Life cycle of the human hookworms Ancylostoma duodenale and Necator americanus
Eggs are passed in the stool (1) and under favorable conditions (moisture, warmth, shade), larvae hatch in 1 to 2 days. The released rhabditiform larvae grow in the feces and/or the soil (2) and after 5 to 10 days (and two molts) they become filariform (third-stage) larvae that are infective (3). These infective larvae can survive 3 to 4 weeks in favorable environmental conditions. On contact with the human host, the larvae penetrate the skin and are carried through the blood vessels to the heart and then to the lungs. They penetrate into the pulmonary alveoli, ascend the bronchial tree to the pharynx, and are swallowed (4). The larvae reach the small intestine, where they establish themselves and mature into adults. Adult worms live in the lumen of the small intestine, where they attach to the intestinal wall with resultant blood loss by the host (5). Most adult worms are eliminated in 1 to 2 years, but the longevity may reach several years. Some A. duodenale larvae, following penetration of the host skin, can become dormant (in the intestine or muscle). In addition, infection by A. duodenale may probably also occur by the oral and transmammary route. Necator americanus, however, requires a transpulmonary migration phase.