Ancylostoma: Causes, Stages, Diagnosis and Treatment

Ancylostoma is a genus of a nematode/parasite known as hookworm. It mainly lives in the small intestine of hosts such as humans, cats and dogs. The infection occurs mainly through the skin and the larvae then enters the small intestine. It is of two types Necator americanus ( New world) and Ancylostoma Duodenale (Old world). Ancylostoma duodenale is prevalent in the southern europe, north africa and north asia whereas N. americanus is mainly seen in western hemisphere.

Ancylostoma Causes 

• It can enter the human body by walking barefoot on contaminated sand or soil, so the route of entry is skin.
• The adult hookworm produces eggs which get deposited with feces in soil where the eggs hatches to release the Rhabditiform Larvae. The larvae which enters human body is called as Filariform larvae ( Infective stage) or Cutaneous Larva Migrans.
• The main hosts are dogs and cats but humans are incidental hosts.
• There is a term called as Chandler’s Index which is the average number of hookworm eggs per gram of feces for the entire community . ( >300: Public health problem)

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Stages of Ancylostoma

• From the Intestine the larvae moves to the lungs( Rhabditiform larva)  where it is coughed and swallowed again. 
• The Cutaneous Larva Migrans (Hookworm) can be differentiated from Visceral Larva migrans ( Roundworm) by skin penetration present in the CLM.

                                                       Cutaneous Larva Migrans                  

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Ancylostoma symptoms

• At the entry point of larvae it can cause skin itching and there can be eruption. Lower extremity is mainly involved there is intensely pruritic, migrating and serpiginous reddish- brown track seen.
• The initial manifestations are epigastric or abdominal pain and loss of appetite. There might be inflammatory diarrhea also. In case of heavy infection there can be Iron deficiency anemia.
• Pulmonary symptoms can be observed. The larvae passing through the lungs can cause mild transient pneumonitis.

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Ancylostoma types

• The male and female can be distinguished on the basis of few aspects like Male is shorter in size than female and has a copulatory bursa present.
• Ancylostoma Duodenale has more pathogenicity than Necator Americanus.
• Ancylostoma Duodenale has free spicules whereas Necator Americanus has fused spicules.

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Ancylostoma Diagnosis

• Mainly history and physical examination like skin manifestations and abdominal symptoms.
• Stool examination shows unembryonated egg in fresh stool and larva in old stool. On light microscopy ,eggs of three different species are indistinguishable, in this scenario PCR is required.
• Eosinophils are usually normal.
• The presence of iron deficiency anemia are characteristic of hookworm infection.

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Ancylostoma Treatment

• Treatment is antihelminthic drug ( Ivermectin). Patient can be given iron pills if it is suffering from Iron deficiency anemia.
• If there is severe hookworm infection that patient is having malabsorption issues or protien loss then increase in protien intake, iron pills and deworming is adviced.

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Ancylostoma Prevention

• It is very important to main hygiene and proper disposal of the fecal matter of humans, dogs and cats.
• Avoid walking barefoot in the dog parks or grounds in the disease prevalent areas.

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