Treatment of Worms in the Duodenum (D1)
Treat with albendazole 400 mg orally as a single dose, which is the first-line anthelminthic for most intestinal helminth infections including hookworm, roundworm, and pinworm found in the duodenum. 1, 2, 3
Immediate Management
- Administer albendazole 400 mg PO as a single dose for most intestinal worms visualized in the duodenum 1, 2, 3
- If hookworm is specifically identified (most common duodenal worm causing visible infection), consider albendazole 400 mg PO daily for 3 days for more severe infections 3, 4
- Alternative regimen: mebendazole 100 mg PO twice daily for 3 consecutive days is FDA-approved for hookworm, roundworm, and whipworm 5
Species-Specific Considerations
Hookworm (Most Likely in D1)
Hookworms (Ancylostoma duodenale and Necator americanus) are the most common helminths causing visible duodenal infestation and acute GI bleeding 6, 7:
- Standard treatment: albendazole 400 mg PO as a single dose, repeated in 2 weeks 4
- For heavy infections with anemia: add iron supplementation and consider prednisolone 40-60 mg once daily if severe hookworm disease 3, 4
- Hookworms attach to duodenal mucosa causing blood loss, leading to iron-deficiency anemia, which requires concurrent iron therapy 8, 9
Roundworm (Ascaris lumbricoides)
- Albendazole 400 mg PO single dose achieves 98% cure rates 5
- Alternative: mebendazole 100 mg PO twice daily for 3 days 5
Strongyloides (If Suspected)
- Do NOT use single-dose albendazole - requires prolonged therapy 3
- Albendazole 400 mg PO twice daily for 21 days with monitoring of liver function and CBC 3
- Critical: Screen for Loa loa before giving ivermectin in patients from Central/West Africa to prevent severe encephalopathy 3, 4
Diagnostic Confirmation
- Direct endoscopic visualization and retrieval with biopsy forceps is diagnostic when worms are seen in the duodenum 6, 7
- Concentrated stool microscopy should be performed to identify eggs and confirm species 1, 3
- Check complete blood count for eosinophilia and iron-deficiency anemia (microcytic, hypochromic) which strongly suggests hookworm 8, 6
Critical Monitoring
- Repeat stool examination 3 weeks after treatment - if not cured, administer a second course 5
- Monitor hemoglobin and iron studies in patients with hookworm-related anemia 4, 8
- No fasting or purging required before or after treatment 5
Prevention of Reinfection
- Treat all household contacts simultaneously with albendazole 400 mg PO single dose, especially for highly contagious infections like pinworm 3
- Implement hand hygiene with soap before eating and after defecation 3
- Wear shoes in endemic areas to prevent percutaneous larval penetration by hookworm 3, 4
Common Pitfalls to Avoid
- Do not assume single-dose therapy is adequate for all helminths - Strongyloides requires 21 days of treatment and can cause fatal hyperinfection in immunocompromised patients 3
- Do not give ivermectin without excluding Loa loa in patients from endemic regions (Central/West Africa) as this can cause fatal encephalopathy 1, 3
- Do not forget iron supplementation in hookworm patients with anemia, as anthelminthic therapy alone will not correct the iron deficiency 4, 8
- Do not overlook household transmission - treat contacts to prevent reinfection cycles 3