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Tiremo SN, Shibeshi MS. Endoscopic Diagnosis of Hookworm Disease in a Patient with Severe Iron Deficiency Anemia: A Case Report. Int Med Case Rep J 2023; 16:841-845. [PMID: 38116465 PMCID: PMC10729675 DOI: 10.2147/imcrj.s443625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/10/2023] [Indexed: 12/21/2023] Open
Abstract
Hookworm infection is an important cause of iron deficiency anemia, especially in heavily infected high-risk populations residing in underdeveloped tropical countries. Stool examination is the main method used for hookworm diagnosis; however, its sensitivity is relatively low. Hookworm infections have been incidentally diagnosed during routine upper gastrointestinal endoscopies. We present the case of a 60-year-old Ethiopian farmer who had severe iron deficiency anemia and positive occult blood in the stool. Repeated stool examinations revealed no ova or parasites. Esophagogastroduodenoscopy revealed the presence of hookworms in the duodenum. The patient was treated with albendazole and ferrous sulfate. Careful endoscopic examination of the duodenum is crucial for identifying unsuspected hookworm infection responsible for chronic gastrointestinal bleeding and iron deficiency anemia.
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Affiliation(s)
- Shamil Nuri Tiremo
- Division of Gastroenterology, Department of Internal Medicine, Hawassa University, Hawassa, Ethiopia
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Shah SS, Shah R, Basnet R, Patel D, Bhattarai U, Shah B, Sharma SK. Worm infestation as a cause of severe anemia in a frail older adult: a case report. Ann Med Surg (Lond) 2023; 85:5149-5152. [PMID: 37811116 PMCID: PMC10553005 DOI: 10.1097/ms9.0000000000001171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/02/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Worm infestations are a common occurrence in low-income countries. Anemia due to iron deficiency can be brought on by human intestinal worms. The authors report a case of an 86-year-old frail older adult with upper gastrointestinal (GI) bleeding caused by a worm infestation most likely to be hookworm. Case presentation An 86-year-old male, presented to the Emergency Department with complaints of bilateral lower limb swelling and shortness of breath for 4 days associated with melena for 2 months. The authors made a provisional diagnosis of heart failure precipitated by anemia. Upper GI endoscopy revealed multiple whitish exudates, which are resistant to water jets. Multiple worms were noted in the second part of the duodenum. Based on clinical evaluation and endoscopy, the diagnosis of oesophagial candidiasis and iron deficiency anemia secondary to upper GI bleeding due to Hookworm infestation was made. Clinical discussion In low-income countries, especially those involving the tropical area, worm infestation should be considered as an important cause of obscure acute GI bleeding and severe anemia. Usually, malignancy is suspected in an older adult with severe anemia but hookworm infestation is a treatable disease with a good prognosis and complete recovery. The most commonly used drugs for treatment are mebendazole and albendazole. In a low-income country with a high burden of worm infestations, empirical treatment of iron deficiency anemia with single dose albendazole has been recommended. Conclusion Usually, severe anemia in an older adult is mostly attributed to an underlying malignancy. Our case serves as a good example of how a treatable condition can improve the quality of life in a frail older adult. Normally, there is a tendency to defer UGI endoscopy in frail elderly due to ageism. However, the diagnosis of a treatable cause of upper GI bleeding can be made by a simple upper GI endoscopy. Severe anemia due to hookworm infestation is treated effectively and quickly with albendazole and iron therapy.
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Affiliation(s)
| | - Raju Shah
- B.P. Koirala Institute of Health Sciences
| | - Rohan Basnet
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Dhruvit Patel
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Urza Bhattarai
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Bhupendra Shah
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Sanjib K. Sharma
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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Li B, Chen S, Cui X, Dai M, Meng W, Wu Q, Sheng H. Chronic Hemorrhagic Anemia Caused by Hookworm Infection: A Case Report. Acta Parasitol 2023; 68:288-292. [PMID: 36539676 DOI: 10.1007/s11686-022-00653-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Hookworm infection is one of the causes of long-term chronic hemorrhagic anemia in patients. This article reports a case of chronic severe anemia caused by hookworm infection. METHODS The capsule endoscopy showed that there were a large number of hookworms in the small intestine of a patient. At the same time, using the technique of saturated brine floatation and the automatic stool analyzer, hookworm eggs were detected. RESULTS The patient's anemia was caused by hookworm infection and was significantly improved after anti-hookworm treatment. CONCLUSION Hookworm infection cannot be ignored in the differential diagnosis of patients with chronic anemia. Capsule endoscopy combined with stool detection haves an important clinical value for the diagnosis of hookworm disease.
