Hookworm - Associated Iron Deficiency Anemia at Age Extremes: Two Case Reports from North Sulawesi, Indonesia

Diana Shintawati Purwanto; Josef Sem Berth Tuda

doi:doi:10.11648/j.ijidt.20251004.12

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Hookworm - Associated Iron Deficiency Anemia at Age Extremes: Two Case Reports from North Sulawesi, Indonesia

Diana Shintawati Purwanto

, Josef Sem Berth Tuda^*

Published in International Journal of Infectious Diseases and Therapy (Volume 10, Issue 4)

Received: 6 November 2025 Accepted: 20 November 2025 Published: 19 December 2025

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Abstract

Iron deficiency anemia (IDA) is the most common form of anemia worldwide and remains a significant health concern in tropical countries where parasitic infections are endemic. Hookworm infestation is a leading but frequently overlooked etiology due to its subtle clinical manifestations and limited routine parasitological testing. We describe two contrasting cases of severe hookworm-related IDA from North Sulawesi, Indonesia: a 72-year-old woman and a 1-year-old infant. Both patients presented with profound microcytic hypochromic anemia but without overt gastrointestinal bleeding. Laboratory evaluation confirmed severe iron deficiency, while stool microscopy revealed hookworm eggs at early cleavage stages, establishing the diagnosis. Despite similar causes, their clinical courses diverged. The infant, whose anemia was compounded by inadequate weaning nutrition, responded rapidly to transfusion, iron supplementation, and single-dose albendazole. The elderly patient, with chronic cumulative exposure from barefoot walking in rural areas, improved more slowly following transfusion, prolonged iron therapy, and a short course of albendazole. These cases highlight the need for routine stool examination in all patients with unexplained IDA in endemic areas, regardless of age. They further emphasize gaps in deworming programs, which often exclude high-risk groups such as infants and older adults. Expanding preventive measures is essential to reduce morbidity and long-term complications.

Published in	International Journal of Infectious Diseases and Therapy (Volume 10, Issue 4)
DOI	10.11648/j.ijidt.20251004.12
Page(s)	85-92
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Iron Deficiency Anemia, Hookworm Infection, Indonesia

References

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APA Style

Purwanto, D. S., Tuda, J. S. B. (2025). Hookworm - Associated Iron Deficiency Anemia at Age Extremes: Two Case Reports from North Sulawesi, Indonesia. International Journal of Infectious Diseases and Therapy, 10(4), 85-92. https://doi.org/10.11648/j.ijidt.20251004.12

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ACS Style

Purwanto, D. S.; Tuda, J. S. B. Hookworm - Associated Iron Deficiency Anemia at Age Extremes: Two Case Reports from North Sulawesi, Indonesia. Int. J. Infect. Dis. Ther. 2025, 10(4), 85-92. doi: 10.11648/j.ijidt.20251004.12

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AMA Style

Purwanto DS, Tuda JSB. Hookworm - Associated Iron Deficiency Anemia at Age Extremes: Two Case Reports from North Sulawesi, Indonesia. Int J Infect Dis Ther. 2025;10(4):85-92. doi: 10.11648/j.ijidt.20251004.12

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@article{10.11648/j.ijidt.20251004.12,
  author = {Diana Shintawati Purwanto and Josef Sem Berth Tuda},
  title = {Hookworm - Associated Iron Deficiency Anemia at Age Extremes: Two Case Reports from North Sulawesi, Indonesia},
  journal = {International Journal of Infectious Diseases and Therapy},
  volume = {10},
  number = {4},
  pages = {85-92},
  doi = {10.11648/j.ijidt.20251004.12},
  url = {https://doi.org/10.11648/j.ijidt.20251004.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijidt.20251004.12},
  abstract = {Iron deficiency anemia (IDA) is the most common form of anemia worldwide and remains a significant health concern in tropical countries where parasitic infections are endemic. Hookworm infestation is a leading but frequently overlooked etiology due to its subtle clinical manifestations and limited routine parasitological testing. We describe two contrasting cases of severe hookworm-related IDA from North Sulawesi, Indonesia: a 72-year-old woman and a 1-year-old infant. Both patients presented with profound microcytic hypochromic anemia but without overt gastrointestinal bleeding. Laboratory evaluation confirmed severe iron deficiency, while stool microscopy revealed hookworm eggs at early cleavage stages, establishing the diagnosis. Despite similar causes, their clinical courses diverged. The infant, whose anemia was compounded by inadequate weaning nutrition, responded rapidly to transfusion, iron supplementation, and single-dose albendazole. The elderly patient, with chronic cumulative exposure from barefoot walking in rural areas, improved more slowly following transfusion, prolonged iron therapy, and a short course of albendazole. These cases highlight the need for routine stool examination in all patients with unexplained IDA in endemic areas, regardless of age. They further emphasize gaps in deworming programs, which often exclude high-risk groups such as infants and older adults. Expanding preventive measures is essential to reduce morbidity and long-term complications.},
 year = {2025}
}

