Anemia severa en adulto joven con infección por uncinarias / Severe anemia in a young adult with hookworm infection

La uncinariasis, anquilostomiasis o también conocida como anemia tropical, es una parasitosis intestinal de gran importancia mundial. Las uncinarias son parásitos nematodos transmitidas por el contacto de la piel con suelos contaminados. Una de las consecuencias más importantes de la infección masiva por estos parásitos es el sangrado intestinal crónico que conduce a disminución de la hemoglobina, y en casos inusuales, esta anemia puede llegar a ser severa. Con el objetivo de poner en discusión la importancia y morbilidad de esta enfermedad, presentamos el caso de un varón de 23 años, procedente de una zona tropical del Perú, quien ingresa por emergencia con un valor de hemoglobina de 2,3 mg/dL, alteración del nivel de conciencia e historia de rectorragia. Durante el proceso diagnóstico se encuentra en la colonoscopia múltiples parásitos con áreas de sangrado y colitis erosiva, mientras que en el examen parasitológico se observan huevos de Ancylostoma/Necator spp 2+. La sintomatología mejora posterior al tratamiento con albendazol. La uncinariasis debe siempre sospecharse en el proceso diagnóstico de pacientes con anemia crónica tanto en Perú como en zonas tropicales del mundo.(AU)

Uncinariasis or ancylostomiasis, a.k.a. tropical anemia, is an intestinal parasitosis of great importance worldwide. Hookworms are parasitic nematodes transmitted by skin contact with contaminated soils. One of the most important consequences of massive infection by these parasites is chronic intestinal bleeding, which leads to reduced hemoglobin. In unusual cases the resulting anemia may be severe. With the purpose of discussing the importance and morbidity of this disease, a case is presented of a male 23-year-old patient from a tropical area in Peru who was admitted for an emergency hemoglobin value of 2.3 mg/dL, altered mental status and a history of rectal bleeding. During diagnostic examination, colonoscopy revealed multiple parasites with bleeding areas and erosive colitis, whereas parasitological analysis found eggs of Ancylostoma/Necator spp 2+. Symptoms improved after treatment with albendazole. Uncinariasis should always be suspected in the process of diagnosis of patients with chronic anemia both in Peru and in tropical areas worldwide(AU)

The effect of hookworm infection and urinary scistosomiasis on blood hemoglobiin concentration of schoolchildren living in northern Mozambique / Infecções por ancilostomídeos e Schistosoma haematobium e sua correlação com a concentração sanguínea de hemoglobina em crianças moçambicanas

This study aims to assess the association between schistosomiasis and hookworm infection with hemoglobin levels of schoolchildren in northern Mozambique. Through a cross-sectional survey, 1,015 children from five to 12 years old in the provinces of Nampula, Cabo Delgado and Niassa were studied. Hookworm infection and urinary schistosomiasis were diagnosed, through Ritchie and filtration methods, with a prevalence of 31.3% and 59.1%, respectively. Hemoglobin levels were obtained with a portable photometer (Hemocue®). The average hemoglobin concentration was 10.8 ± 1.42 g/dL, and 62.1% of the children presented levels below 11.5 g/dL, of which 11.8% of the total number of children had hemoglobin levels below 9 g/dL. A multiple linear regression analysis demonstrated negative interactions between hemoglobin levels and ancylostomiasis, this being restricted to the province of Cabo Delgado (β = -0.55; p < 0.001) where an independent interaction between hemoglobin levels and urinary schistosomiasis was also observed (β = -0.35; p = 0.016). The logistical regression model indicated that hookworm infection represents a predictor of mild (OR = 1.87; 95% CI = 1.17-3.00) and moderate/severe anemia (OR = 2.71; 95% CI = 1.50 - 4.89). We concluded that, in the province of Cabo Delgado, hookworm and Schistosoma haematobium infections negatively influence hemoglobin levels in schoolchildren. Periodical deworming should be considered in the region. Health education and improvements in sanitary infrastructure could achieve long-term and sustainable reductions in soil-transmitted helminthiases and schistosomiasis prevalence rates.

