H. nana is only 15 to 40 mm long. It requires only one host but can also cycle through two. Its larvae migrate only within the gut wall, and its life span is relatively short (4 to 6 weeks).
H. nana is more frequent in populations, particularly children, living in conditions of poverty and poor hygiene, particularly when fleas are present.
H. nana has 3 modes of infection:
Indirect 2-host cycle: Rodents are the primary definitive hosts, and grain beetles, fleas, or other insects feed on contaminated rodent droppings as intermediate hosts; humans can become infected by ingesting parasitized insects.
Human-to-human oral-anal cycle: Eggs are passed from one human to another or recycle externally in a single host.
Internal autoinfection: Eggs hatch within the gut and initiate a 2nd generation without ever exiting the host. Autoinfection can result in large numbers of worms and symptoms.
Infections are often asymptomatic, but heavy infections may cause crampy abdominal pain, diarrhea, anorexia, pruritis ani, and nonspecific systemic symptoms. On occasion H. nana is misdiagnosed as pinworm infection.
Diagnosis is made by finding eggs in stool samples.
The treatment of choice for H. nana infection is
Alternatives include nitazoxanide and niclosamide (not available in the US).
For nitazoxanide, dosage is
For niclosamide, dosage is
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