14072 Hookworm Disease

Overview

Hookworm disease is an infection caused by small worms that live in the intestines (gut). The worms enter the body through the skin, usually from walking barefoot on soil that contains hookworm larvae (immature worms). They can cause itchy skin, tummy problems, and blood loss.

Hookworm is uncommon in the UK and other developed countries, but it still affects hundreds of millions of people worldwide. Most cases in the UK are in people who have travelled to or come from affected countries.

Anyone can get hookworm, but it is most often seen in children, farmers, and people who often walk barefoot in contaminated soil.

Symptoms

Common symptoms

• An itchy red rash where the larvae entered the skin (often the feet)
• Tummy pain or cramps
• Diarrhoea or loose stools
• Nausea
• Tiredness and weakness (from anemia)
• Loss of appetite
• Weight loss
• Blood in the stool (in heavier infections)

Symptoms in children

• Stunted growth and poor weight gain
• Difficulty concentrating or learning
• Severe anemia (pale skin, feeling very tired)
• Delayed development

Symptoms in older adults

• More severe anemia (dizziness, weakness, shortness of breath)
• Falling or difficulty walking
• Worsening of heart problems such as chest pain
• Confusion or feeling faint

Causes

Main causes

• Infection happens when bare skin touches soil contaminated with hookworm larvae (tiny immature worms).
• The larvae enter through the skin (usually the feet) and travel through the body to the small intestine, where they grow into adult worms.
• Adult worms attach to the intestinal wall and feed on blood, which can lead to iron-deficiency anemia.

Risk factors

• Walking barefoot in soil, especially in warm, damp areas
• Living in or visiting regions with poor sanitation or sewage systems
• Working in farming, gardening, or jobs that involve soil contact
• Not having access to safe drinking water or good handwashing facilities

When to see a doctor

See a doctor urgently if:

• You have symptoms of severe anemia (fainting, chest pain, trouble breathing)
• You see blood in your stool or vomit
• You have severe tummy pain that doesn't ease
• You have travelled to an affected area and feel very unwell

Book a routine appointment if:

• You have persistent tummy pain, diarrhoea, or nausea
• You have an unexplained itchy skin rash or tiredness
• You think you may have been exposed to hookworm (from visiting affected areas)

Diagnosis

A doctor will ask about your symptoms, travel history, and whether you have walked barefoot in soil. The main test is a stool (poo) sample to look for hookworm eggs under a microscope.

Tests that may be done

• Stool test (poo sample sent to a lab)
• Blood test to check for anemia or signs of infection

What to expect at your appointment

You will usually be given a small container to collect a stool sample at home or at the clinic. Results may take a few days. The doctor will then explain the treatment and any follow-up needed.

Treatment

Hookworm is treated with a short course of deworming tablets (anthelminthic medication). This is safe, effective, and usually kills the worms in one or two days. If you have anemia, you may also need iron supplements.

Self-care at home

• Wash your hands thoroughly with soap and water after using the toilet and before eating
• Drink plenty of fluids to stay hydrated
• Eat foods rich in iron to help rebuild your red blood cells (like leafy greens, beans, lean meats)
• Rest until your energy returns

Medical treatments

Doctors prescribe medication that kills the worms. You take the tablets by mouth, usually a single dose or a short course. Your doctor may also recommend iron tablets if you have anemia. After treatment, a repeat stool test is often done to check that the infection has cleared.

When is surgery considered?

Surgery is not needed to treat hookworm disease.

Living with this condition

Follow your treatment plan exactly as prescribed. Keep your home clean, wash your hands often, and avoid scratching any itchy rash. Most people feel much better within a few weeks.

Lifestyle tips

• Wear shoes or protective footwear when walking outdoors in at-risk areas
• Use a proper toilet instead of going outdoors
• Wash and dry your hands well after touching soil
• Cook food thoroughly and wash vegetables before eating

Diet and exercise

Eat a balanced diet with plenty of iron-rich foods to help your body recover from anemia. Do gentle exercise, such as walking or stretching, as soon as you feel up to it. Avoid heavy activity until your energy returns.

Mental health and emotional wellbeing

Living with an intestinal infection can feel uncomfortable or embarrassing, but it's very common and not your fault. It's normal to feel anxious while recovering. Talk to your doctor or a trusted friend if these feelings don't pass.

Prevention

Yes, hookworm can be prevented. The most important steps are avoiding bare skin contact with soil in high-risk areas, using proper sanitation, and washing hands well with soap and water.

Vaccines

There is currently no vaccine for hookworm disease. Prevention relies on hygiene and footwear.

Screening programmes

If you have stayed in an area where hookworm is common and you have symptoms, your doctor may offer a stool test. Routine screening is not needed for everyone.

Complications

If left untreated

• Iron-deficiency anemia (low red blood cells) from blood loss
• Protein loss and malnutrition
• In children: slower growth, lower school performance, and poorer development
• In heavy infections: severe blood loss that can lead to heart problems

Long-term outlook

With the right treatment, hookworm disease is completely curable. Most people recover without long-term problems. Early treatment helps your body restore its iron levels and prevents complications. If you think you may have been exposed, see a healthcare professional – the sooner you get treated, the sooner you can feel better.

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