Dracunculiasis is an infection caused by the nematode Dracunculus medinensis, also known as the guinea worm. Dracunculiasis is caused by drinking water containing water fleas (Cyclops species) that have ingested Dracunculus larvae. Most reported dracunculiasis cases occur in the young adult (working) population who may be exposed to contaminated water sources more frequently.
An estimate of 3.5 million new cases occurred. In 1989, based on active village-based searches, 892 055 cases were reported to have occurred in 15 out of the 20 endemic countries (not included are data from Chad, Central African Republic, Senegal and Sudan). In 2012, the disease was confined to 4 countries: Chad, Ethiopia, Mali and South Sudan.
Dracunculiasis is diagnosed by seeing the worms emerging from the lesions on the legs of infected individuals and by microscopic examinations of the larvae. As the worm moves downwards, usually to the lower leg, through the subcutaneous tissues, it leads to intense pain localized to its path of travel. Other symptoms include fever, nausea, and vomiting. Female worms cause allergic reactions during blister formation as they migrate to the skin, causing an intense burning pain. Death of adult worms in joints can lead to arthritis and paralysis in the spinal cord.
The mortality rate is quite low; however, morbidity is a major concern, with secondary infection being the most common complication. Cellulitis or the formation of an abscess requires prompt attention, and pain from the exit sites often can incapacitate patients for weeks. This is usually observed in individuals who have multiple worms and rely on their ability to stand or walk for their livelihood.
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. Topical antibiotics are applied to the wound to prevent secondary bacterial infections and the affected body part is then bandaged with fresh gauze to protect the site. Analgesics, such as aspirin or ibuprofen, are given to help ease the pain of this process and reduce inflammation. Metronidazole or thiabendazole (in adults) is usually adjunctive to stick therapy and somewhat facilitates the extraction process.