Hookworms 鉤蟲 Distribution between 45oN and 30oS

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Hookworms 鉤蟲 Distribution between 45oN and 30oS Approximately 9 billion people infected Over 20 million showed clinical manifestations Necator americanus 美洲鉤蟲 Ancylostoma duodenale 十二指腸鉤蟲 Ancylostoma caninum 犬鉤蟲 Ancylostoma braziliense 巴西鉤蟲 Ancylostoma ceylanicum 鍚蘭鉤蟲 Ancylostoma malayanium 馬來亞鉤蟲

Between 45oN and 30oS A. duodenale 十二指腸鉤蟲 N. americanus 美洲鉤蟲 Middle East Mediterranean countries North China Africa South-East Asia South America Pacific Islands A. duodenale 十二指腸鉤蟲 Far East South Asia Tropical Africa Central and South America N. americanus 美洲鉤蟲

A. duodenale 十二指腸鉤蟲 腹齒 附齒 次腹 齒刀 N. americanus 美洲鉤蟲 腹齒板

Posterior end of N. americanus 雄美洲鉤蟲 9~11 x 0.4 mm 雌美洲鉤蟲 7~9 x 0.3 mm Anus Bursa 交尾囊

Copulatory bursa 交尾囊 externo-dorsal ray 外背側枝 ventral ray 腹面枝 Spicules 交尾刺 postero- latero ray 後側枝 medio-lateral ray 內側枝 externo-lateral ray ventral ray 腹面枝 dorsal ray 背面枝 externo-dorsal ray 外背側枝

Transmission Active penetration of skin by infective filariform larvae (L3) Ingesting of infective larvae in A. duodenale Transmammary transmission of larvae in A. duodenale infective filariform larvae (L3)

Filariform larva (L3) 絲狀幼蟲 Lungs Circulation Penetrates skin Egg in faeces 2nd stage larva (L2) in soil Rhabditiform larva hatches 桿狀幼蟲 Swallowed Pharynx Trachea EXTERNAL ENVIRONMENT Diagnostic stage 診斷期 Infective 感染期 Attached to small intestine 4~6 wks 2~3 wks 1 wk 3 days MAN

Clinical Pathology Pentration of skin by F- form larvae (L3) Skin reaction (uritcaria 蕁痲疹 )at the site of larval pentration Stinging sensation followed by irration, erythea, oedema and papulovesicular eruption Gound itch A. braziliense and A. caninum wandering through the cutaneous layer (cutaneous larva migrans) cause intense irritation and iflammaton. Most of the larva die in the skin. Creeping eruptions 匍行性疹

Clinical Pathology Migration of F-form larvae (L3) In lungs During invasion of the circulation: Usually no ill-effects During migration through the lungs: Pneumonitis (肺炎) with cough (咳嗽), wheeze (哮喘), fever (發燒 ), transient X-ray shadows (Not as severe as Ascaris) Haemorrhages and leukocytic or eosinophilic infiltrations In lungs In respiratory tract Coughing due to irritation of the bronchial and tracheal mucous membranes

Clinical Pathology Established intestinal infection by adult worms Epigastric duodenal-type pain, indigestion, loss of appetite or diarrhoea Hookworm anaemia (HWA) Losses of blood, iron and proteins Occassionally associated with folate deficiency Adult worms attach to duodenum and jejunum by teeth or cutting plates (mechanical) Worms move every 4-6 hours (blood leaking) Worrms feed on blood from cut vessels and mucosal tissue (chronic blood loss)

Laboratory Diagnosis Direct smear for eggs Egg culture for 1st stage larva (L1) Colourless with a thin shell which appears as a black line aroung the ovum Oval in shape, measuring about 65 x 40 mm Contains an ovum which usually appears segmented Larva may be seen inside in some specimen