2. hookworm and strongyloides
TRANSCRIPT
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Hookworms 740,000,000
Ascaris lumbricoides 1,472,000,000
Trichuris trichiura 1,049,000,000
Wuchereria bancrofti 107,000,000
Schistosomes (all) 200,000,000
Estimated Prevalence
Source: American Society For Parasitologists 2003
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Morbidity and Mortality
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The Hookworms Ancylostoma duodenale Necator americanus
Helminths Nematoda:
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Length - 15 kilometersDepth - 1,700 meters
Antonie Dubini* and the Saint Gotthard TunnelHookworm Epidemic of 1880
* Dubini, A. Ann. Univ. Med. Milano. 1843 106:5-13. First record of disease caused by hookworm
“An effort….. to build a rail tunnel through the St. Gotthard massif was treacherous. That construction between 1872 and 1882 was plaguedby bad rock and flooding. It killed 310 workers, incapacitated 877 othersand bankrupted the contractor”.
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Gen. R. E. Lee Gen. G. G. Meade
Pickett’s Charge
Civil War -1861-1865
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Distribution Of hookworm up to 1927
One theory suggeststhat hookworm diseasemay have influenced the outcome of the civil war.Southern troops grew upwith the infection and hadlittle in the way of sturdyclothing or shoes. Hookwormswere brought to America fromAfrica in the early 1800svia the slave trade. They havebeen here ever since.
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Economic recovery was slow following the Civil War, and J. D. Rockefeller wanted to know why!
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John D. RockefellerOil Baron par excellent JDR established a sanitary commission (1909-1915)
headed by Charles Wardell Stiles to look into the matterof “southern laziness”.
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The Pit Privy
Depth - 6 feet
Distribution and installationbegan in the 1920’s followingThe Rockefeller SanitaryCommission Report to Congress.
Height to which hookwormlarvae can crawl = 4 feet.
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Colorado Out House*
Circa 2006* The camper’s best friend
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Adult female Ancylostoma duodenale
Head
Tail
1 cm
Looss’ original elegant drawings
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Adult male Ancylostoma duodenale
Head
Tail
1 cm
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Adult Ancylostoma duodenale
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Adult Necator americanus
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Histological section of adult hookworm attached to villus of small intestine
Head attached to villus
Muscular esophagealbulb
Villus
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Hookworm larvae in dog skin
Hair shaft Capillary
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Pathogenesis:Adult worms suck blood and feed on villus tissue.
In order to do all this, the worm has evolved a set ofpowerful anti-coagulants*evenmore effective than those of themedical leech. The cDNAsfor these HW peptides have beencloned and may offer someinteresting practical applicationsfor medical use.
* Cappello, M. et al. 1995. PNAS USA. 92: 6152-56
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Term: Para-pharmacologyTerm: Para-pharmacology
Definition: The science of taking advantage ofDefinition: The science of taking advantage of parasite-specific products to betterparasite-specific products to better humankind! humankind!
Rationale:Rationale: The current The current pharmacopia pharmacopia of anti-parasiticof anti-parasitic drugs is running out of options. Lets turndrugs is running out of options. Lets turn their swords into our plowshares! their swords into our plowshares!
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Hookworm adult as seen on endoscopy
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Clinical Disease:
1. Iron-deficiency anemia
2. Failure-to-thrive syndrome (idiopathic endocrinopathy)
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Diagnosis:Microscopic examination of feces for eggs
35 µm
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Drug of choice:
MebendazoleMode of Action:De-polymerizes invertebrate microtubules, only
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Prevention and Control
“To prevent this (hookworm) it is only necessary to preventsoil pollution with the feces of infested individuals” ……..Hookworm Disease Asa Chandler, 1929
Greatest single invention of the 20th century!
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Ancylostoma In India
Number Of Worms
Num
ber O
f Peo
ple
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Hookworm In Zimbabwe
Heavy InfectionLight Infection
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Dogs and Ancylostoma caninum
Paro, Bhutan
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Infectious larva of Ancylostoma sp.
photo: E. Grave
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“Creeping eruption” on the foot of a patientwho stepped on an infective larva of A. braziliense
“Serpiginous” lesion
Photo: G. Zalar
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Strongyloides stercoralis
Helminths Nematoda:
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Free-living female Strongyloides stercoralis
30 µm
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Parasitic female Strongyloides stercoralis
Head
TailEggs
60 µm
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Dog
Primate
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Strongyloides stercoralis in situ
S.s. S.s.
S.s.
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Larva of Strongyloides stercoralis in skin
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Pathogenesis:
Worms invade epithelial cells, induce celldeath
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Clinical Disease:
1. Diarrhea
2. Malabsorption syndrome
3. Secondary bacteremia/septicemia as larvae migrate throughout body and defecate microbes that they ingested in large intestine.
4. Death due to overwhelming bacterial
septicemia.
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Diagnosis:
1. Microscopic examination of feces (x 6)
2. “String” test
Second stage larva
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Drug of choice:Ivermectin*
Mode of Action:Blocks Cl(-) ion channels, inhibits γ-aminobutyric acidreceptor complex.* Alternate drug for all geohelminths
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Prevention and Control: Sanitary disposal of human feces*
*Dog is a common reservoir host. Cannot control spread of dog feces which may contain infective larvae.
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