Hookworm anaemia — DTM&H MCQ

Correct answer: A — Albendazole with iron replacement

The correct answer is A, albendazole with iron replacement. The vignette describes hookworm infection (Ancylostoma duodenale or Necator americanus): barefoot walking in rural Southeast Asia allows filariform larvae to penetrate skin, adult worms attach to the small intestinal mucosa and cause chronic occult blood loss, producing pica, fatigue and iron-deficiency (microcytic) anaemia. Thin-shelled oval eggs on stool microscopy are classic for hookworm, distinguishing it from thick-shelled Ascaris or operculated Taenia/Schistosoma eggs. Albendazole is the benzimidazole anthelminthic of choice for soil-transmitted helminths including hookworm, and because the anaemia is due to ongoing intestinal blood loss, iron replacement must be given alongside deworming to correct the deficiency and replenish stores. Why the other options are wrong: C. Metronidazole: this is used for protozoal infections such as giardiasis or amoebiasis, not for soil-transmitted nematodes with thin-shelled ova. D. Praziquantel: this treats trematodes and cestodes (schistosomiasis, tapeworms), which produce different egg morphology (operculated or with lateral spines), not thin-shelled hookworm ova. B. Fluconazole: this is an antifungal with no activity against helminths and has no role in this clinical picture. E. Chloroquine: this is an antimalarial; it does not address intestinal helminth infection or the resulting iron-deficiency anaemia. Key point: barefoot exposure plus microcytic anaemia and thin-shelled ova on stool microscopy signals hookworm, treated with albendazole plus iron replacement to correct chronic blood loss.

Reference: BNF (NICE), Albendazole, Indications and dose: intestinal nematode infections including hookworm (Ancylostoma duodenale, Necator americanus), https://bnf.nice.org.uk/drugs/albendazole/