Year
A 64-year-old man, farmer by occupation presented with progressive fatigue over 3 months, occasional shortness of breath with minimal exertion, pale conjunctiva. He gives history of walking barefoot while working in agricultural areas. Stool sample was sent for microscopy and culture
- What is the diagnosis?
- What is the mode of acquisition?
- What is the treatment of choice?
Case answer – Posted on: 15-Nov-2024
- What is the diagnosis?
Iron deficiency anaemia due to hookworm infection. The microscopy image from the culture shows a hookworm filariform larva (L3) which measures 660-720 µm in length. The larva has an esophageal bulb extending one-third of the body length, and its posterior end is acutely tapered and pointed. - What is the mode of acquisition?
Hookworm infection occurs by the penetration of skin by L3 larva (walking bare foot in dampen soil). - What is the treatment of choice?
T. albendazole 400 mg once with oral iron replacement. Other alternatives include T. mebendazole and pyrantel pamoate. Prevention includes educating people to wear shoes, along with regular deworming of at-risk groups such as children, pregnant women, and women of childbearing age. These measures can prevent and reverse malnutrition and iron-deficiency anaemia.
References:
- Jourdan PM, Lamberton PHL, Fenwick A, Addiss DG. Soil-transmitted helminth infections. Lancet. 2018 Jan 20;391(10117):252–65.
- Taylor-Robinson DC, Maayan N, Soares-Weiser K, Donegan S, Garner P. Deworming drugs for soil-transmitted intestinal worms in children: effects on nutritional indicators, haemoglobin, and school performance. Cochrane Database Syst Rev. 2015 Jul 23;2015(7):CD000371.
- Bieri FA, Gray DJ, Williams GM, Raso G, Li YS, Yuan L, et al. Health-education package to prevent worm infections in Chinese schoolchildren. N Engl J Med. 2013 Apr 25;368(17):1603–12.