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Population biology of hookworms in children in rural West Bengal. II. Acquisition and loss of hookworms.

From changes in hookworm egg counts in feces of children in Gangetic West Bengal we estimate that, on the average, each child lost about 11.1 female hookworms during the 1969 post-monsoon dry period and gained about 10.3 females during the subsequent premonsoon and monsoon seasons, resulting in a net loss of worms over the 22-month study period. However, the mean fecal egg count for each 1-year age group of children from 3-11 years suggests an average net gain of 2.7 female worms/year. From seasonal changes in the relative abundance of larvae recovered from fecal cultures, it is estimated that at least 82% of the yearly gain in Ancylostoma duodenale females is a result of the maturation of hypobiotic (latent) larvae acquired during the previous wet season. A duodenale was present about equally with Necator americanus but it was significantly more common among males than among females, and more common among Muslims than among Hindus. Using damp gauze pads, we sampled the soil surface around freshly-passed feces for infective hookworm larvae and estimated that 252 larvae were contacted by each child durint the transmission season. Efficiency of penetration and maturation of each hookworm species was calculated from estimated larval densities on the soil surface, from seasonal changes in fecal egg counts, and from variations in the number of larvae recovered from fecal cultures by season and age of the host; it is estimated that N. americanus is 17.5% efficient and A. duodenale 5.3%. Children negative for hookworm became positive at all times of the year and at a significantly higher rate in 1970 than in 1969; incidence averaged 4.2% per 2-month period and mean initial fecal egg count suggested infection with about 2.0 female worms. The average life span for N. americanus is calculated to be 3-4 years and that of A. duodenale about 1 year under the conditions of reinfection found in the study area.

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

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

Evaluation of the skin test for hookworm as an epidemiological tool.

The usefulness of a skin test with larval Necator americanus antigen for assessment of hookworm prevalence was evaluated in an endemic area of Costa Rica. In comparison with standard coprologic techniques employed to survey the population, the skin test detected 83% of infections, showing a fairly satisfactory sensitivity. The overall specificity of the test was 50%, i.e., random. No correlation was found between skin reactivity and hookworm burden. The sensitivity of the test increased moderately with age, but its specificity decreased significantly at the same time. False positive reactions were more numerous among persons formerly infected with hookworm who had been negative for as long as 5 years. There was an indication of cross reactivity with intestinal nematodes other than hookworm. The test was used to detect hookworm infected persons in the community for selective treatment, in comparison with mass treatment of all the people in another village. The selective administration of an anthelminthic drug to only skin test positive persons did not achieve the same drop in community hookworm prevalence as did the indiscriminate treatment of the whole population.

Adolescent

The detection of antibodies to hookworm larva in patients by immunofluorescence: a preliminary report.

Using the fluorescent antibody technique 84% of patients with severe hookworm infection and 74% of Nigerian blood donors have detecable antibodies that react with surface antigen of hookworm larvae. On the other hand only 24% of Nigerian medical students and 20% of Caucasians (Canadians) have such antibodies in their sera. It is suggested that while the results of tests on students may be due to the relatively infrequent contact with hookworm the antibody positivity in the Caucasians may be due to cross reaction with other related helminths. The titre of antibody produced in the hookworm infected patients was similar to that of the blood donors but differed from other groups. Lower positivity rates were observed with further dilution of sera in the hookworm infected patients. This may be due to their relative incapacity to produce potent hookworm antibody. Further work on this aspect is required as well as improvement of the specificity of the technique.

Antibodies

Prevalence of hookworm species in Pondicherry, India.

A study was carried out to find out the hookworm species prevalent in Pondicherry, India, based on the identification of filariform larvae recovered from coproculture of hookworm positive stools. A total of 184 hookworm positive stools were cultured using the Harada-Mori coproculture method. The results of the study for the first time showed both hookworm species, Ancylostoma duodenale (60 cases) and Necator americanus (49 cases) to be present in Pondicherry. The former species was relatively more common than the latter. Three cases were infected with both species of hookworm.

Feces

The prevalence of hookworm and of S. haematobium in rural Zambia.

The prevalence of hookworm and of S. haematobium in a representative sample of the rural population of seven provinces of Zambia was assessed during a National Nutrition Status Survey. A total of 7212 people of all age and sex groups were examined for hookworm, of whom 4920 (68%) provided a stool sample and of these 48.6% were positive. Regional figures ranged between 11.4% and 77.1%. No differentiation between species of hookworm was attempted nor was it possible to assess the worm load of the individuals surveyed. Hookworm is highly endemic within the rural areas and this is discussed in relation to its known effects on the general health of the population studied during the survey, and the impact of hookworm infestation on morbidity.

