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In addition, the STHIs exert a powerful negative influence on economic development and disrupt the education of children ( Miguel and Kremer, 2004 Bleakley, 2007). These health effects result in the loss of up to 39 million disability-adjusted life years (DALYs) annually ( Chan, 1997), a disease burden roughly equivalent to that of malaria. STHIs occur almost exclusively in areas of poverty where they inflict great human suffering by causing chronic infections in children that result in retardation of physical, intellectual, and cognitive development ( WHO, 2005). The STHIs are among the most common infections of humans, with an estimated 807 million, 604 million, and 576 million people infected with either the roundworm, Ascaris lumbricoides, the whipworm, Trichuris trichiura, or the hookworms Necator americanus and Ancylostoma duodenale, respectively ( Bethony et al., 2006).

Hookworm infection, together with ascariasis and trichuriasis, comprise a group of human parasitic diseases known as the soil-transmitted helminth infections (STHIs). Hotez, David Diemert, in Vaccines for Biodefense and Emerging and Neglected Diseases, 2009 Introduction: Hookworm Disease Burden For example, hookworm was detected in 55% of Southeast Asian refugees with persistent eosinophilia. 7 Eosinophilia is a useful indicator for hookworm infection among refugees. The appearance of adult hookworms in the intestine coincides with the onset of eosinophilia. Within 5РІР‚вЂњ9 weeks after initial infection the larvae molt twice to the adult stage. However, because it is associated with only recent infections, hookworm pneumonitis would not be expected to be common among refugees.Р”Р„fter leaving the lungs, hookworm larvae pass over the epiglottis and are swallowed. Larval migration through the lungs can result in hookworm pneumonitis, which is characterized by a mild to moderate cough and sore throat.

Subsequently, the larvae enter the venous circulation and reach the lungs within 10 days. duodenale hookworm infection can also result from ingestion of the larvae.

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Repeated episodes of larval skin invasion result in a pruritic, papular rash known as РІР‚Вground itch.' 3 A. Hookworm infection occurs when third-stage larvae penetrate the skin, usually through the hands and feet (especially between the toes). Hotez, in Immigrant Medicine, 2007 Pathogenesis

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