Este estudo tem como objetivo avaliar a relação entre a ancilostomíase e a esquistossomíase urinária com as concentrações sanguíneas de hemoglobina em crianças escolares no norte de Moçambique. Em estudo transversal, 1.015 crianças com idade entre cinco e 12 anos foram incluídas, nas Províncias de Nampula, Cabo Delgado e Niassa. A ancilostomíase e a esquistossomíase urinária foram diagnosticadas através das técnicas de Ritchie e de filtração da urina, respectivamente; prevalências de 31,3% e 59,1% foram observadas. As concentrações sanguíneas de hemoglobina foram obtidas com um fotômetro portátil (Hemocue). A concentração média de hemoglobina foi 10,8 ± 1.42 g/dL, 62,1% das crianças apresentaram concentração abaixo de 11,5 g/dL e 11,8% apresentaram nível abaixo de 9 g/dL. A regressão linear múltipla demonstrou interações negativas entre os níveis de hemoglobina e i) a infecção por ancilostomídeos (β = -0,55; p < 0,001) e ii) a esquistossomíase urinária (β = -0,35; p = 0,016), ambas associações restritas à Província de Cabo Delgado. Também em Cabo Delgado, o modelo de regressão logística demonstrou que a infecção por ancilostomídeos representa um preditor de anemia leve (OR = 1,87; 95% CI = 1,17-3,00) e anemia moderada/grave (OR = 2,71; 95% CI = 1,50 - 4,89). O estudo conclui que em Cabo Delgado, Moçambique, as infecções por ancilostomídeos e Schistosoma haematobium estão significativamente associadas a uma menor concentração sanguínea de hemoglobina em crianças em idade escolar. A administração periódica de anti-helmínticos deve ser feita regularmente. Melhorias na infraestrutura sanitária das regiões estudadas são as medidas mais eficazes para controle destas parasitoses.

Association between intestinal helminth infections and underweight among school children in Tikur Wuha elementary school, Northwestern Ethiopia

The association of intestinal helminths with under nutrition varies by locality. The objective of this study was to investigate the nature of the association of helminth infection with the nutritional status of school children in Tikur Wuha Elementary School, northwestern Ethiopia. A total of 403 school children were examined for intestinal helminth infection [stool samples] and nutritional status, thick Kato-Katz and anthropometric techniques, respectively during a baseline survey. Among these children, 235 were treated for helminth infection and re-examined for weight changes four weeks after treatment. Among the 403 study participants, 29.3%, 28.3% and 58.3% were stunted, underweight and infected with intestinal helminths, respectively. In the multivariate regression model, the probability of being underweight was significantly higher in children who were infected with intestinal helminths, aged 5-10 years and male compared with children who were without helminth infection, aged 11-15 years and female, respectively. The association of helminths with low body mass was strong in the case of hookworm infection, and the probability of being underweight significantly decreased with every one-year increase in the age of the children. The means for weight, weight-for-age z-scores and body mass index-for-age z-scores of the children significantly increased four weeks after treatment for helminth infection, with a single dose of albendazole and/or praziquantel. Helminth-infected male children in the 5- to 10-year-old age group were more vulnerable to undernutrition, which decreased four weeks after treatment. Thus, deforming of children living in the area might be important for improving their nutritional status

Hookworm infestation in children presenting with melena-case series

Hookworm infection is common in children and can present with symptoms of upper gastrointestinal bleeding and severe anemia. Ten children below 5 years presenting with melena and severe pallor were seen from December 2006 to May 2007 in the gastroenterology and hepatology department of children's hospital, Lahore. All patients had history of transfusion. Complete blood picture, eosinophil count with peripheral smear, stool complete examination for ova and cysts were performed in all cases, while upper and lower gastrointestinal endoscopies were performed in three patients to locate the source of bleeding. Stool routine examination in all these cases confirmed hook worm ova. These patients were managed with antihelmenthic and stool complete examination was done three days after the medicine. There was no mortality. Though upper gastrointestinal bleeding with hookworm infestation is very rare but in the developing countries it should be considered when other causes of upper gastrointestinal bleeding are ruled out

A study on the prevalence of hookworm infection in four districts of West Bengal and its linkage with anaemia.

Stool samples collected from the districts of Darjeeling, Jalpaiguri, Hooghly and Calcutta in West Bengal were examined for hookworm and associated parasites. It was found that maximum prevalence of hookworm was in Hooghly district (24.8%). N. americanus appeared to be more prevalent species in all the districts studied. The load ofhookworm infection appeared to be mostly in the mild range. Ascaris lumbricoides appeared to the most common accompanying infection. In the affected population, the degree of anaemia was mostly mild.

The prevalence of malnutrition and geo-helminth infections among primary schoolchildren in rural Kelantan.