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Affiliation(s)
- Baisheng Li
- Department of Clinical Laboratory, Tongren Hospital Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, China.
| | - Shihong Chen
- Department of Clinical Laboratory, Tongren Hospital Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, China
| | - Xiangming Cui
- Department of Clinical Laboratory, Tongren Hospital Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, China
| | - Ming Dai
- Department of Clinical Laboratory, Tongren Hospital Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, China
| | - Wenying Meng
- Department of Gastroenterology, Tongren Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiong Wu
- Department of Gastroenterology, Tongren Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huiming Sheng
- Department of Clinical Laboratory, Tongren Hospital Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, China.
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Ghosh K, Desai GS. Prevalence and detecting spatial clustering of anaemia among children 6–59 months in the districts of India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Prevalence of anaemia among 6- to 59-month-old children in India: the latest picture through the NFHS-4. J Biosoc Sci 2019; 52:97-107. [PMID: 31104639 DOI: 10.1017/s0021932019000294] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
India is the highest contributor to child anaemia among developing countries. To see the latest picture of child anaemia in India, data for 6- to 59-month-old children were taken from the fourth round of the National Family Health Survey conducted in 2015-16 (NFHS-4). The study sample consisted of 1,37,347 children. The dependent variable was the anaemia status of the child. The objectives of the study were to assess (i) the distribution of anaemia prevalence by child age group, (ii) the prevalence of child anaemia by zone and state and (iii) the relation of child anaemia prevalence with social, demographic and economic variables, including maternal nutritional status and low birth weight. The study found that in India in 2015-16, 56% of 6- to 59-month-old children were anaemic - a decrease of only 13.5 percentage points since the NFHS-3 study conducted in 2005-06. It is well known that iron supplementation is necessary for child growth and brain development. This study suggests that, in addition, the socioeconomic conditions of households in India need to be improved to prevent child anaemia. Low birth weight and low maternal nutritional status are also responsible for the high prevalence of anaemia among children in India.
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Doulberis M, Papaefthymiou A, Kountouras J, Polyzos SA, Srivastava DS, Perrig M, Katsinelos P, Özgüler O, Kotronis G, Gialamprinou D, Papamichos S, Ingold J, Xanthis A, Exadaktylos AK. Hookworms in Emergency Department: The "Vampire" Within. J Acute Med 2018; 8:135-148. [PMID: 32995216 PMCID: PMC7517929 DOI: 10.6705/j.jacme.201812_8(4).0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 09/27/2018] [Indexed: 06/11/2023]
Abstract
Hookworms infection is a soil-transmitted helminthic disease particularly endemic in developing counties of tropical regions. It is attributed mainly to two human pathogens nematodes namely Necator americanus and Ancylostoma duodenale. Although the disease has been characterized as "neglected" is very diffi cult to be eliminated and the economic consequences are great. Worms are fed with blood of hosts in small intestine and cause typically iron deficiency anemia with relevant symptoms as well as eosinophilia. Patients admitted in emergency department claim often diffuse general symptoms, whereas cases with obscure gastrointestinal bleeding can be seen. Within this brief review, after introducing some basic elements of hookworms' epidemiology, taxonomy and socioeconomic problem is emphasized, pathogenesis, and life cycle of parasite are concisely explained. Furthermore, clinical manifestations often or rarely seen in emergency department are described. Therapeutic options are also enclosed. Awareness of the problem and critical thinking of patients coming from endemic regions could result to identifying more hookworm cases and their therapy will efficiently alleviate not only the patients per se but health system and societies as well.
