Hookworm anaemia — DTM&H MCQ

Correct answer: D — Albendazole with iron replacement

The correct answer is D, albendazole with iron replacement. Hookworm (Ancylostoma duodenale or Necator americanus) causes chronic intestinal blood loss leading to iron deficiency anaemia, which explains this child's fatigue, pica, poor school performance, low Hb and low ferritin alongside hookworm ova on stool microscopy. Albendazole is the anthelminthic of choice for soil-transmitted helminths including hookworm, but killing the worms alone does not replace lost iron stores, so oral iron replacement is required to correct the anaemia and reverse the pica and cognitive impact. This dual approach (deworming plus iron) is standard practice in endemic settings and reflects UK antihelminthic prescribing guidance for intestinal nematode infections. Why the other options are wrong: A. Praziquantel with folic acid alone: praziquantel targets schistosomes and other trematodes/cestodes, not soil-transmitted nematodes such as hookworm, so it will not clear the infection; folic acid alone does not address the iron deficiency driving this anaemia. B. Metronidazole followed by paromomycin: this regimen treats amoebiasis (Entamoeba histolytica), not hookworm, and has no activity against nematodes. C. Ceftriaxone for 10 days: ceftriaxone is an antibacterial with no role in helminth infection; there is no evidence of bacterial infection here. E. Ivermectin monotherapy: ivermectin is first line for strongyloidiasis and onchocerciasis, not hookworm, and even where partially active, monotherapy ignores the coexisting iron deficiency anaemia that requires correction. Key point: hookworm-associated iron deficiency anaemia needs both an effective anthelminthic (albendazole) and iron replacement, since deworming alone does not restore depleted iron stores.

Reference: NICE BNF, Antihelminthics, Intestinal nematode infections (albendazole), bnf.nice.org.uk