Adolescent

Haemoglobin concentrations and concomitant infections of hookworm and Trichuris trichiura in Panamanian primary schoolchildren.

The blood haemoglobin concentrations and intestinal helminth infections were surveyed in 658 children aged between 6 and 12 years attending 4 primary schools in Coclé Province, Panama, in November 1987. 147 (22.3%) of the children were judged to have haemoglobin concentrations indicative of iron-deficiency anaemia. Blood haemoglobin concentrations were significantly lower in children with heavier Trichuris trichiura infections (> 5000 eggs/g) (P = 0.014), and in children with dual infections of both hookworm and T. trichiura (P = 0.005). Children with concomitant T. trichiura and hookworm infections were also significantly more likely to have blood haemoglobin levels indicative of anaemia than children who were uninfected or had single infections with either of these helminths (P < 0.005). In a longitudinal study involving 171 children selected from the original 658, blood haemoglobin concentrations were measured again in November 1988. Children who were considered to show an improvement in both hookworm and T. trichiura infections over this 12 month period showed a significantly greater increase in blood haemoglobin concentrations than children who had remained uninfected with either of these helminths throughout the study period (P < 0.05).

Child

Investigating Environmental Determinants of Hookworm Transmission using GPS Tracking and Metagenomics Technologies.

To identify potential sources of hookworm infections in a Ghanaian community of endemicity that could be targeted to interrupt transmission, we tracked the movements of infected and noninfected persons to their most frequented locations. Fifty-nine participants (29 hookworm positives and 30 negatives) wore GPS trackers for 10 consecutive days. Their movement data were captured in real time and overlaid on a community grid map. Soil samples were collected and divided into two parts: one for determining the physical and chemical properties and the other for culture of helminth larvae. Soil parameters were determined using standard methods, and the number of larvae recovered from Baermann cultures (expressed as larvae per gram of soil) was recorded. We found no significant difference in the larval counts between sites of infected and noninfected participants (P = 0.59). Sandy-loam soil, pH, and effective cation exchange capacity were associated with high larval recovery counts (P <0.001), whereas nitrogen and clay content were associated with low counts (P <0.001). Genomic DNA was extracted from helminth larvae, and species were identified using metagenomic analysis of DNA sequences. The dominant helminth species identified were Panagrolaimus superbus, Parastrongyloides trichosuri, Trichuris trichiura (human whipworm), and Ancylostoma caninum (dog hookworm). Despite Necator americanus being the predominant species in the community, no larvae of this species were identified. This study, however, demonstrates the feasibility of applying molecular tools for identifying environmental factors and places associated with exposure to human and zoonotic helminths, including areas that may be targeted to break transmission in communities where infection is endemic.

Humans

Activities of dichlorvos or disophenol against the hookworm (Uncinaria lucasi) and sucking lice of northern fur seal pups (Callorhinus ursinus) on St. Paul Island, Alaska.

One controlled and six critical tests were conducted in July, 1977 with northern fur seal pups (Callorhinus ursinus) to determine the efficacies of a single dose of dichlorvos capsules at 29.3 to 32.8 mg/kg, tablets at 10.5 to 11.5 mg/kg, or disophenol at 9.9 mg/kg given subcutaneously against natural infections of adult Uncinaria lucasi. In the controlled test, 20 pups were treated and 10 pups were nontreated. Removal of hookworms in this test was 99% for five pups receiving dichlorvos capsules, 99% for five pups receiving dichlorvos tablets, and 77% for 10 pups receiving disophenol. Also, both formulations of dichlorvos and the formulation of disophenol were highly active against natural infestations of two species of sucking lice (Proechinophthirus fluctus and Antarctopthirus callorhini). In critical tests with four pups treated with dichlorvos capsules at 28.6 to 30.6 mg/kg, removal of hookworms was uniformly 100%. Disophenol at 9.9 mg/kg removed 100% and less than 1% of hookworms in two pups, respectively, in critical tests.

Alaska

The efficacy of amidantel, a new anthelmintic, on hookworms and ascarids in dogs.

Amidantel is a new anthelmintic from a new chemical class with an interesting anthelmintic spectrum. In dogs amidantel is highly effective in a single oral dose of 25 mg/kg against both hookworm species, Ancylostoma caninum and Unicinaria stenocephala. In Toxascaris leonina infected dogs a complete cure rate was achieved with a single oral dose of 50 mg/kg. Similar results were obtained with 8 mg/kg administered three times per day. The most sensitive parasite to amidantel was found to be Toxocara canis with a 100 per cent cure rate after a single oral treatment with 10 mg/kg. In preliminary trials amidantel was also effective against hookworms and ascarids after subcutaneous administration. All hookworms and almost all of the ascarids were eliminated with the faeces within 2 days after treatment. Amidantel was tolerated in all dosages tested by all the dogs without any symptoms.

