[Gastrointestinal bleeding in newborn with hookworm, National Hospital San Bartolome. Case report]. / Hemorragia digestiva en neonato con uncinarias, Hospital Nacional San Bartolomé. Reporte de caso.

We present the case of gastrointestinal bleeding uncinariasis in a newborn baby of 27 days old from anindigenous town of Tangoshiri, located in the province of La Convencion, department of Cuzco, who enters to the service of neonatology National Teaching Hospital San Bartolome in Lima, Peru, with decompensated severe anemia. The baby has melena since the fourth day of his birth, which increased in the third week of life, with hematocrit of 12%. She was hospitalized, receiving blood transfusion and she continue with gastrointestinal bleeding, so she underwent an upper endoscopy that showed multiple larvae Ancylostoma duodenale. She and her mother were treated with mebendazole. Afterwords they had stool examinations without the presence of the parasite.

Hookworm Anemia in a Peritoneal Dialysis Patient in China.

Hookworm infections as well as other intestinal nematodiases are endemic in China. In this case, a 70-year-old male showed symptoms of chest tightness, shortness of breath, and both lower extremities edema. The diagnostic result was chronic renal insufficiency, chronic kidney disease (5th stage), and renal anemia at first. Then, he received treatment with traditional drugs. However, this treatment did not help to alleviate the symptoms of the patient significantly. The results of gastroendoscopy showed hookworms in the duodenum, also confirmed by pathology examination. Anemia was markedly ameliorated after eliminating the parasites. The results mentioned above suggested that ancylostomiasis was the leading causes of anemia in this patient, and the etiology of anemia in uremic patients should be systematically considered. Especially when anemia could not be cured by regular treatments, rare diseases should be investigated.

[Massive hookworm infection as a cause of intestinal bleeding and severe anemia]. / Infección masiva por Ancylostoma duodenale como causa de hemorragia intestinal y anemia severa.

Overt gastrointestinal bleeding caused by hookworm infection is rarely reported. We present a 34 year old male with lower gastrointestinal bleeding with evidence of massive hookworm infection on colonoscopy and discuss the need to consider hookworm infection as a possible etiology of gastrointestinal bleed in endemic areas.

Laurence Moon Bardet Biedl Syndrome with anaemia.

Laurence Moon Bardet Biedl Syndrome is a rare genetic disorder. Consanguineous marriage is usually the common cause. Principal features of Bardet Biedl Syndrome are red cone dystrophy, obesity, polydactyl, hypogonadism and renal anomalies. The diagnosis was overlooked in our patient until he came in our hospital. We here report an infrequent case of autosomal recessive disorder with Anaemia.

Frequency and intensity of exposure mediate resistance to experimental infection with the hookworm, Ancylostoma ceylanicum.

Hookworms are bloodfeeding intestinal nematodes that are a major cause of anemia in resource-limited countries. Despite repeated exposure beginning in early childhood, humans retain lifelong susceptibility to infection without evidence of sterilizing immunity. In contrast, experimental infection of laboratory animals is typically characterized by varying degrees of resistance following primary infection, although the mechanisms underlying this phenomenon remain unknown. In this study, hamsters subjected to a single drug-terminated infection with 100 third stage hookworm larvae were confirmed to be resistant to pathological effects following a subsequent challenge. In a second experiment, hamsters infected twice-weekly with 10 third stage larvae (low inoculum) exhibited clinical and parasitological evidence of continued susceptibility, while those given 100 L3 (high inoculum) developed apparent resistance within 3 days following the initial exposure. The kinetics of parasite-specific IgA, IgM, and IgG antibody production varied by group, which suggests that the humoral immune response to hookworm infection is stimulated by the nature (frequency and intensity) of larval exposure. These results suggest that intermittent low-inoculum larval exposure, which is characterized by prolonged susceptibility to infection, may serve as a more representative model of human hookworm disease for studies of pathogenesis, as well as drug and vaccine development.

