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Guinea Worm Disease (Dracunculiasis)

Guinea Worm Disease (Dracunculiasis) Related Articles

Guinea Worm Disease (Dracunculiasis) Facts

  • Guinea worm disease (GWD or Dracunculus medinensis) is a disease caused by worm-like parasites resulting in painful skin lesions when the worm emerges from them.
  • When humans drink or swallow contaminated water in countries that have not eradicated the disease, a small aquatic crustacean that is a vector of the disease (copepod) is ingested and releases worm larvae that mature to result in skin lesions.
  • Symptoms and signs of Guinea worm disease include fever and painful lesions (including a burning sensation), usually on the legs and/or feet with the blister-like lesions developing into ulcer-like areas where the female worms emerge.
  • Diagnosis of GWD is by clinical history and observation of lesions.
  • Treatment is supportive; worms may be removed carefully and lesions may require topical antibiotics. People may take Tylenol or ibuprofen for pain.
  • Complications of Guinea worm disease include secondary bacterial infections and/or systemic problems like sepsis, joint destruction, and cellulitis.
  • The prognosis of the disease ranges from good to poor, depending on complications.
  • Water purification, education of at-risk populations, and worm removal from patients helps to prevent the disease.

What Is Guinea Worm Disease?

The definition of Guinea worm disease (also termed GWS or dracunculiasis) is an infection caused by the parasite Dracunculus medinensis. Part of the parasite's complex lifecycle involves development inside humans. When adult females are ready, usually about one year after initial infection, they come out of the skin in a painful, slow, and disabling way. The site where the worm emerges from the skin often becomes secondarily infected by bacteria.

Picture 1: CDC drawing of the Guinea worm disease life cycle.
Picture 1: CDC drawing of the Guinea worm disease life cycle.

What Causes Guinea Worm Disease (GWD)?

As seen in the life cycle, humans ingest contaminated water that contains GWD larvae inside a copepod (a small aquatic crustacean that is a vector of the disease) that dies in the human gut, releasing the larvae that produce GWD. The male and female larvae reproduce. Mature fertilized female worms migrate to the skin and then out of the body and release larvae into the environment (usually in cool water).

Picture 2: Skin lesion on ankle with worm (white worm wound onto a matchstick)
Picture 2: Skin lesion on ankle with worm (white worm wound onto a matchstick); photo courtesy of the CDC.

What Are Risk Factors for Guinea Worm Disease?

Due to a worldwide Guinea worm eradication program, only 25 individuals reported infections in 2016. These individuals occurred in three African countries: Chad, Ethiopia, and South Sudan, so travel to these countries increases risk of getting GWD. Drinking water containing copepods (stagnant pools of water) will also increase the risk of contracting the disease.

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What Are Guinea Worm Disease Symptoms and Signs?

The incubation period for Guinea worm disease is long -- about a year. The first signs or symptoms may include fever, itchy rash, nausea and/or vomiting, diarrhea, and dizziness, then leg and/or foot swelling with bumps that resemble hives, followed by a blister or lesion on the skin that has a burning feeling. This can develop into a lesion resembling a skin ulcer and the white-colored worm emerges from the lesion when the burning painful lesions are placed in cool water. The lesions are very painful -- some are debilitating. About 90% of lesions are on the legs or feet, but the worms may emerge almost anywhere on the body.

How Do Medical Professionals Diagnose Guinea Worm Disease?

The diagnosis of Guinea worm disease is done in almost all individuals from the patient's history and by observation of the lesion formation and/or the presence of an emerging female worm.

What Is the Treatment for Guinea Worm Disease?

There is no specific drug or vaccine to treat or prevent GWD. Once the worm begins to emerge to form the lesion (encouraged by placing the lesion in cool water), the worm may be removed by slow and gentle traction. The worm may be wound up with a piece of gauze or a stick. Since some worms can be as long as one meter, worm removal may take several days or even weeks. As the worm is slowly and carefully removed, the lesion in the skin should be kept cleaned and treated with topical antibiotics if it becomes infected.

Individuals can take acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to manage pain.

What Are Complications of Guinea Worm Disease?

Complications of GWD may include infection of the skin and underlying tissues (cellulitis), abscesses, sepsis (can be life-threatening), joint infections, and tetanus. If the worm breaks during removal, it can cause intense inflammation, cellulitis, and even more pain and swelling. These complications can result in long-term effects such as joint destruction.

What Is the Prognosis for Guinea Worm Disease (GWD)?

The prognosis for GWD ranges from good to poor. The successful removal of worms usually allows patients to return to their normal lifestyle. If complications such as joint deformities or joint infections develop, some patients may have chronic disabilities and cannot return to normal everyday activities.

How Can People Prevent Guinea Worm Disease?

Avoid drinking and eating any liquids or foods possibly contaminated with stagnate water in the African countries of Chad, Ethiopia, and South Sudan, where the parasites and vectors have not been eradicated. An approved larvicide, Abate, is used to kill the vectors of GWD in drinking water. However, education, water treatments, and worm removal from patients have almost eradicated the disease.

Statistics show attempts to eradicate this disease are working. The death rate is currently almost at zero and the number of new infections dropped from about 3.5 million per year in 1986 to only 25 reported diagnosed in 2016-2017. This near-eradication is due to efforts of the WHO, CDC, UNICEF, and individuals like former President Jimmy Carter, who has made eradication of the disease a goal since 1986.

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Guinea Worm Disease Symptom

Fever

Body temperature measurements are usually measured by temperature devices inserted on or into the rectum, mouth, axilla (under the armpit), skin, or ear (ear thermometers). Some devices (laryngoscopes, bronchoscopes, rectal probes) may have temperature-sensing probes that can record temperature continually. The most common way to measure body temperature was (and still is in many countries) with a mercury thermometer; because of glass breakage and the possibility of subsequent mercury contamination, many developed countries use digital thermometers with disposable probe covers to measure temperature from all of the body sites listed above. Disposable temperature-sensitive strips that measure skin temperature are also used. Oral temperatures are most commonly measured in adults, but rectal temperatures are the most accurate because environmental factors that increase or decrease temperature measurements have the least effect on the rectal area. Rectal temperatures, when compared to oral temperatures taken at the same time, are about 1.8 F (0.6 C) higher. Consequently, an accurate measurement of body temperature (best is rectal core temperature) of 100.4 F (38 C) or above is considered to be a "fever" and the person has a febrile illness.

Reviewed on 12/14/2018
References

United States. Centers for Disease Control and Prevention. "Parasites -- Guinea Worm." Feb. 7, 2017. <https://www.cdc.gov/parasites/guineaworm/epi.html>.

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