Overview of the disease
Hookworm parasites in the human small intestine and cause disease may have a rash, cough, abdominal pain, loss of appetite, lethargy, fatigue and other manifestations of the use of deworming treatment such as albendazole, supplemented with iron supplementation and other symptomatic treatment, most people can be cured, but the prognosis of pregnant women and children may not be good.
Definition
Hookworm disease is a parasitic disease caused by hookworm infection.
Common hookworms are duodenal hookworm and American hookworm, mainly through the skin infection, mainly manifested as anemia, malnutrition, gastrointestinal dysfunction.
Morbidity
Hookworm disease is one of the common human intestinal nematode diseases, infection throughout the world, it is estimated that the number of infected people in the world amounted to 576 million people, about 39 million people in China.
China’s eastern and northern China to duodenal hookworm infection, South China and Southwest China to American hookworm infection, there can also be mixed infections.
Hookworm disease in China is mainly concentrated in rural areas, and the infection rate is higher among farmers and students working in agriculture [1-2].
Etiology
Causes
Hookworm disease is caused by hookworm infection, the basic conditions leading to the epidemic are the following three aspects.
Source of infection
The sources of infection are mainly hookworm-infected individuals and patients with hookworm disease.
Routes of transmission
Transdermal infection: Infection through skin contact with hookworm-contaminated soil.
Transoral infection: Infection through the oral mucosa by eating raw hookworm-containing vegetables, fruits and melons.
Susceptible people
People are generally susceptible.
The infection rate is high among farmers, mostly vegetable farmers, mulberry farmers, tea farmers, cotton farmers, etc.
Pathogenesis
The larvae of hookworms are called larvae, which can cause inflammatory reactions and bleeding in the skin, lungs and intestines after invading the human body.
The larvae of hookworms cause dermatitis when they invade the skin, causing local congestion, edema and inflammatory cell infiltration.
Leptospira can reach the lungs via lymphatics or microvessels, causing interstitial and alveolar punctate hemorrhage and inflammation. When they migrate up the bronchial tubes to the pharynx, they can cause bronchitis and asthma.
Hookworm adult parasites in the intestinal tract, bite attached to the villous epithelium of the small intestinal mucosa, ingest blood and secrete anticoagulant substances, which can cause scattered hemorrhages in the intestinal mucosa, and even cause gastrointestinal hemorrhage.
Long-term chronic blood loss in the intestinal tract can cause heart enlargement, significant bone marrow hyperplasia, flat nails, anti-nails, dry hair loss, etc. [1-2].
Symptoms
Main Symptoms
Symptoms caused by hookworm disease include larval pathogenicity, adult pathogenicity and other related symptoms, and the infection can cause serious manifestations in people such as infants, young children and pregnant women, as follows.
Symptoms caused by larvae
The larvae invade the skin and migrate to the lungs, liver, eyes and other parts of the body, causing corresponding symptoms.
Hookworm dermatitis
Within minutes of skin invasion, there is a burning sensation, pinprick sensation or itching, followed by the appearance of red dotted papules or vesicles, usually after 1 week, the lesions heal on their own.
If the skin is scratched, pustules may appear secondary to infection.
Respiratory symptoms
About 1 week after infection, a large number of larvae migrate to the lungs, patients may cough, cough sputum, wheeze, pharyngeal itching and other symptoms, the symptoms are more obvious at night, the duration of the disease for several days or weeks.
In severe cases, hemoptysis may occur, as well as paroxysmal wheezing, hoarseness, low-grade fever and other symptoms.
Symptoms in other parts of the body
In rare cases, the larvae may migrate to other tissues and organs, such as the liver and eyes, causing local inflammatory reactions and epigastric discomfort, eye pain and blurred vision.
Symptoms of adult hookworms
Adult hookworms mainly parasitize the intestinal tract and cause gastrointestinal symptoms associated with intestinal mucosal damage and anemia due to chronic blood loss, and in a few cases, gastrointestinal hemorrhage may occur.
Digestive tract symptoms
Most patients develop vague pain in the epigastrium, loss of appetite, dyspepsia, diarrhea, emaciation, and fatigue 1 to 2 months after infection.
Severely infected patients may have xenophagia, such as a preference for raw rice, raw beans, and dirt.
Symptoms related to anemia
Anemia is the main symptom of hookworm disease, and progressive anemia gradually appears after 3 to 5 months of severe infection, which may be secondary to heart failure, etc.. It manifests as dizziness, fatigue, shortness of breath, edema, indifference, waxing and waning of the face.
When gastrointestinal bleeding is obvious, it may manifest as persistent black stool.
Hookworm disease in special populations
Infantile hookworm disease
Infants may show pale face, poor spirit, loss of appetite, crying and restlessness, diarrhea, black stools or bloody watery stools, resulting in growth retardation and malnutrition. If not diagnosed and treated in time, it can lead to death.
Hookworm disease in pregnant women
Combined hookworm infection in pregnancy is prone to iron deficiency anemia and gestational hypertension syndrome, which can lead to miscarriage, preterm delivery or stillbirth, and increased neonatal morbidity and mortality [1-6].
Medical treatment
Department of Medicine
Infection Medicine
If symptoms such as fever, cough and sputum are present, it is recommended to consult the Department of Infectious Diseases.
Respiratory medicine
If you experience any of the above symptoms, you may also consult the Department of Respiratory Medicine.
Dermatology
If itching, pins and needles, pimples, herpes, etc. occur, consult a dermatologist.
Preparation for medical treatment
Preparing for your visit: registering, preparing your documents, FAQs
Tips for the doctor
You may be required to undergo a full body checkup and a chest CT scan, so you should wear loose-fitting clothes and avoid wearing clothes made of metal.
