Iron-deficiency anemia related to ancylostoma duodenale infection among Ethiopian immigrants to Israel

Background: Among the diseases imported by the Ethiopian immigrants to Israel are many parasite infections. Hookworm infections, caused by the nematodes Necator americanus and Ancylostoma duodenale, involve the gastrointestinal tract, causing iron-deficiency anemia. Objectives: To evaluate the rate of iron-deficiency anemia related to hookworm infections among immigrants from an endemic area. Methods: We retrospectively studied the medical records of all Ethiopians over the age of 18, who immigrated to Israel in the early 90's, in two primary care clinics of Clalit Health Services in Ofakim. Results: Sixty patients (64%) had evidence of A.duodenale infection. The mean hemoglobin level was 11.92.3 g/dl in the Ancylostoma group and 13.81.6 g/dl in the control group (p = 0.0001). Analyzing the data according to the patient's sex revealed significant differences in the hemoglobin levels between the Ancylostoma group and the control group. Patients infected with A.duodenale had significantly lower mean corpuscular volume (MCV) and serum iron, and were likely to have eosinophilia and hypoalbuminemia. Conclusion: Among the Ethiopian immigrant population, Ancylostoma duodenale infection is a common cause of iron deficiency anemia. In young patients it should be ruled out before invasive and expensive investigations are performed.