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ANCYLOSTOMIASIS CAUSING UPPER GASTROINTESTINAL BLEEDING

REAL-TIME ENDOSCOPIC PICTURES

AbdAllah, Mohamed, MSc

Section Editor(s): Vitito, LeAnne MS, RN, CGRN, APRN; Department Editor

doi: 10.1097/SGA.0000000000000423
Departments: Clinical Case Study
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Mohamed AbdAllah, MSc, is Assistant Researcher, Medical Research Division, National Research Center, Giza, Egypt; GI Endoscopy Unit (Gieluka), Faculty of Medicine, Cairo University, Egypt.

Correspondence to: Mohamed AbdAllah, MSc, 17 Fatma Rushdy St, Haram, Giza 11212, Egypt (dr.mohamedabda@gmail.com).

THE OFFICIAL JOURNAL OF THE SOCIETY OF GASTROENTEROLOGY NURSES AND ASSOCIATES, INC. AND THE CANADIAN SOCIETY OF GASTROENTEROLOGY NURSES AND ASSOCIATES

DEDICATED TO THE SAFE AND EFFECTIVE PRACTICE OF GASTROENTEROLOGY AND ENDOSCOPY NURSING

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (www.gastroenterologynursing.com).

The author declares no conflicts of interest.

Received July 06, 2018

Accepted September 04, 2018

A 60-year-old farmer presented to our clinic with anemic manifestations for 2 months. The patient also gave a history of intermittent attacks of melena. Physical examination only demonstrated pallor. Laboratory studies revealed iron-deficiency anemia (hemoglobin: 6.1 g/dL) in addition to mild eosinophilia. Upper gastrointestinal endoscopy was performed revealing several live and motile worms about 1 cm in length (Figure 1). One live worm was easily extracted using standard biopsy forceps (Figure 2) (see Video 1, Supplemental Digital Content 1, available at: http://links.lww.com/GNJ/A55). Microscopic examination confirmed an ancylostomiasis or hookworm infection. The patient received albendazole and iron supplementation with rapid improvement of the condition.

FIGURE 1

FIGURE 1

FIGURE 2

FIGURE 2

A. duodenale is one of the most widespread hookworm parasites in the world. It is a common cause of anemia and occult gastrointestinal bleeding in the tropics (Hossain & Bhuiyan, 2016). Studies reveal that only 40 adult hookworms can cause a drop of hemoglobin level to less than 6.82 g/dL (Lwambo, Bundy, & Medley, 1992).

Hookworm infection can be diagnosed by detection of eggs in stool. However, the diagnosis may be missed due to the absence of eggs in a single stool specimen. Therefore, repeated stool examination is preferable (Wu, Hsu, Chiu, Chiu, & Changchien, 2002). Eosinophilia can be detected in 30%–60% of cases. Upper endoscopy is another diagnostic modality. Extraction of a living worm for microscopic examination is preferred for confirmation of diagnosis. Treatment course using albendazole 400 mg orally once or mebendazole 100 mg orally twice a day for 3 days is sufficient to achieve complete cure (Blair & Diemert, 2015).

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REFERENCES

Blair P., Diemert D. (2015). Update on prevention and treatment of intestinal helminth infections. Current Infectious Disease Reports, 17(3), 465.
Hossain M., Bhuiyan J. U. (2016). Hookworm infection: A neglected tropical disease of mankind. Journal of Advanced Veterinary and Animal Research, 3(4), 297–320.
Lwambo N. J., Bundy D. A., Medley G. F. (1992). A new approach to morbidity risk assessment in hookworm endemic communities. Epidemiology & Infection, 108(3), 469–481.
Wu K. L., Hsu S. K., Chiu K. W., Chiu Y. C., Changchien C. S. (2002). Endoscopic diagnosis of hookworm disease of the duodenum: a case report. Journal of Internal Medicine of Taiwan, 13, 27–30.

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