IRON DEFICIENCY ANEMIA AND ANCYLOSTOMA DUODENALE
Onofre Alarcón, Antonio Sánchez del Río, Salvador Baudet,
Servicio de Digestivo. Tenerife. Canary Islands. Spain
INTERNATIONAL COURSE ON
CAPSULE ENDOSCOPY
ICCE 2005
Miami Florida USA
CLINICAL CASE
Fresh ulcer
Fresh ulcer
A duodenale
A duodenale
Ulcer with clot
A 58 year old man with iron deficiency anemia was referred to our Unit for a wireless capsule endoscopy
Study. He had no diarrhea, abdominal pain, weight loss or rectal bleeding.
A hemoccult test was positive, so he had been previously studied with a full colonosocpy, upper endoscopy
and small bowel series with negative resultaste patient had no family history of cancer or inflammatory bowel
Disease.
He had not past history of peptic disease, NSAIDs intake or alcohol consuption.
Celiac disease was also ruled out and a hematologic consultation show not any other specific consultation.
A wireless capsule endoscopy study was done, showing multiple round small ulcers, some fresh and some
covered with black fibrina, along the distal jejunum and ileum.
At ileum several white, small filliform figures attached to the bowel wall were found. They showed a slightly
dilatated reddish portion in the anchorage point.
A suspicion diagnosis of hookworm disease was done, confirmed with a direct fecal examination
which showed oval eggs .
Treatment with iron repletion and antihelmintic therapy with albendazole was started, and the anemia
resolves
DISCUSSION
Hookworm infection is a worlwide intestinal parasitic disease afeccting more than one billion people.
It is caused by the nematodes Ancylostoma duodenale, Necator americanus and Ancylostoma ceylonicum.
A duodenale and N americanus are white, cylindrical worms 0.8-1.5 cm long. Ancylostoma duodenale (Old
World hookworm) is found in most areas of the World , especially Asia, Africa, Middle East and Southern
Europe. In North and South America predominates Necator americanus (New World hookworm).
Adult hookworms anchor themselves in the mucosa of the small intestine. The teeth of the adult hookworm
allow it to grip the intestinal mucosa. The worm secretes an anticoagulant that facilitates the ingestion of
blood and juices from its host. They periodically change their location, which can explain the multiple,
different stage ulcers we found in the capsule exam.
Although hookworm infection represents an important public health problem in developing countries the
immigration process to Western countries has increased the recognition of this disease as a cause of
anemia. Diagnosis of hookworm is usually based on finding the characteristic eggs in the stool. The clinical
manifestations of hookworm infection depends on the life cycle of the organism and the intensity of infection.
The symptoms include skin irritation, pruritus, cough, wheezing, epigastric pain or abdominal tenderness.
However the hallmark of chronic hookworm disease is iron deficiency anemia, as was the case of our
patient.
BIBLIOGRAPHY
Pearson RD Parasitic diseases: helminths Chapter 109, 2442-2459 In Tadataka Yamada Textbook of Gastroenterology
volume 2 Third edition Lippincott Williams & Wilkins Philadelphia 1999
Roca C, Balanzo X, Sauca G, Fernandez-Roure JL, Boixeda R, Ballester M Imported hookworm infection in African immigrants
in Spain A study of 285 patients Med Clin (Barc) 2003 Jun 28; 121(4):139-41
A duodenale and ulcer
CONCLUSIONS
•Hookworm infection represents an important public health problem in developing
countries.
•The inmigration process to Western countries has increased the recognition of this
disease as a cause of anemia.
•As wireless capsule endoscopy has become the procedure of choice for small bowel
imaging in the evaluation of iron deficiency anemia physicians performing this test must
be familiarized with the capsule findings of hookworm infection.