What are Hookworms?

Hookworms are parasites that mainly infect the intestines and feed on blood. Hookworm infection is associated with helminth disease. Hookworm disease is the most common helminth infection associated with hookworms and is caused by nematode parasites, including Ancylostoma duodenale and Necator americanus. People mainly acquire hookworm infection through skin exposure to hookworm larvae in hookworms infested soil. In addition, hookworm could be transmitted by ingesting larvae.

Hookworms living in the intestines lay eggs that pass into the feces and get defecated into the bush or soil in the field. The feces act as fertilizer for the eggs. They mature, hatch, and release larvae into the ground, which can penetrate humans through the skin. Once infested with hookworm eggs, the soil becomes infectious in about nine days and remains infectious for weeks.

Pathophysiology of Hookworm Infection

The lifecycle of hookworms starts after hookworm eggs are passed and deposited into the soil through defecation. A mature female A.duodenale worm produces 10,000 to 30,000 eggs in the intestine. Following the deposition of eggs onto soil and with the right conditions, the eggs mature and hatch into larvae. The larvae cannot feed, meaning they must infect a new host or die after exhausting their metabolic reserve (in about six weeks). The conditions favorable for larvae growth include sandy and most soil at 20 to 30°C, where the eggs hatch into rhabditiform larvae in one to two days.

The rhabditiform larva develops into infective filariform after feeding on feces in 5 to 10 days. The infective filariform larvae undergo a development arrest and can survive dump soil for over two years. The larvae can migrate into the human body through the skin, enter the bloodstream and move into the gastrointestinal tract within ten days. One to two months later, female worms lay eggs again, and the cycle begins.

Statistics and Prevalence of Hookworm Infection and Disease

Historically, hookworm infection disproportionately affected the poor population in less developed countries due to poor access to clean water and sanitation. The CDC provides that there are about 570 to 740 million hookworm infections worldwide. Hookworm infection was mainly widespread in the southeastern region of the US, but increased health education and improved living conditions have significantly reduced the infections. Hookworms Ascaris and whipworm are the most common parasitic worms that crease disease burden worldwide.

Hookworm infection is highly prevalent in the tropics and subtropical zones, with some communities experiencing a prevalence of as high as 90%. In the areas with the highest prevalence, hookworm infections are mainly reported among school children and adolescents. However, males and females show similar infection rates.

Causes of Hookworm Infection and Disease

Once infected with hookworms, the parasites could persist for years in the host leading to impaired intellectual and physical development among children. The common causes of hookworm infection include:

• Necator Americanus. Also known as N. americanus, is the predominant human intestinal hookworm known to infect humans. The parasite has a small, cylindrical shape with an off-white color.
• Ancyclostoma duodenale. Also known as A. duodenale also a major cause of intestinal hookworm disease and penetrates the body through the skin or ingestion of larvae.
• Lack of access to clean water. Drinking water infested with hookworm eggs can lead to the infection of humans with hookworms.
• Poor hygiene and sanitation. Poor hygiene and sanitation habits may lead to dirty, unkempt surroundings supporting the hatching of eggs and the development of hookworm larvae.

Clinical Manifestation of Hookworm Infection

The signs and symptoms of hookworm infection include:

• Dew (Ground) itch. This refers to the irritation at the infection site one to two weeks after infection. This leads to the appearance of a pruritic vesicular erythematous rash that may persist for 1 to 2 weeks. In addition, secondary bacteria infection could occur due to intense scratching of the infection site.
• Pulmonary symptoms. When the hookworm enters the pulmonary air spaces (alveoli), the patient may experience cough, fever, reactive bronchoconstriction, and wheezing.
• Gastrointestinal (GI) symptoms. The patient may experience GI discomfort after hookworm migration into the GI tract. For instance, the patient may experience abdominal pain, diarrhea, nausea, flatulence, and anorexia as worms mature in the small intestines.
• Anemia symptoms. Infection with hookworms for a long time can lead to iron deficiency anemia, where the patient experience chlorosis (skin discoloration), pallor, tachycardia, hypothermia, and spooning nails.
• Cutaneous larva migrans. This is associated with twisting lesions that grow, itchiness, swelling, and discomfort.

Assessment and Diagnostic Tests for Hookworm Infection

The diagnosis of hookworm infection includes the following:

• Stool examination. This involves examining fecal samples with a microscope to establish the presence of hookworm eggs.
• Blood studies. This test involves a complete blood count (CBC) and peripheral blood smear to confirm iron-deficiency anemia. Hookworms attached to the intestinal mucosa may lead to persistent eosinophilia.

Medical Management of Hookworm Infection

• Anthelmintic medications. These are drugs that help get rid of human parasitic worms. They are first-line treatments for hookworm infections and include drugs such as albendazole and mebendazole.
• Iron supplements. Iron therapy with supplements such as folate supplement may be considered in patients with anemia.
• Blood transfusion. This may be indicated in rare cases where the patient experiences chronic anemia or GI hemorrhage.

Nursing Management of Hookworm Infection

Nursing care and management of a patient with hookworm infection include:

Nursing Assessment of Hookworm Infection

Nursing assessment of the patient includes:

• Assess the patient’s history. Assess whether the patient is from endemic areas and their history of walking barefoot or wearing open footwear in these areas.
• Physical examination. Examine the patient’s skin for rashes and lesions in early disease stages. Assess the pulmonary and GI findings.

Nursing Diagnosis of Hookworm Infection

• Impaired skin integrity due to itching and scratching of the infection site.
• Acute pain due to GI infection and discomfort.
• Ineffective tissue perfusion associated with blood loss.
• Deficient knowledge about the disease, diagnoses, and treatment.

Nursing Care Planning and Goals for Hookworm Infection

The nursing care planning goals for patients infected with hookworms include ensuring the following:

• The patient will have reduced irritation, scratching, and itching.
• The patient will have reduced or no pain.
• The patient will restore normal perfusion.
• The patient and caregivers will have adequate knowledge about the disease.

Nursing Intervention for Hookworm Infection

The nursing intervention for a patient with hookworms includes:

• Protecting and maintaining skin integrity.
  • The nurse should monitor the site of infection for redness, warmth, swelling, color changes, pain, and other signs of infection.
  • The nurse should provide skin care as needed by using a sterile dressing at the infection site.
  • The nurse should clip the patient’s nails as needed.
  • The nurse should teach the patient about proper hygiene, including handwashing, wound cleaning, dressing, and medication application when necessary.
• Reducing pain.
  • The nurse should encourage rest, relaxation, and sleep to promote relief.
  • The nurse should assess the patient’s report of pain and respond appropriately.
• Improving tissue perfusion.
  • Provide the diagnostic test results as indicated.
  • Administer blood transfusion as indicated.
• Teach the patient about hookworm infection
  • Establish the patient’s learning needs and readiness to learn.
  • Involve the patient in creating the teaching plan.
  • Provide clear and understandable demonstrations and explanations.

Nursing Evaluation for Hookworm Infection

The nursing evaluation for the patient should include establishing that:

• The patient reduced itching and scratching.
• The patient’s pain diminished.
• The perfusion returned to normal.
• The patient and caregivers acquired relevant knowledge about hookworm infection.

Nursing Documentation Guideline

The  nurse should document the following:

• The patient’s cultural and religious expectations and beliefs.
• The nursing plan of care
• The patient’s teaching plan
• The patient’s response to interventions.
• The patient’s progress towards the desired outcome.