If you have a fever before the visit, you can first apply physical cool-down measures, such as applying warm towels to your forehead or wiping your armpits.
Preparation Checklist
Symptom checklist
Pay particular attention to the time of onset of symptoms, special manifestations, etc.
Is there any rash, itchy skin, etc.?
Is there cough, phlegm, wheezing?
Any abdominal pain, loss of appetite, indigestion, etc.?
List of medical history
Has there been any recent barefoot labor in farmland?
Have you recently eaten raw vegetables, fruits or melons?
Has there been any recent drinking of unclean water?
Checklist
Test results in the last six months, which can be brought to the doctor’s office
Laboratory tests: blood test, liver function, etc.
Imaging tests: chest CT, abdominal ultrasound, etc.
Medication list
Medication in the last 1 week, if there is a box or package, you can bring it to the doctor
Topical skin medication: Dehumidifying and anti-itching ointment, compound dexamethasone acetate cream, etc.
Antipyretics: ibuprofen, acetaminophen, etc.
Diagnosis
Diagnosis is based on
Medical history
Patients with this disease may have the following epidemiologic history.
There is a history of barefoot labor on farmland.
A history of eating raw fruits and vegetables.
History of traveling to an infected area with hookworm disease.
Clinical manifestations
Symptoms.
In patients with hookworm dermatitis, they present with burning, pinching and itching of the skin, accompanied by papules and herpes.
Lung infection patients, manifested by fever, cough, cough sputum, hemoptysis and so on.
Adult parasites in the intestinal tract can appear epigastric pain, loss of appetite, dyspepsia, diarrhea, emaciation and so on.
Physical signs
In patients with pulmonary infection, dry rales or rales may be heard in the lungs.
In anemia, the skin and face may be seen to be waxy and the sclera white.
Laboratory Tests
Blood counts
The white blood cell count is mostly normal, eosinophils may be mildly elevated, hemoglobin may be decreased to varying degrees, and reticulocyte count is normal or mildly elevated.
Bone Marrow Imaging
Bone marrow examination reveals exuberant hematopoiesis, with a decrease or disappearance of free ferritin and ferric granulocytes in the bone marrow.
Pathogenetic examination
Hookworm eggs can be detected on direct fecal smears and saturated saline floatation.
Gastroenteroscopy may reveal live adult worms microscopically [7-8].
Differential diagnosis
Hookworm disease can cause skin, respiratory, and gastrointestinal related symptoms, which are not specific and need to be differentiated from similarly symptomatic diseases under the guidance of a physician.
Hookworm-induced dermatitis needs to be differentiated from atopic dermatitis, urticaria, and atopic dermatitis.
Lung infections caused by hookworms need to be differentiated from bacterial pneumonia and tuberculosis.
Digestive tract symptoms caused by hookworms need to be differentiated from chronic gastritis, duodenal ulcer, etc.
Treatment
Aim of treatment: relieve symptoms and improve anemia.
Treatment principle: early deworming treatment, and active symptomatic treatment.
Deworming treatment
At present, widely used anthelmintic drugs include albendazole and mebendazole, which can kill adult worms and eggs when taken orally.
Combined use of drugs can improve the efficacy of treatment, often need to be repeated several times to give drugs.
Symptomatic treatment
Patients with symptoms of hookworm dermatitis can apply local hot compresses or hot water immersion to help relieve itching and anti-inflammation; or apply levamisole skin coating or albendazole ointment to the local skin.
Anemic people need to supplement iron such as ferrous sulfate, ferrous succinate, etc., can be supplemented with vitamin C and folic acid to help iron absorption. Severe cases can be treated with small amounts of blood transfusion.
Prognosis
Cure
Hookworm disease is mostly curable with medication, and most symptoms disappear once the infection is cleared.
A small number of patients have a poorer prognosis. Pregnant women may have miscarriages, etc., and infants and young children may have growth retardation.
Hazard
Pregnant women with hookworm disease are prone to iron deficiency anemia, gestational hypertension syndrome, causing miscarriage, preterm delivery or stillbirth.
Infants with hookworm disease may have diarrhea, black stools or bloody watery stools, which can lead to growth retardation and anemia, and can lead to death if not diagnosed and treated in time.
Daily
Daily management
Daily diet needs to be rich in iron and protein foods such as beef and pork, fish and milk, and fresh fruits and vegetables such as spinach, lettuce, oranges and apples.
Patients with loss of appetite and black stools should eat soft food that is easy to digest, such as noodles, rice porridge, etc. Avoid eating cold and spicy food, and avoid rough and hard food.
Anemic people need to pay attention to rest, moderate exercise, reduce strenuous farm work and housework, avoid strenuous exercise.
Prevention
The following ways can be used to help reduce hookworm infections.
Managing sources of infection
In infected areas, actively deworming patients with hookworm disease, publicizing knowledge about hookworm disease to villagers and school children, and conducting annual hookworm disease screening.
Cutting off transmission routes
Use sanitary toilet facilities, enhance harmless treatment of feces, and avoid fecal contamination of soil.
Prevent direct skin contact with the soil, do not work barefoot in the fields, and do not touch the ground with bare hands.
Pay attention to dietary hygiene, do not eat unhygienic vegetables, and wash hands before and after meals to prevent oral infection by hookworms.
Protection of susceptible people
Currently there is no safe and effective hookworm vaccine, for high-risk groups such as farmers, preschool children, women of childbearing age, should do a good job of personal protection, pay attention to do not come into direct contact with the contaminated soil, if you have to come into contact with the need to wear shoes or waterproof gloves, etc. [9-11].