Evaluation of parasitological and immunological aspects of acute infection by Ancylostoma caninum and Ancylostoma braziliense in mixed-breed dogs.

This study compared the course of infection by Ancylostoma caninum and Ancylostoma braziliense in mixed-breed dogs infected with L3 larvae. Dogs infected with A. caninum eliminated more eggs than did those infected with A. braziliense. A total of 38 % of A. caninum and 44 % of A. braziliense larvae were recovered as adult worms. There were no marked clinical abnormalities in dogs with either infection. A. caninum was associated with anemia and an increased number of circulating neutrophils, whereas infection with A. braziliense led to a decrease in the number of leukocytes. The humoral response against excreted and secreted antigens from adult worms was more sensitive and specific than the response induced with the crude antigen. No immune response was observed for either crude or excreted-secreted (ES) antigens from larvae of either species. A nonspecific response against the crude antigen of A. braziliense was found at 0 and 7 days postinfection and maintained throughout the infection period. However, antibody titers against ES antigens were elevated in A. caninum infection at patency and death, showing that this antigen has a higher specificity. The immune response elicited by infection with A. braziliense in dogs has not been described previously. No significant differences were observed in the infection processes of the two Ancylostoma species, except for the higher number of eggs eliminated from dogs infected with A. caninum, which may indicate a better evolutionary adaptation of the parasite to its host in comparison with A. braziliense.

[Chronic and severe anemia caused by Ancylostoma duodenale in Ecuador. Diagnosis by duodenoscopy]. / Anemia crónica grave por Ancylostoma duodenale en Ecuador. Diagnóstico por duodenoscopia.

For 11 years, a 38-year-old male residing in a subtropical region of Ecuador, was repeatedly diagnosed with chronic anemia, and treated with blood transfusions in a hospital of province of Cotopaxi, Ecuador. He was transferred to Quito for severe anemia, having hemoglobin of 4 g/dL. Duodenoscopy was performed and adult nematodes, identified later as Ancylostoma duodenale, were observed. The patient was successfully treated with albendazole for five consecutive days and given blood transfusions. In the control visit at eight months, without anemia and no hookworm ova in the stool examined were found.

Colitis due to Ancylostoma duodenale.

The larva of hookworm matures into the adult stage in the small intestine, causing chronic intestinal blood loss and iron-deficiency anemia. Hookworm infestation of colon has not been reported previously. We report a 35-year-old man who presented with diarrhea with blood and mucus in stools. Colonoscopy revealed several hookworms in the colon firmly adherent to the mucosa, with oozing of blood and surrounding mucosal erosions. He was treated with mebendazole and symptoms recovered completely.

[Anaemia in a school of rural Cambodia: detection, prevalence, and links with intestinal worms and malnutrition]. / Anémie dans une école du Cambodge rural: détection, prévalence et liens avec les parasitoses intestinales et la malnutrition.

According to WHO, half of the world's children suffers from anaemia, which is a silent and neglected endemic resulting from three major causes: iron deficiency intestinal worms and malaria. A two month transversal study was conducted in a rural primary school in Battambang Province, Cambodia, in a malaria-free area. The main objective of the study was to assess the prevalence of anaemia and two of its possible driving factors, intestinal parasites and general malnutrition; a secondary objective was to assess the accuracy of haemoglobin colour scale, an easy and cheap visual technique compared to spectrophotometry used as the reference. Among 168 school children (average age: 11), the prevalence rates of moderate and severe anaemia were 24% and nil respectively; average haemoglobin was 12.6 g/dl. These results compared favourably with previous data from Cambodia. In our study's conditions, the haemoglobin colour scale grossly overestimated the anaemia prevalence: 83 vs. 24%, specificity 22%. Despite its simplicity and very low cost, this technique appeared inaccurate. Anaemia was independently associated with Ancylostoma carriage (p = 0.05), and stunting (p = 0.01), which prevalences were 54% et 40% respectively; and this, despite a mebendazole 500 mg dose given 9 months prior to the study as part of a regular deworming school program. Although periodical mass deworming in schools does not prevent early Ancylostoma reinfection, it may reduce the severity of anaemia. It therefore appears fully justified, and may be strengthened, notably by switching from mebendazole to albendazole.

