Thirty‐One‐Year‐Old Man with Hookworm Infection and Complicated Treatment

1Beth Israel Deaconess Medical Center, Boston, MA

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 507

Case Presentation:

This is a 31‐year‐old man with no significant medical history who presented with 2 weeks of progressive lower abdominal pain, nausea, and anorexia. The patient otherwise denied fevers, chills, chest pain, shortness of breath, emesis, diarrhea, bloody or black stool, dysuria, or rash. His medical history was negative, and he took no daily medications. He was a student from Uganda, recently returning from a trip home two months prior to presentation. His family history was unremarkable. Physical exam was notable for normal vital signs, and a thin male in mild distress, with normal heart and lung exams, and an abdominal exam with hypoactive bowel sounds, periumbilical pain to light palpation and voluntary guarding but no rebound tenderness. Laboratory analysis showed a mild leukopenia at 38,000/μL, 46% neutrophils, 43% lymphocytes, and 5% eosinophils, with normal electrolytes, renal function, and liver function. CT scan of the abdomen demonstrated a partial small bowel obstruction versus focal ileus with no clear transition point in the midintestine. Stool culture was preliminarily negative, as was HIV serology. His symptoms stabilized after 48 hours of supportive care, and he was discharged home to follow up closely with his primary care physician, diagnosed with a gastroenteritis. However, one day after discharge, the patient's stool returned positive for hookworm eggs. Attempts were made to arrange for treatment with albendazole or mebendazole at local pharmacies. Unfortunately, these medications were on back order and therefore unavailable. After a several‐day delay in treatment, he was prescribed a third‐line agent, pyrantel pamoate, with eventual improvement in his symptoms.

Discussion:

Hookworm infection, caused by the helminth nematodes Necator americanus and Ancylostoma duodenale, is one of the most common infections worldwide, affecting an estimated 740 million people. Infection is caused by larval penetration of the skin leading to colonization in the intestine. Symptoms range from asymptomatic state to abdominal pain with iron‐deficiency anemia. Treatment involves a short course of albendazole, mebendazole, or, alternatively, pyrantel pamoate. Unfortunately, antimicrobial agent shortages are the second most common type of drug shortages behind oncologic agents. Drug shortages can delay treatment and complicate transitions of care, forcing hospitalists to use inferior agents that potentially lead to increased toxicity, increased resistance, and decreased efficacy of treatment.

Conclusions:

Hookworm infection is an important global disease rarely seen in the United States, causing significant morbidity in humans. It is important that hospitalists understand the presentation and treatment of hookworm infection, particularly in recent travelers. In addition, hospitalists must appreciate the growing problem of antimicrobial drug shortages, adversely affecting the timing, cost, and outcome of treatment.

To cite this abstract:

Hill M. Thirty‐One‐Year‐Old Man with Hookworm Infection and Complicated Treatment. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 507. https://www.shmabstracts.com/abstract/thirtyoneyearold-man-with-hookworm-infection-and-complicated-treatment/. Accessed December 10, 2018.

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