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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 3  |  Issue : 2  |  Page : 39-41

Co-Infection of Hookworm and Plasmodium Vivax Leading to Severe Anemia Associated with Diffuse Nodular Proctocolitis - A Case Report


1 Senior Resident, Department of Microbiology, Indira Gandhi institute of Medical Sciences, Sheikhpura, Patna - 14, Bihar, India
2 Additional Professor, Department of Microbiology, Indira Gandhi institute of Medical Sciences, Sheikhpura, Patna - 14, Bihar, India
3 Assistant professor, Department of Microbiology, Indira Gandhi institute of Medical Sciences, Sheikhpura, Patna - 14, Bihar, India
4 Professor, Department of Microbiology, Indira Gandhi institute of Medical Sciences, Sheikhpura, Patna - 14, Bihar, India

Date of Web Publication11-Dec-2020

Correspondence Address:
Kumar Ajay
Senior Resident, Department of Microbiology, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna -14, Bihar
India
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Source of Support: None, Conflict of Interest: None


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  Abstract 


Introduction
Malaria is well known since antiquity, and its parasites are also found in various part of the world. The mixed parasitic infections are not very uncommon ,but the protozoal and intestinal nematode mixed infection is uncommon. We are presenting a case which is a proved mixed parasitic infection having protozoal and intestinal nematode infection admitted in IGIMS, Gastro1ogy department.
Case Report
A 35 year old male presented with febrile illness with severe anemia, anasarca, ascitis and melena. The hemoglobin value was 1.8gm percent. Gastrointestinal endoscopy was normal but white thread like structure attached to mucosa of duodenum was found. Later on it proved to be Hookworm during microscopic examination. Patient was positive for Plasmodium vivax also. The colonoscopic finding was diffuse nodular proctocolitis. No clinical sign or histopathological evidence was detected for inflammatory bowel Syndrome. No evidence of granuloma or neoplasia was seen in serial section.
Conclusion
Co-infection of Hookworm and Plasmodium vivax is an unusual finding. Both Hookworm and Plasmodium vivax cause anemia. Severe anemia in this case may be due to Hookworm or Plasmodium vivax individually or may be due to synergistic infection of both the parasites.


How to cite this article:
Ajay K, Shailesh K, Rakesh K, Namrata K, Anima X, Shahi S K. Co-Infection of Hookworm and Plasmodium Vivax Leading to Severe Anemia Associated with Diffuse Nodular Proctocolitis - A Case Report. J Indira Gandhi Inst Med Sci 2017;3:39-41

How to cite this URL:
Ajay K, Shailesh K, Rakesh K, Namrata K, Anima X, Shahi S K. Co-Infection of Hookworm and Plasmodium Vivax Leading to Severe Anemia Associated with Diffuse Nodular Proctocolitis - A Case Report. J Indira Gandhi Inst Med Sci [serial online] 2017 [cited 2021 Dec 7];3:39-41. Available from: http://www.jigims.co.in/text.asp?2017/3/2/39/303145




  Introduction Top


Parasitic diseases are common and may present clinically in a variety of ways. Although travel to endemic areas suggests particular infections, many parasites are transmitted through fomites or acquired by contact with human carriers and can occur anywhere. Hookworm is one of important soil-transmitted helminthes (STH) for humans around the world. About 740 million people are estimated to be infected by hookworm. Human infection by hookworms induces blood loss, iron-deficiency anemia, and other anemia associated-symptoms and signs. Human hookworm includes two species, Necator americanus and Ancylostoma duodenale. Worldwide, N. americanus accounts for the predominant etiology of human hookworm infection, whereas A. duodenale occurs in more scattered focal environments[1].

The annual number or deaths may be approimately 50,000 as a resu1t of hookworm anemia. Hookworm infection is widely prevaent in india. Necator americanus is predominant in south india, and Ancylostoma duodenale in north india. Recenty another species, A. ceylanicum has been reported from a village near Calcutta[2].

Malaria is a protozoal disease transmitted by the bite of infected anopheles mosquitoes. It is the most important of the parasitic diseases of humans, with transmission in 107 countries containing 3 billion people and causing 1-3 million death each year. Malaria is a major cause of mortality and morbidity in the tropical and subtropical regions of world. Developed countries are relatively free of malaria, but it remains well entrenched across the tropical world[3].

The incidence of malaria worldwide is estimated to be 300-500 million clinical cases each year, with about 90 percent of these occurring in Sub -Saharan Africa, and mostly caused by P.falciparum. Of reported cases of malaria, India accounts for 77 percent of the regional total Major endemic areas in India are in the North-Eastern states, Andhra Pradesh, Chhattisgarh, Gujarat, Jharkhand, Bihar, M.P, Maharashtra, Rajasthan and Orissa. Five species of the genus Plasmodium cause nearly all malarial infections in humans Out of the infections caused by the five species of plasmodium almost all deaths are caused by falciparum malaria[4].

