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(Guinea Worm Disease)

By Richard D. Pearson, MD, Emeritus Professor of Medicine, University of Virginia School of Medicine

Dracunculiasis is infection caused by the roundworm Dracunculus medinensis. It causes a painful, inflamed skin sore and debilitating arthritis.

  • People become infected by drinking water containing tiny crustaceans infected with the roundworm.

  • A blister forms, usually on the lower legs or feet, with swelling, redness, and burning pain in the area around it, and the joints near the blister may be damaged.

  • Doctors diagnose the infection when they see the worm come out through the blister.

  • Drinking only water that has been filtered, boiled, or chlorinated helps prevent the infection.

  • The worm is removed by slowly rolling it on a stick or surgically.

About 25 years ago, dracunculiasis was widespread in many parts of tropical Africa, Yemen, India, and Pakistan. Today, because of international efforts to stop the disease, infection occurs in only a few African countries. The Carter Center reports that only 542 cases occurred in 2012. All of those cases were in 4 African countries—South Sudan, Chad, Mali, and Ethiopia.

Transmission of dracunculiasis

People become infected by drinking water containing tiny infected crustaceans. The immature worms (larvae) live inside the crustaceans. After the crustaceans are ingested, they die and release the larvae, which penetrate the wall of the intestine and enter the abdominal cavity. Inside the abdomen, larvae mature into adult worms in about 1 year, and the adult worms mate. After mating, female worms leave the abdomen and move through tissues under the skin, usually to the lower legs or feet. There, they create an opening through the skin, which causes severe, burning discomfort. When people attempt to relieve the burning by soaking their leg in water, the pregnant worm releases larvae into the water. Once the larvae are in the water, they find and infect another crustacean. If the pregnant worms do not reach the skin, they die and disintegrate or harden (calcify) under the skin.

Symptoms of Dracunculiasis

Dracunculiasis symptoms start when the worm begins to break through the skin. A blister forms over the worm's location. The area around the blister itches, burns, and is inflamed—swollen, red, and painful. Materials released by the worm may cause an allergic reaction, which can result in difficulty breathing, vomiting, an itchy rash, and disabling pain. Soon the blister opens, and the worm can be seen. Later the worm leaves the body, and symptoms subside.

Usually, the blister heals after the adult worm leaves the body. However, in about 50% of people, bacterial infections develop around the opening for the worm. Sometimes joints and tendons near the blister are damaged.

Diagnosis of Dracunculiasis

  • Appearance of a worm at the blister

Diagnosis of dracunculiasis is obvious when the adult worm appears at the blister.

X-rays may be taken to locate calcified worms.

Prevention of Dracunculiasis

The following can help prevent dracunculiasis:

  • Filtering drinking water through a piece of fine-mesh cheesecloth

  • Boiling water

  • Drinking only chlorinated water

Infected people are instructed not to enter sources of drinking water so that these sources are not contaminated.

Treatment of Dracunculiasis

  • Removal of the adult worm

Usually, the adult worm is slowly removed over days to weeks by rolling it on a stick. When the head starts to come out, the person grasps it and wraps the end of the worm around a small stick. Gradually, as the worm loosens, the stick is turned, wrapping more of the worm around the stick. Eventually, the worm is pulled free and discarded. When health care workers are available, they can remove the worm through a small incision made after a local anesthetic is used.

No drugs can kill the worms. But if a bacterial infection develops around the worm's opening, people may need antibiotics.

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