[Upper gastrointestinal bleeding induced by hookworm infection: one case report].

This paper reports a case of upper gastrointestinal bleeding induced by hookworm infection, which was misdiagnosed at the beginning, and analyzes the causes of misdiagnosis.

Multiparasitism and intensity of helminth infections in relation to symptoms and nutritional status among children: a cross-sectional study in southern Lao People's Democratic Republic.

The occurrence and spatial distribution of intestinal helminth infection in children is fairly well understood. However, knowledge on how helminth infections govern intestinal morbidity is scarce. We conducted a cross-sectional study to assess and quantify the relationship between single and multiple species helminth infection with clinical and self-reported morbidity indicators and nutritional status in Champasack province, southern Lao People's Democratic Republic (Lao PDR). A random sample of 1313 children, aged 6 months to 12 years, from villages in nine rural districts were enrolled and examined for helminth infection using duplicate Kato-Katz thick smears. Morbidity was assessed by self-reported symptoms, coupled with clinical examination and appraisal of nutritional status and anaemia. Bivariate and multivariate logistic regression was employed to study associations between helminth infection and morbidity indicators and anaemia. We found considerable morbidity among the surveyed children, including hepatomegaly (13.7%), pale conjunctiva (13.2%) and abdominal pain (10.4%). Anaemia was recorded in 60.4% of the children, whilst signs of stunting and low body mass index (BMI) were observed in 49.8% and 33.3% of the surveyed children, respectively. Hookworm and Opisthorchis viverrini were the predominant helminth species with prevalences of 51.0% and 43.3%, respectively. The prevalence of Schistosoma mekongi in the surveyed children was 5.6%. Multiple species helminth infections were recorded in 40.4% of the study cohort. Morbidity was associated with specific helminth species infection (e.g. S. mekongi with hepatomegaly; adjusted odds ratio (aOR): 9.49, 95% confidence interval (CI): 2.07-43.51) and multiparasitism (e.g. two or more helminth species with abdominal pain; aOR: 2.40, 95% CI: 1.46-3.93). Anaemia was associated with hookworm infection (aOR: 1.64, 95% CI: 1.16-2.34) and multiparasitism (aOR: 1.64, 95% CI: 1.18-2.29). Low BMI was associated with O. viverrini infection (aOR: 1.68, 95% CI: 1.14-2.49) and multiparasitism (aOR: 1.42, 95% CI: 1.01-2.00). The multiple strong associations reported here between helminth infections (single or multiple species) and intestinal morbidity among children in rural parts of southern Lao PDR call for concerted efforts to control helminth infections, which in turn might improve children's health and development.

Parasites ana malabsorption.

Intestinal parasites not only cause diarrheal illnesses but may also cause significant malabsorption in man. Separation of true malabsorption caused by a particular parasite from other factors that may coexist with and even mimic malabsorption, such as malnutrition may be very difficult. Despite these problems, it appears that giardiasis, coccidiasis, strongyloidiasis and capillariasis cause malabsorption of many important nutrients. D. latum interfere with vitamin B12 absorption.

Resistance of the hookworms Ancylostoma ceylanicum and Necator americanus to intestinal inflammatory responses induced by heterologous infection.

Experiments were carried out to ascertain whether the acute inflammatory phase of the intestinal response of hamsters to infection with Trichinella spiralis would adversely affect hookworms in concurrently infected animals. The survival and growth of hookworms were unaffected. However, the presence of hookworms reduced the establishment of T. spiralis, the initial growth of female worms and their fecundity. The expulsion of T. spiralis was also significantly slower in concurrently infected animals and there was significant depression of the serum IgG antibody response to muscle stage and adult worm antigens of T. spiralis in concurrently infected animals. These results are discussed in relation to the chronicity of human hookworm infections.

