Biopharmaceutical Solutions

Background information

• What is Human Hookworm Infection?
  Human hookworm infection is a parasitic disease caused by soil-dwelling nematodes. Whereas light infections may be asymptomatic, heavy infections may cause anemia, diarrhea, abdominal pain, weight loss, and loss of appetite. 
• Global burden
  An estimated 576 million people are infected with hookworm, and approximately 3 billion people are at risk for acquiring the infection.
• Geographic distribution
  The largest number of cases occurs in impoverished rural areas of sub-Saharan Africa (198 million cases), Southeast Asia (59 million), India (71 million), and tropical regions of the Americas (50 million).
• Causative agent/transmission
  Text here. Hookworm infection is caused by the parasitic nematodes Necator americanus and Ancylostoma duodenale. N. americanus is found in the Americas, sub-Saharan Africa, Southeast Asia, China, and Indonesia and is the more prevalent cause of infection; A. duodenale is geographically restricted to the Middle East, North Africa, and India. Hookworms hatch in soil and mature through three larval stages. Upon contact with humans, larvae penetrate the skin, enter the blood stream, and eventually migrate into the lung trachea, where they are swallowed into the stomach. They then travel through the digestive tract to the small intestine where, over five to nine weeks, they feed on blood components and mature into adult worms that are approximately one centimeter in length. Adult females lay eggs, which are released in feces into the environment, reinitiating the cycle of infection.

Presentation

To feed, hookworms attach to the walls of the small intestine, resulting in host blood loss and injury to the mucosa. In children, chronic disease causes iron-deficiency anemia, which impairs physical and cognitive development. In expectant mothers, severe infection results in adverse outcomes for both mother and child, including low birth weight, impaired milk production, and increased risk of death.

Trends

Currently, human hookworm infection is treated by deworming with the drugs, and deworming programs are a crucial component of hookworm control programs. Many control programs, however, are school-based, which limits their ability to reach adults and the elderly. Also, drug treatment has variable efficacy, and with frequent and repeated use, there are concerns that drug resistance may develop. Moreover, re-infection occurs rapidly post-treatment, especially in areas of high transmission where it can occur within four to 12 months.

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