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Epidemiology of hookworm infection in Soong nern district, Korat province, Thailand.

Stool surveys in Soong Nern district, Korat Province, were done by the MF concentration technique. The intensity of hookworm infection, egg counts, results of treatment by anthelminthic drugs, observations on new infections and reinfections following treatment throughout the year and the density of nematode larvae in soil in the study area were investigated. Hookworm infection rates were high in Na-Glang village, both in adult villagers and school-aged children. The intensity of hookworm infections was considered mild and after treatment the numbers of eggs in the stools diminished or disappeared. New cases and reinfection increased during the rainy month, due to socio-environmental factors in the village that favoured the development of hookworm larvai in the soil. Although in this study it was impossible to distinguish hookworm larvae among the nematode larvae collected form soil it was highly probable that hookworm larvae were present. Control of hookworm infection in the study area was proposed by improvement of environmental sanitation and health education.

Adolescent

Serum and red cell folate activity and folic acid absorption in patients with hookworm infection.

Red cell and serum folate levels and folic acid absorption were studied in patients with hookworm infection. The mean value of serum folic acid level was found to be significantly lower than that of the normal subjects and 32% of cases had serum folic acid level less than 4 ng/ml. The red cell folate content in all patients studied were within the normal limits. The mean value of the folic acid absorption was also lower than that of the normal. Six out of 13 patients absorbed folic acid less than 38%, the lowest value obtained from the normal subjects. These findings indicated that there was a negative balance of folic acid in some patients with hookworm infection which was probably due to impairment in absorption.

Adolescent

Clinical evaluation of a new anthelmintic - C. 9333 Go./CGP 4540 in human hookworm infection.

A new antihookworm compound, C.9333 Go./CGP 4540, was evaluated clinically in 65 adult patients with hookworm infection. Several dosage schedules were evaluated to determine an effective, well tolerated and convenient regime. The lowest effective dose was 125 mg administered at four-hourly intervals for three doses. The compound was generally well tolerated; mild giddiness was observed in nine patients and severe giddiness was present in one patient. Clinical and biochemical monitoring revealed no other toxicity of the compound.

Ancylostoma

Clinical trials of a new anthelmintic, 4-isothiocyanato-4'-nitrodiphenylamine (C.9333-Go/CGP 4540), for the cure of hookworm infection.

A new compound, 4-isothiocyanato-4'-nitrodiphenylamine (C.9333-Go/CGP 4540), was tried in 39 hospitalized patients with hookworm infection, using several treatment schedules. At effective dose schedules (125 mg X 3 given 4-hourly; 250 mg X 3, 8-hourly; 1,000 mg X 3, 12-hourly), the egg reduction was 96% to 100%; the zero egg-counts were confirmed by coproculture for larvae. The compound was very well tolerated. Transient and mild side effects--giddiness, diarrhea and sweating--were observed in only three patients. No toxic effects were seen as judged by serial organ function tests, except a transient and mild asymptomatic elevation of transaminases in one patient.

Adult

Skin penetration of infective hookworm larvae. II. The path of migration of infective larvae of Ancylostoma braziliense in the metacarpal foot pads of dogs.

The hairless metacarpal foot pads of six hookworm-free puppies were exposed to infective larvae of Ancylostoma braziliense. Serial sections of the biopts stained with Harris' haematoxylin and eosin showed that the infective larvae are able to penetrate the toughest region of canine skin. Pores of eccrine sweat glands did not seem to constitute sites of entry and no larvae were detected in these glands. Larvae were only observed in the epidermis. The histopathology of the infected skin of the foot pads of the puppies was similar to that in human skin with "creeping eruption" as described by Fülleborn (1927). The biopts appeared to consist of hairy skin as well. In the unexposed adjacent hairy skin of the foot pads, larvae were also observed. They were found in the epidermis, hair follicle systems and dermis, suggesting that the migration from the epidermis into deeper tissue depends on the presence of the hair follicle systems.

Ancylostoma

Skin penetration of infective hookworm larvae. I. The path of migration of infective larvae of Ancylostoma braziliense in canine skin.

Migratory behaviour of Ancylostoma braziliense was studied in relation to the structure of the skin in dogs after primary infections. Data were obtained studying serial sections of lateral skin areas 6 mm in diameter, which had been exposed to larvae. The sections were stained either with Harris' haematoxylin and eosin or with P.A.S. or as outlined by Crossmon. Most of the larvae managed to penetrate the skin within 1/2 hr after the application. Hairs did not seem to constitute sites of entry. The larvae moved into the horny layer where edges of keratinized cells provide uneven spots. They migrated approximately parallel to the surface from the horny layer into the living epidermis and continued into an external root sheath of a hair follicle. They could only leave this site via sebaceous glands for the dermis or via apocrine sweat glands for the hypodermis. Tunnels from the epidermis into the dermis, however, suggested that a direct trans-epidermal migration had occurred. The vessels invaded by larvae were hypodermal lymphatic vessels. The first ones were found in these structures 1/2 h after the onset of the exposure.

Ancylostoma

Skin penetration of infective hookworm larvae. III. Comparative studies on the path of migration of the hookworms Ancylostoma braziliense, Ancylostoma ceylanicum, and Ancylostoma caninum.

The lateral skin areas of nine hookworm-free puppies were exposed to infective larvae of Ancylostoma braziliense, Ancylostoma ceylanicum and Ancylostoma caninum. Serial sections, stained with Harris' haematoxylin and eosin, showed that many similarities exist in the migration patterns of the hookworm species used. However, striking differences were observed between Ancylostoma braziliense on the one hand and Ancylostoma ceylanicum and Ancylostoma caninum on the other hand with regard to the speed with which the penetration occurred. Larvae of Ancylostoma braziliense may travel directly from the epidermis into the dermis--apart from migration via hair follicle systems--a path of migration we did not observe in infections with the other species used. Larvae of Ancylostoma braziliense seem to pass the skin more rapidly than those of Ancylostoma ceylanicum and Ancylostoma caninum. Many larvae of Ancylostoma ceylanicum managed to penetrate the skin 2--6 h after the onset of the exposure.

Ancylostoma