What is Dracunculiasis (Guinea Worm Disease)?
Dracunculiasis, also known as Guinea-worm disease, is an infection caused by a type of parasite called the Dracunculus medinensis. This disease spreads to humans when they consume water contaminated with small water-dwelling creatures called copepod crustaceans (Cyclops), which carry the larvae of the parasite. Humans are the main host of this parasite, while the Cyclops crustaceans act as a second, intermediate host.
This disease typically affects people living in rural and economically disadvantaged areas of the world. It is particularly widespread in African countries including Chad, South Sudan, Ethiopia, and Mali. Actions are being taken globally to eliminate this disease.
The adult female worms of this species can grow up to 1 meter long and are 1 to 2 mm wide. The male worms, however, are smaller, measuring between 15 to 40mm in length and are 0.4 mm wide.
What Causes Dracunculiasis (Guinea Worm Disease)?
Dracunculiasis, also known as Guinea worm disease, is caused by a parasite called Dracunculus medinensis. This parasite is passed on to humans when they drink unclean water that contains small water fleas called copepods, which are infested with the baby forms of this parasite. In this process, humans act as the main host for the parasite, and the copepods are considered the secondary host.
Risk Factors and Frequency for Dracunculiasis (Guinea Worm Disease)
Guinea worm disease is mostly found in rural and poor parts of the world, especially in African countries like Chad, South Sudan, Ethiopia, and Mali. It often impacts people living in these areas who rely on farming for their survival. The disease can affect any age group but it’s mostly common among young adults aged 15 to 45 years. Both men and women are affected equally. The transmission of the disease changes with seasons, and it usually occurs during both rainy and dry seasons.
- In the 1940s, around 48 million people were affected by Guinea worm disease in Africa, the Middle East, and India.
- About 3.5 million cases were reported annually in the mid-1980s.
- Ever since the Guinea Worm Eradication Program started in the 1980s, the number of cases of this disease has greatly reduced and is now close to being wiped out.
- Recent reports from the World Health Organization (WHO) in October 2018 state that now only a few cases have been reported in Chad, South Sudan, and Angola.
- The goal is to completely get rid of this disease globally by 2020.
Signs and Symptoms of Dracunculiasis (Guinea Worm Disease)
Patients usually do not show any signs of the infection for about a year. However, when symptoms do appear, they can include skin redness and soreness at the point where the worm is coming out. This can lead to blisters, sores, swelling, and itching at the spot where the worm emerges. The worm commonly comes out from the lower parts of the body, especially the feet, in 80 to 90% of cases. However, it can emerge from any part of the body. It’s also possible for more than one worm to come out at the same time. The process of the worm coming out can be painful and may take more than 8 weeks.
Additional symptoms can include fever, skin rash, feelign sick, vomiting, and diarrhea. If the worms move to other parts of the body, they can cause an abscess. This can happen if the worms go to the lungs, the sack around the heart, or the spinal cord. If the worms go through the joints, they can cause joint pain and tightening of the muscles. In some cases, patients may also develop sepsis, a severe infection that spreads through the body. Skin infection called cellulitis can also happen. If the worm breaks before it comes out fully, it can cause strong inflammation, pain, swelling, and cellulitis. Sometimes, the worm may die before it comes out and harden inside the skin, leading to ongoing pain and swelling.
- Redness and soreness where the worm comes out
- Blisters and sores at the point where the worm emerges
- Swelling and itching on the skin where the worm comes out
- The worm commonly comes out from the lower part of the body, especially the feet
- More than one worm may come out at the same time
- Painful process of the worm coming out which may take more than 8 weeks
- Additional symptoms: fever, skin rash, feeling sick, vomiting, and diarrhea
- Possible complications: abscess, joint pain, muscle tightening, sepsis, cellulitis
- Inflammation, pain, swelling, and cellulitis if the worm breaks before coming out
- Ongoing pain and swelling if the worm dies before coming out
Testing for Dracunculiasis (Guinea Worm Disease)
Generally, doctors diagnose this condition based on the patient’s symptoms. Blood tests might show a high number of a certain type of white blood cells called eosinophils. A protein called Immunoglobulin G4 could also be increased.
If the worms die before surfacing from the skin, they can harden, turning into a substance similar to bone. These hardened worms can be seen on x-rays.
Treatment Options for Dracunculiasis (Guinea Worm Disease)
Pain and swelling from infections can be lessened with the use of anti-inflammatory medications like aspirin and ibuprofen. Itching is typically treated with a medication known as diphenhydramine. Also, to prevent other bacteria from causing infections at the area where the worm emerges, a skin cream or ointment with antibiotics can be applied. In more serious cases where the skin gets infected or an abscess forms, antibiotics might have to be taken orally or intravenously. Taking good care of the wound is essential.
The process of removing the worm involves several steps. Firstly, by applying water to the affected part of the body, the worm can be encouraged to come to the skin surface. Subsequently, the wound needs to be cleaned thoroughly. After that, the worm is drawn out gently to ensure it doesn’t break. To aid in the extraction process, the worm can be wrapped around a small stick or piece of gauze, which helps apply tension and prevent the worm from going back into the body. To prevent any additional bacterial infections, antibiotic cream is used. Finally, the wound is covered with a gauze and bandage.
Anti-inflammatory drugs, such as aspirin and ibuprofen, can help with any residual pain or swelling after the extraction. This whole process is done every day, potentially for 8 weeks or more, until the worm is fully removed. It’s important for people who are infected to avoid getting into water bodies, as this could contaminate the water and cause the disease to spread to others.
In cases of guinea worm disease, no medication is fully effective. Performing surgery to remove the worm is typically the best treatment option and is usually done where proper medical facilities are available.
What else can Dracunculiasis (Guinea Worm Disease) be?
- Filariasis (an infection caused by worms that mainly affect the lymphatic system)
- Cellulitis (a common, potentially serious skin infection)
What to expect with Dracunculiasis (Guinea Worm Disease)
Guinea worm disease, while rarely leading to death, can cause serious health problems. These complications often arise from additional bacterial infections and sepsis. The condition could result in both temporary and permanent disabilities. Currently, the most effective way to avoid getting this disease is through prevention.
Possible Complications When Diagnosed with Dracunculiasis (Guinea Worm Disease)
Abscesses, which are collections of pus in body tissues, can develop when the worms spread to different areas like the lung, the pericardium (which is the membrane around the heart), or the spinal cord. Sometimes, serious systemic infections known as sepsis can occur, as well as cellulitis, which is a common skin infection. If a worm gets broken before it’s fully removed from the skin, it can cause intense inflammation, pain, swelling, and cellulitis.
In some instances, the worm might die before it comes out of the skin, leading to calcification, or becoming hardened and encapsulated. This situation could result in repeated bouts of pain and swelling. If worms pass through the joints, they can cause joint pain and contractures, which are permanent shortening of a muscle or joint.
Here are some complications that can arise:
- Abscesses in different body tissues
- Systemic infections and cellulitis
- Severe inflammatory reaction, pain, swelling, and cellulitis if a worm breaks prematurely
- Chronic recurrent pain and swelling when a worm calcifies and becomes encapsulated
- Joint pain and contractures when worms pass through joints
Preventing Dracunculiasis (Guinea Worm Disease)
Currently, there isn’t a medication to cure dracunculiasis, or a vaccine to prevent it. To stop the spread of this disease, it’s very important that infected individuals do not touch sources of drinking water. This is to avoid contaminating them. Promoting the use of safe drinking water is crucial in this situation.