Anaemic individuals in poorly resourced communities are vulnerable to a cycle driven by low host immunity, an increased susceptibility to malnutrition and infection, which gives rise to further haemopoietic suppression and haemolysis[5]. As the hemoglobin concentration falls below 8g/dl the risk of mortality rises. In those who do not succumb, the consequences of severe anaemia can be long-lasting, including cognitive impairment, stunting and delays in motor development.[6]


  Case Report Top


A 35 year old male presented with febrile illness with severe anemia, anasarca, ascitis and melena. The hemoglobin value was 1.8gm percent. Gastrointestinal endoscopy was normal [Figure 1]
Figure 1: Endoscopic report

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but white thread like structure attached to mucosa of duodenum was found, later on it proved to be Hookworm during microscopic examination.[Figure 2]
Figure 2: Hookworm in duodenal fluid (wet mount)

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Patient was positive for Plasmodium vivax also. Antigen detection was performed using a commercially available antigen detection kit Manuffactured by Aspen Laboratories Pvt Ltd.[Figure 3] Confirmation of diagnosis was made by demonstration of plasmodium in the peripheral blood by thin and thick periphera1 blood smear examination.
Figure 3: kit positive for P. vivax

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No clinical sign or histopathological evidence was detected for inflammatory bowel Syndrom. No evidence of granuloma or neoplasia was seen in serial section. After the diagnosis, he was treated with packed RBC transfusion, iron supportive therapy and albendazole medication, 400 mg twice per day for two days. His symptoms of dyspnea, dizziness, and severe anemia improved.


  Discussion Top


Clinical findings of the present case included anemia, dyspnea, and undernourished condition, which are known to be associated with hookworm infection. The severe anemia may have been due not only to the hookworm infection, but also to undernourishment. In general, infection by a few hookworms is not sufficient to induce clinical anemia. The present patient recovered greatly from anemia by albendazole therapy, choloroquine and supportive medical treatment. This fact confirmed that the anemia of the present case was caused by heavy infection of the hookworm. Reviewing his medical records, it was unfortunate that his fecal specimen was not examined properly throughout his whole past medical history. He had visited several hospitals but no doctors had suspected hookworm anemia and his feces had not been properly checked for more than 2 yr. The present patient suffered from this disease for at least 2 yr because the possibility of hookworm anemia in this case was completely neglected by physicians.

A systematic review of randomised controlled trials (RCTs) investigating the impact of anthelmintic treatment reported an increase in haemoglobin concentration (Hb) of 1.71 g/l after treatment. But this review did not distinguish between different helminth species or account for intensity of infection, which may have underestimated the true treatment effect; the effect of treatment is likely to be greatest where hookworm is most prevalent and intense.

Chloroquine (CQ) is the first line treatment for confirmed P. vivax malaria in the country. However, the efficacy of this drug has been compromised by CQ resistant P. vivax (CRPv) strains.


  Conclusion Top


General condition of the patient well improved with anti-parasitic and anti-anemia treatment. Co-infection of Hookworm and Plasmodium vivax is an unusual finding. Both Hookworm and Plasmodium vivax cause anemia. The presence of hookworm was particularly important, increasing the risk of anaemia 2.6 fold. Severe anemia in this case may be due to Hookworm or Plasmodium vivax individually or may be due to synergistic infection of both the parasites.



 
  References Top

1.
Burdam FH, Hakimi M, Thio F, Kenangaem E, Indrawati R,. Asymptomatic Vivax and Falciparum Parasitaemia with Helminth Co-Infection: Major Risk Factors for Anaemia in Early Life. Journa1P1oS One. 2016; 11(8): 160-917.  Back to cited text no. 1
    
2.
Chimelli L.A Morphological Approach to the Diagnosis of Protozoal Infections of the Central Nervous System. Patholog Res Int. 2011; 29(8): 3-5.  Back to cited text no. 2
    
3.
Hyun F, Weatherall DJ, Wickrama Singhe SN and Hughes M, et al. A Case of Severe Anemia by Necator americanus Infection in Korea. J Korean Med Sci. 2010 ; 25(12): 1802-1804.  Back to cited text no. 3
    
4.
Jennifer L Smith, Simon Brooker. Impact of hookworm infection and deworming on anaemia in non-pregnant populations: a systematic review. Trop Med Int Health. 2010; 15(7): 776-795.  Back to cited text no. 4
    
5.
Reddy SC, Vega KJ. Endoscopic diagnosis of chronic severe upper GI bleeding due to helminthic infection. Gastrointest Endosc. 2008; 67: 990-992  Back to cited text no. 5
    
6.
Seifu S, Zeynudin A, Zemene E, Suleman S, Biruksew A. Therapeutic efficacy of Chloroquine for the treatment of Plasmodium vivax malaria among outpatients at Shawa Robit Health Care Center, North-East Ethiopia. Acta Trop. 2017;11(7): 47-45.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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