A 32-year-old male with no prior comorbidity, presented to the gastroenterology outpatient
department of our institute with complaints of pain epigastrium, heartburn, and easy
fatigability. There was no history of hematemesis, melena, or hematochezia and on
examination pallor was noted; rest of the physical examination was within normal limits.
The patient had hemoglobin of 9.2 g/dL with mean corpuscular volume of 76 fL and iron
studies suggestive of iron deficiency. Immunoglobulin A-tissue transglutaminase levels
were within normal limits. There was no history of blood transfusion but had been
recently prescribed oral iron therapy by a general physician. No stool testing for
worms was done. The patient underwent esophagogastroduodenoscopy for evaluation of
iron deficiency anemia and multiple live hookworms in the duodenum were seen ([Fig. 1]). D2 folds were normal. The patient was given antihelminthic treatment in the form
of albendazole and oral iron replacement was continued. The patient improved symptomatically
and on follow-up, his current hemoglobin is 13.5 g/dL.
Fig. 1 Esophagogastroduodenoscopy image showing multiple live hookworms present in the second
part of the duodenum (yellow side arrow).
Hookworms are soil-transmitted nematode parasites that can reside for many years in
the small intestine of their human hosts. By feeding on the blood of their host, the
adult worms can induce iron deficiency anemia, especially in high-risk groups including
children and women of childbearing age. The primary morbidity associated with human
hookworm infection stems from the loss of blood in the intestine (mostly from leakage
around the attachment site of the worm and, to a lesser extent, from actively feeding
adult worms). [1] Each adult hookworm causes loss of an estimated 0.3 to 0.5mL of blood each day.[2] Stool microscopic examination is the main diagnostic method for hookworm infection,
although the yield depends on the worm burden and the diagnostic technique.[3]
