Dracunculiasis (Guinea Worm Disease)

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Overview

A parasitic infection occurring in parts of Africa without access to safe water.

Dracunculiasis is an infection caused by a parasite called the Guinea worm. A person becomes infected when they drink contaminated water. This disease has been eliminated in most parts of the world, but still exists in Chad, Ethiopia, Mali and South Sudan.

Usually the disease has no initial symptoms. About one year later, there is a painful burning feeling as a blister forms, usually on the legs. The blister bursts as the worm then comes out of the skin over a few weeks.

The worm can be pulled out a few centimetres each day. The process usually takes weeks. Permanent damage is uncommon.

 Dracunculiasis (also known as Guinea Worm Disease) Guinea worm disease, a neglected tropical disease (NTD), is caused by the parasite Dracunculus medinensis. The disease affects poor communities in remote parts of Africa that do not have safe water to drink.

Symptoms

Usually the disease has no initial symptoms. About one year later, there is a painful burning feeling as a blister forms, usually on the legs. The blister bursts as the worm then comes out of the skin over a few weeks.

People may experience:

Skin: worm emerging from a skin blister, blister, ulcers, or hives

Gastrointestinal: diarrhoea, nausea, or vomiting

Also common: fever or itching

Causes

Dracunculiasis is typically asymptomatic for the first year. Symptoms develop when the worm erupts through the skin. Local symptoms include intense itching and a burning pain at the site of the skin lesion. Urticaria, erythema, dyspnea, vomiting, and pruritus are thought to reflect allergic reactions to worm antigens. If the worm is broken during expulsion or extraction, a severe inflammatory reaction ensues, causing disabling pain. Symptoms subside and the ulcer heals once the adult worm is expelled. In about 50% of cases, secondary bacterial infections occur along the track of the emerging worm.


The chronic stage of infection is associated with inflammation and pain in the joints and other signs of arthritis. Sequelae include fibrous ankylosis of joints and contraction of tendons.


Risk factors

Farmers, herders, and those fetching drinking water for the household may be more likely to become infected, possibly because they drink contaminated stagnant water while away from home. In certain areas, GWD affects some ethnic groups more than others 

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Complications

Redness and swelling of the skin (cellulitis)

Boils (abscesses)

Generalized infection (sepsis)

Joint infections (septic arthritis) that can cause the joints to lock and deform (contractures)

Lock jaw (tetanus)

Prevention

Filtering drinking water through a piece of fine-mesh cloth, chlorination, or boiling effectively protects against dracunculiasis. Infected people should be instructed not to enter drinking water sources to avoid contaminating them.

 

The guinea worm has almost been eradicated.

When an infected person immerses the affected extremity in water to relieve the intense discomfort caused by eruption of the female worm through the skin, larvae are released and ingested by microcrustaceans; humans are infected when they ingest water contaminated with the microcrustaceans.

If a worm is broken during expulsion or extraction, a severe inflammatory reaction ensues, causing disabling pain.

Diagnose based on observation of a white, filamentous adult worm at a cutaneous ulcer.

Treat dracunculiasis by slowly removing the adult worm over days to weeks by rolling it on a stick or sometimes by surgically removing it.

Filtering drinking water through a piece of fine-mesh cloth, chlorination, or boiling effectively protects against dracunculiasis.