An immigrant with easy fatigability and eosinophila caused by hookworm (A neglected tropical disease)

Hookworm; a one among the 20 neglected tropical disease (NTD) defined by WHO causing severe anemia, weakness, malnutrition in tropical countries like India, estimated that affected one billion people in the world. The blood sucking A. duodenal and N. Americanus are the causative agents. An adult immigrant landed in emergency with severe lethargy and fatigability with H/o travel to endemic area in a short time; laborer in farm been evaluated for possible cause. Lab reports concluded with severe anemia and eosinophilia. Stool culture was sterile. Next day fresh sample of stool for microscopy revealed eggs of hookworm with larva inside. We concluded with the diagnosis of hookworm & patient improved with blood transfusion which was started before labelling the diagnosis because of severe anemia and also with albendazole given in proper manner. So it is important to keep in mind that generalized weakness, lethargy, anemia, eosinophilia in immigrants drawing attention to parasitic disease and we have to break the chain of transmission by giving community treatment, deworming, increase sanitation, WASH program implementation, footwear wearing practices to workers, public education. Keep in mind the diagnosis as hookworm infection & other NTDs especially in the immigrants. Proper treatment, regular surveillance involving multiple departments of hospital & medical college is important to eliminate this blood-sucking nematodes in 21century.