A cross-sectional study of the nutritional status of schoolchildren aged 7-10 years from the Kuala Betis Resettlement Scheme in Gua Musang, Kelantan was done. A total of 291 schoolchildren were examined but only 183 (62.9%) fecal samples were returned for geo-helminth infection analysis. The prevalence of stunting was 40.4% and underweight was 28.4%. A total of 127 schoolchildren (69.4%) were positive for at least one of the 3 geo-helminth infections. The most common geo-helminth was Ascaris lumbricoides (62.8%), followed by Trichuris trichiura (38.9%), and hookworm infection was relatively low (12.6%). All the anthropometric indices measured were lower in the geo-helminth infected children compared to the uninfected childen, except for the weight-for-height z-score. However the differences were insignificant Geo-helminth infections may not be a significant factor in malnutrition of these schoolchildren. However, with the availability of safe, efficacious and cheap broad spectrum anthelmintics, regular mass treatment should be given in selected areas where the prevalence of geo-helminth infections is still high, so that these schoolchildren will be able to achieve their growth potential during their school years.

Uncinariasis grave que simuló enfermedad quirúrgica / Massive hookworm infestation that simulated a surgical problem

La uncinariasis es una parasitosis transmitida por el suelo que afecta aproximadamente a mil millones de personas en los países subdesarrollados. En el humano, esta enfermedad se caracteriza por verter grandes cantidades de sangre hacia el tubo digestivo del huésped. La hemorragia gastrointestinal grave debida a la infestación por Necator americanus es una complicación observada en niños pequeños; sin embargo, el íleo paralítico es un suceso muy raro y puede manifestarse como una urgencia quirúrgica. Se presentan los casos de dos niños que sufrieron peritonitis secundaria a uncinariasis. Uno de ellos sufrió además hemorragia grave. El otro, oclusión duodenal que requirió una duodenoyeyunoanastomosis laterolateral como procedimiento paliativo

Parámetros hematológicos en niños portadores de uncinarias en una población de la provincia de Corrientes / Hematologic parameters in hookworm infested children of a Corrientes province population

Se investigó la prevalencia de enteroparasitosis en 207 escolares de ambos sexos de la población rural de San Cayetano, Corrientes y en los parasitados con uncinaria se evaluó hemoglobina, valores de hierro sérico, capacidad total de fijación de hierro del plasma y saturación de transferrina. Se halló que 171 niños (82 por ciento de la población estudiada) eran portadores de un parásito o más, de los cuales 46 niños (28 varones y 18 mujeres) presentaron examen coproparasitológico positivo para uncinaria. De los 46 niños parasitados con uncinaria, el 67,4 por ciento fueron portadores de Necator americano; 23,91 por ciento de Necator americano + Ancylostoma duodenale; y 8,69 por ciento sólo de Ancylostoma duodenale. Una alta proporción de varones (78,57 por ciento) y de niñas (83,33 por ciento) presentaron anemia; definida con valores de hemoglobina inferiores al percentilo 3 de las tablas de Dallman y Siimes, aunque sólo el 7,14 por ciento de varones y el 11,11 por ciento de niñas presentaron valores de hemoglobina menores de 9 g por ciento. Un 21,42 por ciento de los varones y 33,33 por ciento de las niñas presentaron valores de hierro sérico menores de 35 µg/dl y 28,57 por ciento de varones y 27,77 por ciento de niñas presentaron saturación de transferrina menor de 13 por ciento. Los resultados hallados hacen necesaria la implementación de estrategias destinadas tanto a la disminución como a la prevención de la parasitosis y de la anemia en los niños de esta población rural

Hookworm anemia in the adult population of Jagapati village, Bali, Indonesia.

A cross sectional study was conducted in Jagapati Village, Bali to assess some characteristics of hookworm anemia among the adult population. Hookworm anemia was defined as an iron deficiency anemia in heavily infected individuals (EPG > 2,000). WHO criteria for anemia and criteria of Hercberg for iron deficiency were used. In this study, 15 cases of hookworm anemia were found among 454 total samples (3.3%), or among 123 cases of iron deficiency anemia (12.2%). The age varied between 16-69 years with male to female ratio of 1:2.8. Twelve cases were found with symptoms and signs of anemia, 1 case with full blown hookworm anemia, and 2 cases were asymptomatic. The hemoglobin level was found to be 4.5-12.9 g/dl, with 12 cases (80.0%) being classified as mild anemia, 2 cases (13.3%) as moderate anemia, and 1 case as severe anemia. The mean serum iron level was 39.6 mg/dl, mean transferrin saturation was 11.1%, and mean serum ferritin level was 9.6 ng/dl. Hypoalbuminemia was found in 9 cases (60.0%), eosinophilia in 8 cases (53.3%), and low serum folic acid level in 5 cases (38.5%). High total serum IgE level was found in all but one case, with mean total serum IgE level of 3,739 U/ml. The intensity of hookworm infection was moderate in 11 cases (73.3%) and severe in 4 cases (26.7%). It could be concluded that hookworm anemia was characterized by iron deficiency anemia with eosinophilia, high serum total IgE level, hypoalbuminemia and moderate to severe hookworm infection.

