Modern Medicine: Can hookworm hook you?


“Worms” are everywhere. Probably the commonest infestation of mankind. All children go through harboring worms at some stage, but usually the tiny thread worms.

Of course, when you talk about ‘worms’, most people only think of threadworms that all children seem to get. The answer is always “a good worming”. Yes, we’ve all been down to the chemist shop and bought a packet of ‘worming’ tablets.

However, you should not imagine that ‘worms’ stops there. I can assure you that there are far more dangerous wrigglers in the community. And the sandy beaches are the habitat for some of them.

My friends laugh at me when they see me walking along the beach. Instead of letting the cool sand squish between my toes, I wear closed shoes. Does this mean I am a pedantic pedestrian? Or a member of a weird anti-sandal sect? Fortunately it is neither. I am just a trifle afraid of Ancylostoma duodenale. And so should you!

Ancylostoma duodenale is one of the two hookworms that can get their hooks into you (and me if I let them). The other is called Necator americanus. These little chaps are roundworms between 7 to 13 mm long and are far from rare. Approximately one-quarter of the world’s population is infected with Hookworm.

So how do you get infected? Easy, the hookworm eggs are passed in feces (or poop if you prefer) and infection results when you come in contact with the eggs from the contaminated soil. The larvae enter through the skin and travel to the lungs through the blood. They ascend the lungs through the bronchi and trachea and are then swallowed. As the larvae pass into the digestive tract, they attach themselves to the wall of the small intestine. Here they mature into adult worms, mate and feed on the blood of the host. And adult hookworms may live up to ten years. A not so Happy Birthday!

Unfortunately many hookworm infestations do not produce symptoms; however, there may be local irritation of the skin where the worm penetrated or even an itchy rash. While going through the lungs, there may be asthma-like symptoms or even pneumonia. The most common symptoms of hookworm infection, however, are from their taking up residence in the intestine. Hookworm here can lead to abdominal pain, diarrhea, weight loss, loss of appetite and excessive gas.

With long-standing infections, the intestine’s owner may become anemic as the worms feed on the individual’s blood. This in turn leads to the usual anemic symptoms including pale complexion, tiredness and weakness.

Diagnosis is done by looking for hookworm eggs in the stool (by using a microscope). Blood tests will show the amount of blood loss and can be used as a pointer towards the seriousness of the infestation.

Fortunately hookworm is treatable, generally with the drug mebendazole. This drug cures more than 99 percent of all cases of hookworm if given twice per day for three days. It kills both the worms and the eggs, but is contraindicated during pregnancy (your pregnancy, not its pregnancy!). If anemia has become a problem, then iron supplements can be given as well. Once treated, the symptoms settle quickly in a few weeks at most.

So what can you do to avoid hookworms? Well since hookworm infection comes from non-hygienic practices and fecal contact in the soil, my shoes sound like a great idea, don’t you think? Never mind the problems with hypodermic needles found in the sand in many countries these days!

Hookworm infections should be dealt quickly and stringently. Known symptomatic infections should be treated rapidly and treatment given to asymptomatic family members or neighbors. Strict attention to cleanliness and sanitary practices is needed when a hookworm infection is detected to prevent its spread. This means hygienic disposal of human waste, limiting skin contact with soil and even water, where there is untreated sewage.

Hookworm can be a very serious illness so it is essential to be aware of any change in one’s health status. Any difficulty breathing, rapid heartbeat, chest or abdominal pain, bloody diarrhea, blood with coughing, asthma-like symptoms, skin rashes, abdominal swelling or bloating, lightheadedness or weight loss should be brought to your doctor’s attention.

Me? I’ll just keep wearing shoes!