Dracunculiasis

Disease Pathophysiology Dracunculiasis is infection with Dracunculus medinensis, a nematode worm. It is caused by drinking water containing water fleas (Cyclops species) that have ingested Dracunculus larvae. In the human body, the larvae are released and migrate through the intestinal wall into body tissues, where they develop into adult worms. The female worms move through the person’s subcutaneous tissue, causing intense pain, and eventually emerge through the skin, usually at the feet, producing oedema, a blister and eventually an ulcer, accompanied by fever, nausea, and vomiting. If they come into contact with water as they are emerging, the female worms discharge their larvae, setting in motion a new life cycle. There are no drugs available for the treatment of this disease. However, it can be prevented by protecting water sources and filtering potentially contaminated water. Disease Statistics Frequent migration in India for labour work to earn their livelihood to states such as Gujarat, Madhya Pradesh and Maharashtra and drinking water from open wells and step wells, causes Dracunculiasis. Worldwide 3.5 million cases were registered annually in the mid-1980s to 148 cases in 2013. In 2014, only 126 cases were reported worldwide—a 15% reduction in cases from the previous year. Global eradication is within reach. Disease Treatment The mainstay of treatment is the extraction of the adult worm from the patient using a stick at the skin surface and wrapping or winding the worm a few centimeters per day. Because the worm can be as long as one meter in length, full extraction can take several days to weeks. This slow process is required to avoid breakage and leaving behind a portion of the worm. Related To Major Research on Disease The standard of care for treatment of the Guinea worm infection is to slowly extract the worm from the wound by winding it around a stick a few centimeters a day until it is fully removed. There are no drugs available to treat dracunculiasis and attempts to repurpose other antiparasitic compounds to treat dracunculiasis have been largely unsuccessful. The benzimidazole class of antiparasitic drugs was shown to reduce inflammation secondary to infection, but have no direct effect against the parasite. Ivermectin was found to have no effect against the worms. In clinical trials mebendazole often caused the worms to migrate to other places in the body, causing even more complications.