Necator Americanus / Ancylostoma Duodenale

Lisette van Lieshout ©[email protected] by author

Department of Parasitology ESCMID OnlineLUMC, TheLecture Netherlands Library

Department of Parasitology Leiden University MedicalLUMC Centre - Parasitology Helminths

Nematodes (roundworm) • Geohelminths • Strongyloides

Cestodes (tapeworm) • Taenia • Echinococcus© by author ESCMIDTrematodes Online(flukes) Lecture Library • Schistosoma • Food born trematodes

Department of Parasitology Leiden University MedicalLUMC Centre - Parasitology Intestinal nematodes: geo-helminths

1 cm

Department of Parasitology 30 cm Leiden University MedicalLUMC Centre - Parasitology Intestinal nematodes: geo-helminths

Ascaris lumbricoides • large roundworm (spoelworm) Hookworm • Necator americanus / Ancylostoma duodenale • (mijnworm) Trichuris trichiura • wipworm (zweepworm) © by author Review: BethonyESCMID et al., (2006) Online Lancet Lecture367:1521-1532 Library Knopp et al., (2012) Infect Dis Clin N Am 26: 341-358

Department of Parasitology Leiden University MedicalLUMC Centre - Parasitology Intestinal nematodes

+ Strongyloides 4 geohelminths / STH

Enterobius vermicularis (pinworm)

Toxocara spp. (ascaridida of dogs/cats) Baylisascaris (ascaridida of raccoons) Anisakis / Pseudoterranova (raw fish)

Capillaria philippinensis (Trichuris like eggs) Trichinella © by author Trichostrongylus (hookworm like eggs) Angiostrongylus (rat lungworm, snails) Ternidens (hookworm like, non-human primates) ESCMIDOesophagostomum (eggsOnline as hookworm) Lecture Library

Gnathostoma (uncooked fish)

Department of Parasitology Leiden University MedicalLUMC Centre - Parasitology Distribution of STH www.thiswormyworld.org/

Department of Parasitology Leiden University MedicalLUMC Centre - Parasitology Savioli and Albonico (2004) Nature Reviews Microbiology 2: 618-619

2 billion people infected with STH Morbidity >> Mortality

1946 – this wormy world 25 different helminth species, 2.3 billion infections, 2.2. billion people world population 1999 update: © by author 4.5 billion infections, 5.8 billion people world population

*) Loker (2013) This de-wormed world? J. parasitol 99:933 ESCMID Online Lecture Library

Department of Parasitology Leiden University MedicalLUMC Centre - Parasitology 2012 update: 4.2 billion infections, 7 billion people world population “The bottom billion” © by author *) Loker (2013) This de-wormed world? J. parasitol 99:933 ESCMID Online Lecture Library

Department of Parasitology Leiden University MedicalLUMC Centre - Parasitology Distribution of STH

Department of Parasitology Leiden University MedicalLUMC Centre - Parasitology Helminth infections: the great neglected tropical diseases

J. Clin. Invest. Peter J. Hotez, et al. 118:1311 – April 2008 doi:10.1172/JCI34261 [Go to this article.]

Department of Parasitology Leiden University MedicalLUMC Centre - Parasitology Global burden of disease (?)

Children: • malnutrition • delayed cognitive development Pregnant women • anaemia

Department of Parasitology Bethony et al., (2006) Lancet 367:1521-1532 Leiden University MedicalLUMC Centre - Parasitology Soil transmitted helminths

Characteristics of the soil-transmitted helminths:

Department of Parasitology Leiden University MedicalLUMC Centre - Parasitology Intensity of infection  morbidity

Department of Parasitology Leiden University MedicalLUMC Centre - Parasitology Summary diagnostics soil transmitted helminths (STH)

• Microscopy (quantification of eggs) • High egg production (A.l. + T.t.) • Serology (Ab detection) • Antigen detection • Molecular diagnosis© by author (PCR) • Research tool mainly (LUMC) ESCMID Online Lecture Library

Department of Parasitology Leiden University MedicalLUMC Centre - Parasitology Oral contamination intestinal nematodes - hygiene

Trichuris – clinical aspects

• intensity of infection • often asymptomatic or mild symptoms • rectal prolaps (children) © by author ESCMID Online Lecture Library Trichuris

Department of Parasitology Leiden University MedicalLUMC Centre - Parasitology Trichuris microscopic diagnosis

57x25 µm

Department of Parasitology Example atypical egg Leiden University MedicalLUMC Centre - Parasitology Oral contamination intestinal nematodes - hygiene

