Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

726 Hookworm

■Exposure: walking barefoot or other contact of skin with contami-

nated soil

Signs & Symptoms

■Penetration stage: local dermatitis and itching

■Migratory phase: cough, wheeze, eosinophilia, and sometimes shad-

ows on chest x-ray (Loeffler’s syndrome)

■Intestinal phase: no symptoms in light infection. In heavier infec-

tions, epigastric or midabdominal pain, dyspepsia, and/or diarrhea,

and in severe infections, abdominal protuberance.

tests

■Basic tests: blood: Migration phase: eosinophilia

■Intestinal phase: Sometimes eosinophilia. In heavy infection there

is microcytic hypochromic anemia, low serum iron and ferritin.

■Basic tests: urine: normal

■Specific tests: Stool O&P shows eggs and is diagnostic.

■Other tests: Barium study may show irritable upper small bowel,

where worms attached.

differential diagnosis

■Migratory phase: mimics migratory phase of ascariasis, strongyloidi-

asis, schistosomiasis

■Intestinal phase: mimics many causes of dyspepsia, diarrhea. Most

important in differential are strongyloides and schistosomiasis.

management

What to Do First

■Assess severity, nutritional state, degree of anemia. Administer iron

if needed. Anemia responds to iron even if worms not treated.

General measures

■Determine source of infection.

specific therapy

Indications

■All symptomatic or anemic patients. Light infections are treated

optionally.

Treatment Options

■Mebendazole for 3 days

■Pyrantel pamoate

■Albendazole