Ancylostoma

Changes in hookworm distribution in Surinam.

During the months May-July, 1974, a follow-up investigation was carried out on hookworm infections in dogs and cats in order to study changes in the hookworm distribution in Surinam since 1967. Fifty-two cats and 152 dogs were examined for the presence of helminths in the oesophagus, small intestine, coecum and heart. In total 15,942 helminths were isolated; most of these (14,006) were hookworms belonging to the species Ancylostoma caninum, A. tubaeforme, A. ceylanicum and A. braziliense. The average size of the hookworn load in dogs and cats appeared to have decreased since 1967, especially as regards A. ceylanicum. The distribution area of A. braziliense had extended largely by 1974 to the east and south in Surinam. In west Surinam A. braziliense infection was not found, just as in 1967.. The remaining parasites were Dipylidium caninum, Toxocara sp., Dirofilaria immitis, Spirocerca sanguinolenta, Spirometra mansonoides, Taenia taeniaeformis and Trichurisvulpis.

Ancylostomatoidea

Hookworm in dogs and cats in the area of Jakarta.

An investigation of the distribution and prevalence of hookworms in dogs and cats was carried out during the year 1976 in the area of Jakarta. Sixty-eight percent of the dogs harboured A. caninum, whereas 37% harboured A. ceylanicum and 18% A. braziliense and 32.1% as A. ceylanicum. Hookworms were recovered from 78% of the fifty cats; 72% of the cats were infected with A. braziliense and 24% with A.ceylanicum. Among the 1895 hookworms in cats, 73,5% were A. braziliense and 24.5% were A. ceylanicum. Only one female A. tubaeforme was found in one cat.

Ancylostomiasis

Comparative single/dose treatment of hookworm and roundworm infections with levamisole, pyrantel and bephenium*.

One-hundred and forty-five farmers aged 7-45 years who were infected with Ancylostoma duodenale and/or ascaris were treated with a single dose of levamisole, pyrantel, or bephenium. The percentage cure rates were ascaris 100 per cent ahd hookworm 93 per cent for levamisole; ascaris 90 per cent and hookworm 78 per cent for pyrantel; and ascaris 73 per cent and hookworm 81 per cent for bephenium. The 3 drugs were well tolerated. The opinions and assertions contained herein are the private ones of the authors and are not to be construed as official or as reflecting the views of the Department of the Navy or The Egyptian Ministry of Healty.

Adolescent

Effectiveness of single doses of Fenbendazole Hoe 88I against Ascaris, hookworm and Trichuris in man.

Fenbendazole (Hoe 881) 5-(phenylthio)-2-benzimidazolecarbaminicacidmethylester in doses of 1-0 g and 1-5 g per person were effective against Ascaris and gave substantial egg count reductions against hookworm (mainly Necator americanus). The 1-5 g dose gave good results against Trichuris. In a trial with a suspension of Hoe 881 with a high specific surface of 25 m2/g there was no advantage over tablets with a specific surface of approximately 8 m2/g. Two doses of 500 mg given with an interval of 24 hours were no more effective than one dose of 1-0 g. In a comparative trial using Hoe 881 1-5 g, Pyrantel 10 mg/kg and placebo respectively Hoe 881 showed equal potency against hookworms and Acsaris as Pyrantel and good effectiveness against Trichuris. Pyrantel showed only moderate activity against Trichuris in this trial.

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

A comparative in vitro study of antibody binding to different stages of the hookworm Ancylostoma caninum.

The Indirect Fluorescent Antibody Technique (IFAT) and the Indirect Immuno Peroxidase Technique (IIPT) have been applied to cryostat sections and intact stages of the hookworm species Ancylostoma caninum with sera from infected dogs. Especially the role of the body surface (= cuticle (cortex, matrix, basal layer) and hypodermis) in immunity was studied. Using cryostat sections and dead intact stages as the antigen, specific antibody binding was demonstrated round the ovum membrane and the cuticle of all stages of this hookworm species. Cryostat sections of adult worms showed, that it probably is not the cuticle itself that is antigenic, but that the specific reaction that is observed consisted of a layer, covering the cortex of the cuticle. Infective and parasitic living stages, however, showed no antibody binding in contrast to the free-living stages in which specific antibody binding was demonstrated.

Ancylostoma