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TY - JOUR
T1 - Hookworm - Associated Iron Deficiency Anemia at Age Extremes: Two Case Reports from North Sulawesi, Indonesia
AU - Diana Shintawati Purwanto
AU - Josef Sem Berth Tuda
Y1 - 2025/12/19
PY - 2025
N1 - https://doi.org/10.11648/j.ijidt.20251004.12
DO - 10.11648/j.ijidt.20251004.12
T2 - International Journal of Infectious Diseases and Therapy
JF - International Journal of Infectious Diseases and Therapy
JO - International Journal of Infectious Diseases and Therapy
SP - 85
EP - 92
PB - Science Publishing Group
SN - 2578-966X
UR - https://doi.org/10.11648/j.ijidt.20251004.12
AB - Iron deficiency anemia (IDA) is the most common form of anemia worldwide and remains a significant health concern in tropical countries where parasitic infections are endemic. Hookworm infestation is a leading but frequently overlooked etiology due to its subtle clinical manifestations and limited routine parasitological testing. We describe two contrasting cases of severe hookworm-related IDA from North Sulawesi, Indonesia: a 72-year-old woman and a 1-year-old infant. Both patients presented with profound microcytic hypochromic anemia but without overt gastrointestinal bleeding. Laboratory evaluation confirmed severe iron deficiency, while stool microscopy revealed hookworm eggs at early cleavage stages, establishing the diagnosis. Despite similar causes, their clinical courses diverged. The infant, whose anemia was compounded by inadequate weaning nutrition, responded rapidly to transfusion, iron supplementation, and single-dose albendazole. The elderly patient, with chronic cumulative exposure from barefoot walking in rural areas, improved more slowly following transfusion, prolonged iron therapy, and a short course of albendazole. These cases highlight the need for routine stool examination in all patients with unexplained IDA in endemic areas, regardless of age. They further emphasize gaps in deworming programs, which often exclude high-risk groups such as infants and older adults. Expanding preventive measures is essential to reduce morbidity and long-term complications.
VL - 10
IS - 4
ER -

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Author Information

Diana Shintawati Purwanto

Department of Biochemistry, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia;Department of Clinical Laboratory, Kandou General Hospital, Manado, Indonesia

Contact Email

http://orcid.org/0000-0002-9349-3937
Josef Sem Berth Tuda

Department of Parasitology, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia

Contact Email

http://orcid.org/0009-0009-8273-2902

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APA Style

Purwanto, D. S., Tuda, J. S. B. (2025). Hookworm - Associated Iron Deficiency Anemia at Age Extremes: Two Case Reports from North Sulawesi, Indonesia. International Journal of Infectious Diseases and Therapy, 10(4), 85-92. https://doi.org/10.11648/j.ijidt.20251004.12

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ACS Style

Purwanto, D. S.; Tuda, J. S. B. Hookworm - Associated Iron Deficiency Anemia at Age Extremes: Two Case Reports from North Sulawesi, Indonesia. Int. J. Infect. Dis. Ther. 2025, 10(4), 85-92. doi: 10.11648/j.ijidt.20251004.12

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AMA Style

Purwanto DS, Tuda JSB. Hookworm - Associated Iron Deficiency Anemia at Age Extremes: Two Case Reports from North Sulawesi, Indonesia. Int J Infect Dis Ther. 2025;10(4):85-92. doi: 10.11648/j.ijidt.20251004.12

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@article{10.11648/j.ijidt.20251004.12,
  author = {Diana Shintawati Purwanto and Josef Sem Berth Tuda},
  title = {Hookworm - Associated Iron Deficiency Anemia at Age Extremes: Two Case Reports from North Sulawesi, Indonesia},
  journal = {International Journal of Infectious Diseases and Therapy},
  volume = {10},
  number = {4},
  pages = {85-92},
  doi = {10.11648/j.ijidt.20251004.12},
  url = {https://doi.org/10.11648/j.ijidt.20251004.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijidt.20251004.12},
  abstract = {Iron deficiency anemia (IDA) is the most common form of anemia worldwide and remains a significant health concern in tropical countries where parasitic infections are endemic. Hookworm infestation is a leading but frequently overlooked etiology due to its subtle clinical manifestations and limited routine parasitological testing. We describe two contrasting cases of severe hookworm-related IDA from North Sulawesi, Indonesia: a 72-year-old woman and a 1-year-old infant. Both patients presented with profound microcytic hypochromic anemia but without overt gastrointestinal bleeding. Laboratory evaluation confirmed severe iron deficiency, while stool microscopy revealed hookworm eggs at early cleavage stages, establishing the diagnosis. Despite similar causes, their clinical courses diverged. The infant, whose anemia was compounded by inadequate weaning nutrition, responded rapidly to transfusion, iron supplementation, and single-dose albendazole. The elderly patient, with chronic cumulative exposure from barefoot walking in rural areas, improved more slowly following transfusion, prolonged iron therapy, and a short course of albendazole. These cases highlight the need for routine stool examination in all patients with unexplained IDA in endemic areas, regardless of age. They further emphasize gaps in deworming programs, which often exclude high-risk groups such as infants and older adults. Expanding preventive measures is essential to reduce morbidity and long-term complications.},
 year = {2025}
}

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