Dracunulosis or Guinea worm infection is a chronic ulcer of the foot or lower leg with a protruding worm. It has been eliminated from 16 formerly endemic countries. In 1986, an estimated 3.5 million cases occurred. By 2012, only 542 cases were reported, 521 in South Sudan.
CASES/YEAR
0 (US); 500 (Global)
OTHER NAMES
Guinea worm infection; Dracontiasis; Dracunculiasis;
INCUBATION
About 10-14 months; [CCDM]
INITIAL SYMPTOMS
Painful papule that becomes a blister that ruptures; [Guerrant, p. 759] Chronic ulcer of foot or lower leg with a protruding worm; [PPID, p. 3445]
PRECAUTIONS
Villagers with ulcers or blisters not to enter drinking H2O source; Filter drinking water with fine mesh cloth; "No direct person-to-person transmission." [CCDM, p. 156-7]
COMMENTS
Humans become infected after ingesting contaminated drinking water containing the intermediate hosts--the water fleas that carry the infective larvae of this tissue nematode. [ID, p. 2373-4] Ingested larvae cross the duodenal wall, and the adult worms mature. After mating the female migrates to subcutaneous tissue, usually of the legs. Symptoms preceding the papule formation may include urticaria, fever, diarrhea, nausea, and vomiting, Eggs are discharged through an opening in the skin every time the infected person wades in water. Contractures of joints and arthritis result when these skin openings become secondarily infected. [CCDM, p. 155] Patients have no symptoms for about the first year after ingestion of the infected water fleas. Then a painful papule appears, and a blister develops within 24 hours. When the blister ruptures, the worm can discharge the larvae into water containing water fleas to complete the life cycle of the parasite. Secondary bacterial infections and sepsis are common in chronic cases. [Guerrant, p. 759-62] At the time the painful papule forms, some patients react with urticaria, nausea, and fever. [PPID, p. 3445]
DIAGNOSTIC
Identify adult worm protruding from ulcer in skin; [CCDM] The female worms are up to 1 m long. [PPID, p. 3445]
SCOPE
Has been eliminated from 16 formerly endemic countries; Still endemic in Ethiopia, Chad, Mali, and South Sudan; [CCDM] The 4619 cases reported in 2008 is a 99.9% reduction from the 3.5 million cases in 1986. [Guerrant, p. 761]
SIGNS & SYMPTOMS
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>fever
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G diarrhea
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G nausea, vomiting
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H eosinophilia
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R dyspnea
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R wheezing
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S papules or plaques
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S skin blister or vesicles
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S ulcer of skin
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S urticaria
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*arthritis
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*sepsis
SOURCE
Waterborne (Ingesting, Inhaling, or Swimming)
RISK FACTORS
- Ingest infectious agents in food/water
- Travel to endemic area
TREATMENT
No drugs are effective in killing worm; Use antibiotic ointment and tetanus toxoid. [CCDM]
REFERENCES FOR CASES/YEAR
1.
2. (Global) Previously found in India, Pakistan, and Latin America; Fewer than 50 cases reported in 2017; [Cecil, p. 2139] In 5 countries south of the Sahara: Mali, Ethiopia, Chad, and South Sudan; Eradicated in 16 formerly endemic countries as of 2013; [CCDM, p. 156] In 1986 and estimated 3.5 million cases occurred. By 2012, only 542 cases were reported, 521 in South Sudan. [WHO website] Estimate is 500 cases per year (20 X 50 reported cases);