title: Hookworm infestation as a cause of melena and severe anaemia in farmer.
abstract: Hookworm infections remain a major cause of morbidity in the developing world. Prevalence is highest in agricultural areas, where use of waste water for irrigation and poor hygiene increases infection rates among farmers. Infections present with gastrointestinal symptoms and chronic anaemia, and there are usually no signs of overt blood loss. The following report describes a case of melena in a middle-aged farmer, where the diagnosis of hookworm infestation was delayed due to the unusual presentation. The patient underwent multiple blood transfusions before referral to the Aga Khan University Hospital (AKUH), Karachi and was managed conservatively with mebendazole at our hospital after exclusion of other possible causes of gastrointestinal bleeding. This case highlights the importance of considering hookworm infestations as a cause of melena in the older age group, where other critical differentials such as peptic ulcer disease and occult malignancy may result in delay in initiation of treatment and a significant financial burden on the patient.
authors.affiliation: Medical Student, Class of 2017, Karachi, Pakistan.
authors.forename: Marvi
authors.initials: M
authors.lastname: Tariq
authors.affiliation: MBBS, Aga Khan University, Karachi, Pakistan.
authors.forename: Syeda Maria
authors.initials: SM
authors.lastname: Muzammil
authors.affiliation: Department of Surgery, Aga Khan University, Karachi, Pakistan.
authors.forename: Fareed Ahmed
authors.initials: FA
authors.lastname: Shaikh
authors.affiliation: Consultant General Surgeon, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: K M Inam
authors.initials: KM
authors.lastname: Pal
mesh_terms: D000740:Anemia / Q000469:parasitology*; D000969:Antinematodal Agents / Q000627:therapeutic use; D004386:Duodenum / Q000469:parasitology; D000067565:Farmers; D006725:Hookworm Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000469:parasitology; D006801:Humans; D008297:Male; D008463:Mebendazole / Q000627:therapeutic use; D008551:Melena / Q000469:parasitology*; D008875:Middle Aged
chemical_list: D000969:Antinematodal Agents; D008463:Mebendazole
keywords:  Hookworm, Anaemia, Melena, Farmer, Case report.