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Affiliation(s)
- Michael Doulberis
- University Hospital Inselspital Bern Department of General Internal Medicine Bern Switzerland
- Aristotle University of Thessaloniki Department of Internal Medicine, Second Medical Clinic, Ippokration Hospital Thessaloniki, Macedonia Greece
| | | | - Jannis Kountouras
- Aristotle University of Thessaloniki Department of Internal Medicine, Second Medical Clinic, Ippokration Hospital Thessaloniki, Macedonia Greece
| | - Stergios A Polyzos
- Thessaloniki First Department of Pharmacology, Medical School, Aristotle University of Thessaloniki Macedonia Greece
| | | | - Martin Perrig
- University Hospital Inselspital Bern Department of General Internal Medicine Bern Switzerland
| | - Panagiotis Katsinelos
- Aristotle University of Thessaloniki Department of Internal Medicine, Second Medical Clinic, Ippokration Hospital Thessaloniki, Macedonia Greece
| | - Onur Özgüler
- General Hospital Bürgerspital Department of Emergency Medicine Solothurn Switzerland
| | - Georgios Kotronis
- General Hospital Agios Pavlos of Thessaloniki Department of Internal Medicine Thessaloniki, Macedonia Greece
| | - Dimitra Gialamprinou
- Aristotle University of Thessaloniki Department of Pediatrics, Papageorgiou University Hospital Thessaloniki, Macedonia Greece
| | - Spyros Papamichos
- University Hospital Inselspital Bern Department of Hematology Bern Switzerland
| | - Jonas Ingold
- Tiefenau Hospital of Bern Department of General Internal Medicine Bern Switzerland
| | - Andreas Xanthis
- Aristotle University of Thessaloniki Department of Internal Medicine, Second Medical Clinic, Ippokration Hospital Thessaloniki, Macedonia Greece
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Human hookworm disease: Enteroscopy and video capsule endoscopy features. Clin Res Hepatol Gastroenterol 2018; 42:e39-e40. [PMID: 29307516 DOI: 10.1016/j.clinre.2017.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 11/20/2017] [Indexed: 02/04/2023]
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Tan X, Cheng M, Zhang J, Chen G, Liu D, Liu Y, Liu H. Hookworm Infection Caused Acute Intestinal Bleeding Diagnosed by Capsule: A Case Report and Literature Review. THE KOREAN JOURNAL OF PARASITOLOGY 2017; 55:417-420. [PMID: 28877573 PMCID: PMC5594724 DOI: 10.3347/kjp.2017.55.4.417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 05/31/2017] [Accepted: 06/19/2017] [Indexed: 11/23/2022]
Abstract
Hookworm infections are rare causes of acute gastrointestinal bleeding. We report a middle aged man with primary nephrotic syndrome and pulmonary embolism. During the treatment with steroids and anticoagulants, the patient presented acute massive hemorrhage of the gastrointestinal tract. The results of gastroscopy showed red worms in the duodenum. Colonoscopy and CT angiogram of abdomen were unremarkable. Capsule endoscopy revealed fresh blood and multiple hookworms in the jejunum and ileum. Hookworms caused the acute intestinal bleeding. The patient responded well to albendazole. Hematochezia was markedly ameliorated after eliminating the parasites. Hence, hookworm infection should be considered in the differential diagnosis of a patient with obscure gastrointestinal bleeding. Capsule endoscopy may offer a better means of diagnosis for intestinal hookworm infections.
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Affiliation(s)
- Xia Tan
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Renal Research Institute of Central South University, Key Laboratory of Kidney Disease and Blood Purification in Hunan, Changsha 410011, Hunan, P. R. China
| | - Meichu Cheng
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Renal Research Institute of Central South University, Key Laboratory of Kidney Disease and Blood Purification in Hunan, Changsha 410011, Hunan, P. R. China
| | - Jie Zhang
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Renal Research Institute of Central South University, Key Laboratory of Kidney Disease and Blood Purification in Hunan, Changsha 410011, Hunan, P. R. China
| | - Guochun Chen
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Renal Research Institute of Central South University, Key Laboratory of Kidney Disease and Blood Purification in Hunan, Changsha 410011, Hunan, P. R. China
| | - Di Liu
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Renal Research Institute of Central South University, Key Laboratory of Kidney Disease and Blood Purification in Hunan, Changsha 410011, Hunan, P. R. China
| | - Yexin Liu
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Renal Research Institute of Central South University, Key Laboratory of Kidney Disease and Blood Purification in Hunan, Changsha 410011, Hunan, P. R. China
| | - Hong Liu
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Renal Research Institute of Central South University, Key Laboratory of Kidney Disease and Blood Purification in Hunan, Changsha 410011, Hunan, P. R. China
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