• Cycle starts over again and adults live 1-2 years
Life Cycle
Life cycle of hookworm
 Transmission
• Filariform juveniles wait in soil or feces and
wave back and forth to increase chances of
finding a host
• Filariforms then penetrate the skin (usually
hands or feet)
• Children, elderly people and people who work
about contaminated soil are at high risk
 III. Pathogenesis and Clinical Manifestations

• 1. Larval migration
(1) Dermatitis, known as "ground itch" or "stool
poison".The larvae penetrating the skin cause allergic
reaction, petechiae 0r papule with itching and burning
sensation. Scratching leads to secondary infection.
(2) pneumonitis (allergic reaction), Loeffier's syndrome:
cough, asthma, low fever, biood-tinged sputum or
hemoptysis, chest-pain, inflammation shadows in lungs
under X-ray. These manifestations go on about 2 weeks.
2. Adults in small intestine
(1) Epigastric pain as that of a duodenal ulcer.
(2) A large worm burden results in microcytic hypochromatic
anemia (character manifestation). The symptoms are lassitude,
edema, palpitation of the heart. In severe case, death may result
from cardiac failure or physical exhaustion.
(3) Allotriophagy (orpica) is due to the lack of trace element iron .
(4) Amenorrhea, sterility, abortionmay take place in women.
(5) Gastrointestinal bleeding
(6) Infantile hookworm disease
Adults in intestinal mucosa
 Diagnosis
• Stool samples showing eggs or actual worms
• Watching for symptoms
 Control and Treatment
• Scientist are trying to develop a vaccine
• In some countries, infections aren’t treated
because they are so common
• Drugs of choice are Albendazole,
Mebendazole, and Pyrantel Pamoate
 Prevention
• Wear shoes
• Monitor the disposal of humans feces