What is the treatment for hookworm infection with anemia of chronic disease?

Treatment of Hookworm Infection with Anemia of Chronic Disease

The recommended treatment for hookworm infection with anemia of chronic disease is albendazole 400 mg orally with a repeat dose in 2 weeks, combined with iron supplementation to address the anemia. 1, 2

Diagnosis

• Diagnosis of hookworm infection should be made through concentrated stool microscopy, which is recommended for all returning travelers/migrants with eosinophilia 3
• Multiple stool samples may be needed due to intermittent egg shedding 1
• Eosinophilia is a common finding in hookworm infections, especially during the migratory phase (Loeffler's syndrome) 3
• Evaluate for anemia of chronic disease by checking iron studies, including ferritin, transferrin saturation, and inflammatory markers 3

Treatment Algorithm

Step 1: Antihelminthic Therapy

• First-line treatment: Albendazole 400 mg orally as a single dose with a repeat dose in 2 weeks 1, 4
• Alternative: Mebendazole can be used with high efficacy (96% cure rate for hookworm infections) 4, 2

Step 2: Address Anemia

• Iron supplementation should be initiated concurrently with antihelminthic therapy 5, 2
• For severe anemia (Hb < 7 g/dL), blood transfusion may be considered, followed by intravenous iron supplementation 3
• Optimize treatment of any underlying inflammatory condition contributing to anemia of chronic disease 3

Clinical Considerations

• Hookworm infection commonly presents with:

  • Respiratory symptoms: wheeze, dry cough (Loeffler's syndrome) 3
  • Gastrointestinal symptoms: nausea, vomiting, diarrhea, abdominal pain 3, 1
  • Cutaneous manifestations: urticarial rash 3
  • Anemia, particularly in children and heavily infected individuals 3, 5

• The combination of albendazole with iron supplementation addresses both the parasitic infection and the resulting anemia 2

• Meta-analysis shows that albendazole treatment corresponds to a 1.89 g/L increase in mean hemoglobin levels 2

Follow-up and Monitoring

• Repeat stool examination 2-3 weeks after treatment to confirm eradication of infection 1
• Monitor hemoglobin levels and iron studies to assess response to treatment 2
• In cases of persistent anemia despite parasite clearance, consider other causes or complications 3, 6

Special Considerations

• Heavy hookworm infections can cause severe, life-threatening anemia requiring urgent blood transfusion before antihelminthic treatment 7, 6
• The impact of treatment is greatest when albendazole is administered, with mebendazole showing less impact on improving hemoglobin levels in some studies 2
• Consider screening household contacts in endemic settings to prevent reinfection 1
• Prevention strategies include hand hygiene and wearing shoes in endemic areas 1, 8

Pitfalls to Avoid

• Failing to investigate for hookworm infection in patients with unexplained iron deficiency anemia who have traveled to endemic areas 3, 7
• Treating anemia without addressing the underlying hookworm infection will lead to persistent blood loss and treatment failure 5, 6
• Not considering other concomitant parasitic infections that may contribute to anemia 3, 2
• Inadequate follow-up after treatment, as reinfection is common in endemic areas 8