Hookworm in Emergency Medicine Workup

  • Author: Anika Baxter Tam, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Mar 30, 2011
 

Laboratory Studies

Early infection (larval migration phase)

  • A differential may reveal eosinophilia (1000-4000 cells/mcL).
  • In the early phase, the stool examination is normal.

Established infection (adult/GI phase)

  • In patients with mature infection, eggs may be seen during stool examination.
  • If eggs are not seen, the likelihood of clinically significant infection is very low.
  • When infection is suspected, stool should be promptly evaluated because eggs hatch into infective larvae within 24 hours.
  • Laboratory findings may be consistent with iron deficiency anemia.

Hookworm anemia

  • A CBC count may demonstrate iron deficiency anemia.
  • Stool examination may demonstrate significant number of hookworm eggs.
  • Other causes of iron loss and blood loss should be excluded.
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Imaging Studies

  • In the larval migration phase, a patchy infiltrate may be revealed by chest radiography.
  • Imaging studies are not helpful once infection is established in the gut.
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Other Tests

  • Stool should be examined for ova and parasites. However, because egg laying may be delayed, stool examination should not be considered a sensitive test for identifying hookworm infection. Stool examinations may need to be repeated.
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Contributor Information and Disclosures
Author

Anika Baxter Tam, MD  Staff Physician, Department of Emergency Medicine, New York University / Bellevue Hospital

Disclosure: Nothing to disclose.

Coauthor(s)

Aaron Hexdall, MD  Assistant Professor, Director of the International Emergency Medicine Initiative, Department of Emergency Medicine, Tufts University School of Medicine, Baystate Medical Center

Disclosure: Nothing to disclose.

Eric L Weiss, MD, DTM&H  Director of Stanford Travel Medicine, Medical Director of Stanford Lifeflight, Assistant Professor, Departments of Emergency Medicine and Infectious Diseases, Stanford University School of Medicine

Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Association for Oncology, Southern Clinical Neurological Society, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mark Louden, MD, FACEP  Assistant Medical Director, Emergency Department, Duke Raleigh Hospital

Mark Louden, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Jeffrey L Arnold, MD, FACEP  Chairman, Department of Emergency Medicine, Santa Clara Valley Medical Center

Jeffrey L Arnold, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

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  4. de Silva NR, Brooker S, Hotez PJ. Soil-transmitted helminth infections: updating the global picture. Trends Parasitol. Dec 2003;19(12):547-51. [Medline].

  5. Freedman DO. Intestinal nematodes. In: Gorbach SL, Bartlett JG, Blacklow NR, eds. Infectious Diseases. WB Saunders Company; 1992:2003-8.

  6. Gilles HM. Intestinal nematode infections. In: Hunter's Tropical Medicine. WB Saunders Company; 1984:620-46.

  7. Hotez PJ. A plan to defeat neglected tropical diseases. Sci Am. Jan 2010;302(1):90-4, 96. [Medline].

  8. Hotez PJ, Brooker S, Bethony JM. Hookworm infection. N Engl J Med. Aug 19 2004;351(8):799-807. [Medline].

  9. Hotez PJ, Pritchard DI. Hookworm infection. Sci Am. Jun 1995;272(6):68-74. [Medline].

  10. Medical Letter, Inc. Drugs for parasitic infections. Med Lett Drugs Ther. The Medical Letter. Available at http://www.medletter.com. Accessed March 12, 2006.

  11. Nawalinski TA, Schad GA. Arrested development in Ancylostoma duodenale: course of a self-induced infection in man. Am J Trop Med Hyg. Sep 1974;23(5):895-8. [Medline].

  12. Rizzitelli G, Scarabelli G, Veraldi S. Albendazole: a new therapeutic regimen in cutaneous larva migrans. Int J Dermatol. Sep 1997;36(9):700-3. [Medline].

  13. Sakti H, Nokes C, Hertanto WS. Evidence for an association between hookworm infection and cognitive function in Indonesian school children. Trop Med Int Health. May 1999;4(5):322-34. [Medline].

 
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