A rare infection
acquired by drinking
contaminated water

Dracunculiasis, also called Guinea-worm disease used to be very common but is now largely extinct. Before 1990 millions of cases were registered each year. This number has dropped to virtually none to a couple of tens per year.

Still, efforts are needed to keep this disease from re-emerging.

What causes Dracunculiasis

Dracunculiasis, also known as Guinea-worm disease, is a parasitic infection caused by the Guinea worm (Dracunculus medinensis). The disease is transmitted via water fleas infected with the Guinea worm larvae- infection occurs when water contaminated with these fleas is ingested.

Once inside the body, the worm will grow. Adult females are 60 to 100 cm long and two millimeter wide. Male worms are much shorter at 1 to 3 cm long.

The name dracunculiasis is derived from the Latin “affliction with little dragons”. It is named Guinea worm, after Europeans in the 17th century spotted the disease on the coast of West-Africa.

Photo: A method used to extract a Guinea worm from the leg vein of a human patient.

Where is Dracunculiasis found

The spread of dracunculiasis has greatly decreased in recent years. In the 1990s, there were millions of cases reported in countries across four continents. In 2019, that number was reduced to 30 reported cases in four countries, all in Africa: South Sudan, Chad, Mali, and Ethiopia.

While the pathogen is rarely found in humans, over 1000 infected dogs are still reported every year from Chad (1001), Ethiopia (11) and Mali (16), indicating that this disease is far from extinct.

Dracunculiasis has been a recognized disease for thousands of years. Guinea worm has been found in calcified Egyptian mummies. When dracunculiasis was widespread, it would often affect entire villages at once.

Image: geographical distribution of Dracunculiasis.

What are the symptoms of Dracunculiasis

There are no symptoms initially. About a year from initial infection, the worm will migrate to its final site (typically the lower leg) in preparation to leave the body.

This can cause allergic reactions in some people, symptoms of which include fever, dizziness, nausea, vomiting, and diarrhea. When the worm reaches its destination, it causes a large and extremely painful fluid-filled ulcer to form. This ulcer will eventually rupture which releases the worm.

People with worms emerging can be disabled for the three to ten weeks it takes the worms to fully emerge. When worms emerge near joints, the inflammation around a dead worm, or infection of the open wound can result in permanent stiffness, pain, or destruction of the joint. Some people with dracunculiasis have continuing pain for 12 to 18 months after the worm has emerged.

Photo: Dracunculiasis emerging from knee.

How can Dracunculiasis be prevented

There is no vaccination against the disease. Prevention efforts center around monitoring cases, providing safe drinking water, and reaching out to affected communities.

Monitoring new cases helps in providing effective and prompt treatment, as well as ensuring that the afflicted persons do not inadvertently contaminate communal water bodies.

Safe drinking water sources include well water, flowing water, and water that has been filtered or boiled. Fine-mesh cloth filters and pipe filters are provided to many households in at-risk areas.

Community education and involvement are critical in preventing dracunculiasis. Prevention efforts depend on the communities understanding how the disease is transmitted, so that they may take the necessary actions to prevent infection and spread. Community volunteers have also been very helpful in monitoring new cases.

How is Dracunculiasis diagnosed

The disease is generally undetectable until the worm begins to emerge. The blister and emerging white worm are unique to dracunculiasis, so it is generally diagnosed by simple visual examination at that point.

How is Dracunculiasis treated

There is no existing medication for the disease. Treatment focuses on removing the worm slowly and carefully by gently winding it around a piece of gauze or a stick as it emerges over the course of a few days or weeks. During this process, the wound needs to be kept clean to prevent infection. At any point, the worm can break and die, leading to severe swelling and pain at the site of the ulcer.

Treatment for dracunculiasis also tends to include regular wound care to avoid infection of the open ulcer while the worm is leaving.

Edited by: Shreya Sarathy

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