To the Editor.—
The article by De la Riva et al (1981;246:68) regarding a 19-year-old man with acute, massive, intestinal bleeding caused by hookworm leaves three areas of contention. Though the surgeons reported "large numbers" of hookworm in the patient's jejunum and the observers described "many hookworm excreted" in the feces after treatment, a diagnosis of heavy worm burden should not be made without fecal egg counts. In addition, no mention of the patient's coagulation status nor of aspirin or alcohol intake was made in the article as these factors can facilitate major blood loss with a minimal underlying pathological condition.The observation that the patient returned two months after his gastrointestinal bleeding with hepatosplenomegaly, an elevated SGOT level, lymphadenopathy, and mild eosinophilia with hookworm seen on stool examination in no way implicates hookworm as the cause of the patient's disease. A 19-year-old man with this syndrome would be more
McIntyre L, Keystone JS. Diagnosis of Hookworm Disease. JAMA. 1982;247(11):1565. doi:10.1001/jama.1982.03320360017014
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