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Pathology of Dracunculiasis (Guinea Worm Disease)

Dr Sampurna Roy MD

 

                                                                                                                      

 

 

Syn: Guinea worm infection; Medina worm infection. 

                      

"Staff of Asclepius is one of the most common symbols associated with medical profession. The serpent on the staff may in fact represent the guinea worm (Dracunculus medinensis), commonly called the fiery serpent.

The  serpent and staff are symbolic of the removal of the worm by winding it around a staff and slowly withdrawing it from the unfortunate victim's tissues."

 

Eighteen of 20 countries were known in 1986 to have endemic dracunculiasis, i.e., Benin, Burkina Faso, Cameroon, Chad, Cote d'Ivoire, Ethiopia, Ghana, India, Kenya, Mali, Mauritania, Niger, Nigeria, Pakistan, Senegal, Sudan, Togo, and Uganda. Image Link

Transmission of the disease in Yemen was documented in 1995, and the World Health Organization (WHO) declared Central African Republic endemic in 1995.

As of the end of 2004, a total of 16026 cases of dracunculiasis were reported from 12 endemic countries (91% of these cases were reported from Ghana and Sudan, combined).

WHO has certified 168 countries free of dracunculiasis, including Pakistan (1996), India (2000),Senegal and Yemen (2004).

Asia is now free of dracunculiasis.

 Source: Image Link

 

The disease is caused by the parasite Dracunculus medinensis, or the guinea worm. It is commonly referred to as a filaria , but it lacks a microfilarial stage and the adult worms are distinctly different from the true filariae.

The larvae are taken up by a freshwater crustacean of the genus Cyclops (water fleas).

They mature within the crustacean into elongated larvae infective for humans.

These larvae are liberated by the gastric digestive juices when a person drinks water contaminated with infected Cyclops (water fleas).

The larvae migrate through the wall of stomach or small intestine into the connective tissue of the abdominal wall.  

The male worm is small and probably dies after copulation. The female worm, which averages 1m in length, wanders out to the subcutaneous tissue, specially that of the feet and legs.

A small papule appears, which later becomes a vesicle with  a small ulceration in the center through which the embryo are liberated.

The latter are usually present in milky fluid contained in a segment of the worm’s uterus that is extruded and breaks away from the body of the parasite.

On rare occasions the worms may be found in joints and serosal cavities.

The signs and symptoms of dracunculiasis are limited to the period of liberation of embryos.

Pruritus and moderate edema may be accompanied by low-grade fever and urticarial rash, caused by an anaphylactic reaction to the products of the worm.

If the worm dies or if the embryos are liberated into the tissues, a severe inflammatory reaction with abscess formation ensues.

Image1 Image2 ;  Image3 ;  Image4  ; Image5 .

(Dr Y. Tsutsumi MD)

 

Further reading

Dracunculiasis eradication: the final inch.

Dracunculiasis eradication: neglected no longer.

The peculiar epidemiology of dracunculiasis in Chad.

Pustular dermatitis caused by subcutaneous dracunculiasis

Long-term disability due to guinea worm disease.

The staff and the fiery serpent

Dracunculiasis (Guinea worm disease) eradication.

Progress toward global eradication of dracunculiasis, January-June 2003.

Dracunculiasis (guinea worm disease).

Water contacts in dracunculiasis-infected patients in Mali: transmission risk activities.  

 

 


 

 

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