Dracunculiasis

Dracunculiasis General Information

Dracunculiasis, or the Guinea Worm Disease, is the generic medical term given to an infection caused by a parasite worm in the human body (Dracunculus Medinensis). This is a parasite that infects the host through unpurified drinking water, more specifically by the ingestion of the microscopic arthropods known as copepods (water fleas) that carry the larvae inside them. Once inside the body, the copepods are dissolved by the gastric acids, releasing the larvae which develop in the infective stage within 10 to 14 days. They move to the small intestine and are absorbed into the body cavity, continuing their life cycle inside the host. Over the following 10 to 14 months, the female worm copulates with the male. The male then dies and is absorbed by the larger female, which develops to full length (60-100 cm) and carries hundreds of thousands of larvae inside her. The worm then migrates to a part of the body she will emerge from (usually the lower limbs), where it will finally stop and begin the next part of her life cycle.

In this stage of Dracunculiasis, the worm creates an opening in the body and starts releasing her larvae whenever her exposed ends comes in contact with water, under the form of a white, milky liquid, containing thousands of larvae. This stage of the infection can last for days. Once in the water, the copepods eat the larvae, which thus start the cycle again. In order to avoid Dracunculiasis, as well as a very large number of other infections and diseases, it is highly recommended never to rely on an unpurified water supply.

Dracunculiasis Symptoms

Dracunculiasis does not appear to have any symptoms during the initial stages. It may pass unnoticed for up to a year or more, until the female worm is beginning to emerge in order to release the larvae. At that point, the symptoms begin to appear, under the form of localized intense itching and burning pains. The worm usually emerges on the lower limbs, but cases have shown them able to appear anywhere on the body. A blister forms on the skin, and within 24 to 72 hours, the blister ruptures into an ulcer, and this stage is usually accompanied by fever and disabling burning pain which often cause the patient to immerse the affected body part in water, in order to relieve the pain, and thus allowing the next stage to start. Once the ulcer is in contact with water, the worm emerges and begins releasing its larvae. The symptoms for this stage are urticaria, dyspnea, pruritus, erythema and vomiting, and also the worm is visible at this point in the ulcer, allowing the Dracunculiasis diagnosis to be placed. Once the worm is extracted or expelled, the ulcer heals and the symptoms subside, although in half of the cases complications occur due to bacterial infections.

Extra care is highly recommended, because if the worm breaks during extraction or expulsion the patient will experience severe disabling pain along with localized infections and inflammatory reactions. Larvae that are released within the body can be absorbed, but many become calcified causing further complications.

Dracunculiasis Treatment

While Dracunculiasis can be surgically treated, and the worm can be removed under local anesthesia, most of the time the facilities allowing this procedure are not available in the place where the patient is located. Instead, a very common practice usually employed in order to remove the worm is rolling it around a stick at a pace of a few centimeters per day. The procedure is long and tedious, sometimes taking up to a few weeks, and the risk of breaking the worm is higher, thus exposing the patient to the risk of experiencing extreme pain and further complications.

In cases of Dracunculiasis, at times doctors prescribe thiabendazole or metronidazole for adult patients. However, research has shown that in certain cases the antihelminthic components and therapy may cause an abnormal migration of the worms, thus resulting in them emerging in unusual parts of the body. The situation should be considered with care, and the decision to prescribe a Dracunculiasis patient to take this type of medicines should only be made by a doctor specialized in this area of expertise.

Dracunculiasis in itself is not lethal, and the death rate associated with it comes from complications left untreated or from pain caused by worm breakage. Bacterial infections left untreated at the worm emerging site can prove to be a lethal complication. Also, it is possible for permanent scarring or deformity to occur, and one of the most common cases of such complications if the localized calcification of the worm after releasing its larvae. If the calcified worm remains within the body, this will most likely result in chronic pain accompanied with swellings of the affected extremity.

As over 50% of the Dracunculiasis cases are accompanied by complications, protective anti-inflammatory and anti-bacterial actions should be taken in order to avoid further infections at the spot where the worm emerges. Constant medical care and observation is advised, so that if any signs of complications appear, counter methods can be applied immediately. If the worm breaks, immediate attention is required to surgically remove the remaining part of the worm, as failing to do so will lead to severe inflammatory reactions accompanied with extreme pain. Most often, in cases where larvae were released inside the body, they will become calcified and remain within the organism, with a possibility of causing further complications. In this case, they can be discovered by performing X-ray exams of the patient, and the calcified larvae can be removed.

Typically, infections such as Dracunculiasis appear in locations where insufficient care is taken to purify the water supply. The infection can be prevented by taking extra preventive measures, such as filtering the water by any means available, boiling it before consuming or through chlorination. It is also highly advised against consuming water from unsafe, uncertified water sources, and also previously informing if the area is endemic or has endemic potential.