Ascaris – clinical aspects:

• intensity of infection (obstruction) • pneumonia (Löffner) eosinophilia • vague abdominal problems • migration of adult worm © by author ESCMID Online Lecture Library Ascaris

Department of Parasitology Leiden University MedicalLUMC Centre - Parasitology Ascaris microscopic diagnosis

65x46 µm

decorticated egg Department of Parasitology (no mammillated layer) Leiden University MedicalLUMC Centre - Parasitology Ascaris diagnosis at home

Department of Parasitology Leiden University MedicalLUMC Centre - Parasitology Skin penetration of intestinal nematodes - tropical

Strongyloides Department of Parasitology Leiden University MedicalLUMC Centre - Parasitology hookworm – clinical aspects

• intensity of infection • anaemia

• comparatively to Ascaris less pneumonia

Hookworm ESCMID Online Lecture Library

Department of Parasitology Leiden University MedicalLUMC Centre - Parasitology Hookworm species

NecatorESCMID americanus OnlineAncylostoma Lecture duodenale Library

Department of Parasitology Kato slide Leiden University MedicalLUMC Centre - Parasitology Hookworm microscopic diagnosis

65x40ESCMID µm Online Lecture Library Hookworm – L1 long buccal cavity

Department of Parasitology invisible genital premordium Leiden University MedicalLUMC Centre - Parasitology Hookworm microscopic diagnosis

Trichostrongylus

65x40ESCMID µm Online Lecture Library

Department of Parasitology 75x100 µm Leiden University MedicalLUMC Centre - Parasitology World distribution of two hookworm species

Department of Parasitology Leiden University MedicalLUMC Centre - Parasitology Hookworm species

NecatorESCMID americanus OnlineAncylostoma Lecture duodenale Library  0.02 mL/w/d  0.2 mL/w/d

Department of Parasitology => 100 mL/d Leiden University MedicalLUMC Centre - Parasitology Hookworm - microscopic diagnosis

Figure 5 Stool culture

• L3 = filariaform larvae

• 3-7 days • laborious

Department of Parasitology 30x600 µm Leiden University MedicalLUMC Centre - Parasitology Ancylostoma duodenale

Necator americanus Department of Parasitology Leiden University MedicalLUMC Centre - Parasitology Ancylostoma duodenale

Necator americanus Department of Parasitology Leiden University MedicalLUMC Centre - Parasitology Mozambique - Hookworm

Positive Diagnostic method N (% of 303) Direct Smear 22 (7%) Ridley 77 (25%) Kato 79 (26%) Culture © by author88 (29%) ESCMIDMicroscopy all Online Lecture100 Library(33%) Real time PCR 106 (35%)

Department of Parasitology Van Lieshout et al (in preparation) Leiden University MedicalLUMC Centre - Parasitology Mozambique - Hookworm

Necator PCR Positive Negative Total Ancylostoma PCR Positive 155% 60 7525% Negative 31 197 228 Total © by46 author15% 257 303 ESCMID Online Lecture Library

Department of Parasitology Van Lieshout et al (in preparation) Leiden University MedicalLUMC Centre - Parasitology Mozambique - Hookworm

N. americanus A. duodenale 50

20 © by author % PCR positive% PCR 10 ESCMID Online Lecture Library 0 1-4 years 5-9 years 10-19 years 20-39 years >40 years N = 43 50 75 86 41 N= 303 - 8

Department of Parasitology Van Lieshout et al (in preparation) Leiden University MedicalLUMC Centre - Parasitology Enterobius, no geo-helminth

Department of Parasitology Leiden University MedicalLUMC Centre - Parasitology Enterobius, no geo-helminth

• mild symptoms (?) • under diagnosed • group infections

Department of Parasitology Leiden University MedicalLUMC Centre - Parasitology Enterobius – symptoms?

Asymptomatic or perianal pruritus De Jong et al. NTVG; 2003 147: 813 Case: • Heavy diarhoea (10-15x, watery) • Eosinofilia (> 31%) (?????) • Extreme high worm load Enterobius • Complete recovery after mebendazol © by author Similar case: •ESCMIDTijdschr. Infect. 2008;Online 3:115 Stelma Lectureet al. Library

Department of Parasitology Leiden University MedicalLUMC Centre - Parasitology € 0.90 for 2 tablets

Enterobius: 1 tabl + repeat after 14 days STH: 2 dd tablet, 3dg

Department of Parasitology Leiden University MedicalLUMC Centre - Parasitology Deworming debate

Department of Parasitology Leiden University MedicalLUMC Centre - Parasitology