Hookworm infection and iron stores: a survey in a rural community in Bali, Indonesia.

A study of the rural population of the village of Belumbang, Province of Bali, Indonesia, has been conducted to assess the relationship between intensity of hookworm infection (hookworm egg count) and iron stores, hemoglobin level or hematocrit. There was a significant negative correlation between serum ferritin level and hookworm egg count. However no correlation was found between hookworm egg count and hemoglobin level or hematocrit. In a separate analysis the above correlation could be shown in male hosts but not in female hosts. It is concluded that hookworm infection, even in light infection, can interfere with iron stores, but in female hosts this effect might be masked by other factors.

Association of hook worm infestation with post cricoid carcinoma

During the period of August 1986 to April 1989 we had seen 50 cases of postcricoid carcinoma. Out of that, 10 cases had sideropenic dysphagia. Six patients [4 females and 2 males] of postcricoid carcinoma had hookworm infestation while rest of the four patients had other causes of iron deficiency anaemia. By timely diagnosis and treatment of infestation, pre-malignant changes can be reverted and malignancy avoided. The number of patients studied is however small which may be open to criticism but this definitely shows a trend. However, further large studies are needed

Gastrointestinal lesions in patients over 40 years of age with iron deficiency anemia and hookworm infection.

A prospective study of 41 patients (24 male and 17 female) aged over 40 years with iron deficiency anemia and hookworm infection was performed by endoscopy and barium enema to determine the incidence of GI lesions. Alcohol ingestion, smoking, abdominal pain, anorexia, loss in weight, bowel habit change, analgesic consumption and stool occult blood test were analyzed for their positive predictive value of GI lesions. The mean age of the patients was 62.8 years (SD = 10.1). The mean hemoglobin was 5.99 gm.% (SD = 1.9). Twenty patients (48.8%) had GI lesions. The lesions included 10 erosive gastritis, 1 erosive duodenitis, 5 gastric ulcers, 2 duodenal ulcers, 1 carcinoma of stomach and 1 carcinoma of colon. Gastric ulcer, duodenal ulcer and carcinoma were regarded as significant lesions. Abdominal pain was found in 16 of the 20 patients with GI lesions and 8 of the 21 without GI lesion (Chi square with Yate's correction, x2 = 5.78 p = 0.02). Four of the 17 patients without pain had GI lesions but only one of these 4 (5.8%) had gastric ulcer. Abdominal pain had an 80% sensitivity and 62% specificity for the positive prediction of GI lesions based on the above findings. GI investigation is recommended for all patients with abdominal pain. In those without pain, treatment of hookworm and iron therapy with follow-up may be justified.

Prevalence of intestinal parasitic infections in Kuwait

Individuals who were suspected of suffering from intestinal parasitic infections during the calender year of 1986 were examined macroscopically and microscopically for the identification of parasites at the 6 general hospitals in Kuwait city and its suburbs. A total of 1,437 females and 2,335 males were positive for parasites, and 2,228 individuals were reported being negative. The prevalence of potentially pathogenic parasites was 67% of the total, while the commensals reached 33%. Of the first group Giardia lamblia and Trichuris trichiura were the commonest followed by Strongyloides stercoralis and Hymenolepis nana. Among the commensals Entamoeba coli was encountered frequently, followed by Trichomonas hominis and Endolimax nana. The highest rate of infection was found among Kuwaiti nationals followed by the Bangladeshis, Sri Lankans, Indians and Egyptians. The high prevalence rate among Kuwaitis indicates that there is a high transmission rate of parasitic infections possibly due to importation of disease with imported labour for domestic help and poor hygiene from both parties. Therefore, it is recommended that domestic helpers, arriving from endemic areas, be routinely checked. Effective chemotherapy and proper education should be implemented