Hookworm and Strongyloides are parasites that are acquired by walking barefoot (or wearing thongs or sandals) on earth contaminated by faeces. The larvae penetrate the skin, travel through the lungs and settle in the small intestine. The first sign is local irritation or 'creeping eruption' at the point of entry known as 'ground itch', which is often unnoticed. This subsides within 2 days or so and is followed 1-2 weeks later by respiratory symptoms, which may be associated with bronchitis and bronchopneumonia. Eventually a severe and chronic anaemia may develop. Hookworm infection is the commonest cause of iron deficiency anaemia in the world. Strongyloidiasis, which usually does not present with anaemia, is an important pathogen since it remains undetected for decades and presents as a severe infection such as septicaemia when the host becomes immunocompromised for any reason.
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