Necatoriasis: treatment and developmental therapeutics.

Two hookworm parasites, Necator americanus and Ancylostoma duodenale, infect approximately one billion people worldwide. These hookworms are one of the leading causes of iron-deficiency anaemia especially in children, resulting directly from intestinal capillary blood loss following the feeding activities of fourth-stage (L(4)) larva and adult worms. If ignored, human hookworm infections can retard growth and the intellectual development of children. Another clinical manifestation often associated with hookworm infections is cutaneous larva migrans (CLM). It is a well recognised, usually self-limiting condition caused by the infectious larvae of nematodes, especially Ancylostoma spp. CLM is characterised by skin eruption and represents a clinical description rather than a definitive diagnosis. Of the hookworm parasites, the dog and cat worm A. braziliense and A. caninum are the most common nematodes causing CLM, although many other species have also been implicated. The major subject of this review article will be discussion of the evolution of therapies and treatment of human necatoriasis and the development of experimental infections with N. americanus. Difference in the clinical efficacy of mebendazole and albendazole will be discussed along with drug resistance of N. americanus.

Epidemiological evidence for a differential effect of hookworm species, Ancylostoma duodenale or Necator americanus, on iron status of children.

BACKGROUND: The hookworms, Ancylostoma duodenale and Necator americanus, cause significant gastrointestinal blood loss. In clinical studies, greater blood losses have been reported with A. duodenale. However, there has been no evidence that endemic A. duodenale infection has greater impact than N. americanus infection on the iron status of populations. METHODS: In a sample of 525 school children in Pemba Island, Tanzania, we compared the degree of anaemia and iron deficiency associated with the two hookworm species at the individual and community (i.e. school) levels. Multiple regression was used to control for infection intensities and other child characteristics. RESULTS: In the 492 children with hookworm positive faecal cultures, haemoglobin and ferritin concentrations decreased with increasing proportions of A. duodenale. Among children with only N. americanus larvae, the prevalence of anaemia was 60.5 % and the prevalence of ferritin <12 microg/l was 33.1%, while in children with > or =50% A. duodenale larvae, the respective prevalences were 80.6% and 58.9%. When children were grouped by the prevalence of A. duodenale at the school level, children from high prevalence (> or =20%) schools had significantly worse iron deficiency and anaemia than children from low prevalence schools. CONCLUSIONS: The species of hookworm being transmitted in a community influences the burden of iron deficiency anaemia in the community, and should be considered in prioritizing and planning programmes for hookworm and anaemia control.

PIP: Hookworms infect 1.3 billion people annually. Iron-deficiency anemia caused or exacerbated by intestinal blood loss is the major feature of hookworm infection, with such loss caused by the feeding of hookworms upon the intestinal mucosa. The hookworms Ancylostoma duodenale and Necator americanus cause major gastrointestinal blood loss. While relatively greater blood loss has been reported in clinical studies due to infection with A. duodenale, there has been no evidence that endemic A. duodenale infection has a greater impact than N. americanus infection upon the iron status of populations. The authors compared the degree of anemia and iron deficiency associated with these 2 hookworm species at the individual and community levels using a sample of 525 school children in grades 1-4 in Pemba Island, Tanzania, and controlling for infection intensities and other child characteristics through multiple regression. In the 492 children with hookworm-positive fecal cultures, hemoglobin and ferritin concentrations decreased with increasing proportions of A. duodenale. Among children with only N. americanus larvae, the prevalence of anemia was 60.5% and the prevalence of ferritin under 12 mcg/l was 33.1%. In children with 50% or higher proportions of A. duodenale larvae, the respective prevalences were 80.6% and 58.9%. Children from schools with high prevalences of A. duodenale infection had significantly worse iron deficiency and anemia than did children from low prevalence schools.