Pediatric Hookworm Infection Clinical Presentation

  • Author: Christopher M Watson, MD, MPH; Chief Editor: Russell W Steele, MD   more...
 
Updated: Apr 26, 2012
 

History

  • Most individuals with hookworm infection are asymptomatic.[12]
  • During the first 1-2 weeks after a cutaneous infection, hookworm produces an intensely pruritic dermatitis at the site of infection termed ground itch.[12]
  • Wakana syndrome occurs in people who have been infected with a large burden of A duodenale by means of oral ingestion. This syndrome is similar to an immediate-type hypersensitivity reaction characterized by pharyngeal itching, hoarseness, nausea, vomiting, cough, dyspnea, and eosinophilia.[7]
  • Mild cough, dysphagia, and fever may occur during pulmonary migration.
  • Loeffler syndrome is rare during pulmonary infection. It is characterized by paroxysmal attacks of cough, dyspnea, pleurisy, little or no fever, and eosinophilic pulmonary infiltrates that last several weeks after the initial infection.[7]
  • After the worm migrates into the intestines, patients may have nausea, abdominal pain, and flatulence. These symptoms peak 30-45 days after infection.
  • Patients with severe anemia may have fatigue, syncope, or exertional dyspnea. They may also have a history of perverted taste and pica.
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Physical

  • Stunted growth may be observed in children with severe infection.[13]
  • An erythematous, pruritic, papulovesicular rash on the palms and soles at the site of initial infection may persist for 1-2 weeks after initial infection.
  • During pulmonary migration, cough, fever, and a reactive bronchoconstriction may be observed, with wheezing heard on auscultation.
  • Abdominal examination may reveal midepigastric pain on palpation during the period of intestinal involvement.
  • Hypoproteinemia may lead to anasarca and peripheral edema.[4]
  • Tachycardia, hypothermia, and pallor may be present due to anemia.
  • Stools may be bloody or melanotic.
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Causes

Poor sanitation, limited access to clean water, and low income are well-documented risk factors for hookworm infection. High-risk populations include international travelers, refugees, international adoptees, and recent immigrants.[12]

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Contributor Information and Disclosures
Author

Christopher M Watson, MD, MPH  Assistant Professor of Pediatrics, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Assistant Professor of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine

Christopher M Watson, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Medical Association, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Patrick W Hickey, MD, FAAP  Assistant Professor of Pediatrics and Preventive Medicine, Uniformed Services University of the Health Sciences; Consulting Staff, Department of Pediatrics, Division of Pediatric Infectious Disease, Walter Reed Army Medical Center

Patrick W Hickey, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society of Tropical Medicine and Hygiene, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Ashir Kumar, MD, MBBS, FAAP  Professor Emeritus, Department of Pediatrics and Human Development, Michigan State University College of Human Medicine

Ashir Kumar, MD, MBBS, FAAP is a member of the following medical societies: American Association of Physicians of Indian Origin and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Martin Weisse, MD  Program Director, Associate Professor, Department of Pediatrics, West Virginia University

Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Walter Reed National Military Medical Center, Uniformed Services University of Health Sciences, Department of the Navy, Department of the Army, or the Department of Defense.

References

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  16. Stoltzfus RJ, Kvalsvig JD, Chwaya HM, et al. Effects of iron supplementation and anthelmintic treatment on motor and language development of preschool children in Zanzibar: double blind, placebo controlled study. BMJ. Dec 15 2001;323(7326):1389-93. [Medline].

  17. Le Huong T, Brouwer ID, Nguyen KC, Burema J, Kok FJ. The effect of iron fortification and de-worming on anaemia and iron status of Vietnamese schoolchildren. Br J Nutr. May 2007;97(5):955-62. [Medline].

  18. Flohr C, Tuyen LN, Lewis S, et al. Low efficacy of mebendazole against hookworm in Vietnam: two randomized controlled trials. Am J Trop Med Hyg. Apr 2007;76(4):732-6. [Medline].

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  20. Soukhathammavong PA, Sayasone S, Phongluxa K, Xayaseng V, Utzinger J, Vounatsou P. Low efficacy of single-dose albendazole and mebendazole against hookworm and effect on concomitant helminth infection in Lao PDR. PLoS Negl Trop Dis. Jan 2012;6(1):e1417. [Medline].

  21. Ziegelbauer K, Speich B, Mäusezahl D, Bos R, Keiser J, Utzinger J. Effect of sanitation on soil-transmitted helminth infection: systematic review and meta-analysis. PLoS Med. Jan 2012;9(1):e1001162. [Medline].

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  23. Sakti H, Nokes C, Hertanto WS, et al. 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].

  24. Diemert DJ, Bethony JM, Hotez PJ. Hookworm vaccines. Clin Infect Dis. Jan 15 2008;46(2):282-8. [Medline].

  25. Hotez PJ, Zhan B, Bethony JM, et al. Progress in the development of a recombinant vaccine for human hookworm disease: the Human Hookworm Vaccine Initiative. Int J Parasitol. Sep 30 2003;33(11):1245-58. [Medline].

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  27. Bethony JM, Simon G, Diemert DJ, et al. Randomized, placebo-controlled, double-blind trial of the Na-ASP-2 hookworm vaccine in unexposed adults. Vaccine. May 2 2008;26(19):2408-17. [Medline].

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  29. Larocque R, Casapia M, Gotuzzo E, et al. A double-blind randomized controlled trial of antenatal mebendazole to reduce low birthweight in a hookworm-endemic area of Peru. Trop Med Int Health. Oct 2006;11(10):1485-95. [Medline].

  30. Stoltzfus RJ, Albonico M, Chwaya HM, et al. Effects of the Zanzibar school-based deworming program on iron status of children. Am J Clin Nutr. Jul 1998;68(1):179-86. [Medline].

 
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Life cycle of the hookworm. Courtesy of the Division of Parasitic Diseases, Centers for Disease Control and Prevention (CDC).
Hookworm egg. Courtesy of Patrick W Hickey, MD.
Hookworm rhabditiform larva. Courtesy of the Division of Parasitic Diseases, Centers for Disease Control and Prevention (CDC).
Hookworm filariform larva. Courtesy of the Division of Parasitic Diseases, Centers for Disease Control and Prevention (CDC).
Adult Ancylostoma duodenale worm. Anterior end with mouth parts visible. Courtesy of Patrick W Hickey, MD.
Adult Necator americanus worm. Anterior end with mouth parts visible. Courtesy of Patrick W Hickey, MD.
 
 
 
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