Disease: Guinea Worm Disease (Dracunculiasis)

    Guinea worm disease facts*

    *Guinea worm disease facts by John P. Cunha, DO, FACOEP

    • Dracunculiasis, more commonly known as Guinea worm disease (GWD), is a preventable infection caused by the parasite Dracunculus medinensis.
    • In 2011, only four countries reported cases of GWD: Chad, Ethiopia, Mali, and South Sudan.
    • Anyone who drinks standing pond water contaminated by persons with GWD is at risk for infection.
    • About 1 year after a person drinks contaminated water, the adult female Guinea worm emerges from a painful blister on the skin of the infected person.
    • A few days to hours before the worm emerges, the person may develop symptoms of fever, swelling, and pain in the area. More than 90% of the worms appear on the legs and feet.
    • There is no drug to treat Guinea worm disease (GWD) and no vaccine to prevent infection. Once the worm emerges from the wound, it can only be pulled out a few centimeters each day and wrapped around a piece of gauze or small stick. This process usually takes weeks or months. The worm can also be surgically removed by a doctor before an ulcer forms.
    • To prevent GWD, education on how to make drinking water safe is key.

    What is dracunculiasis?

    Dracunculiasis, more commonly known as Guinea worm disease (GWD), is a preventable infection caused by the parasite Dracunculus medinensis. Infection affects poor communities in remote parts of Africa that do not have safe water to drink.

    Currently, many organizations, including The Global 2000 program of The Carter Center of Emory University, UNICEF, Centers for Disease Control and Prevention (CDC), and the World Health Organization (WHO) are helping to eradicate the disease. Since 1986, when an estimated 3.5 million people were infected annually, the campaign has eliminated much of the disease. The number of cases went down to 542 in 2012.

    In 2011, only four countries reported cases of GWD: Chad, Ethiopia, Mali, and South Sudan. All affected countries are aiming to eliminate Guinea worm disease as soon as possible.

    Life cycle of Dracunculus medinensis (Guinea worm disease). Source: CDC

    How does Guinea worm disease spread?

    Approximately 1 year after a person drinks contaminated water, the adult female Guinea worm emerges from the skin of the infected person. Persons with worms protruding through the skin may enter sources of drinking water and unwittingly allow the worm to release larvae into the water. These larvae are ingested by microscopic copepods (tiny "water fleas") that live in these water sources. Persons become infected by drinking water containing the water fleas harboring the Guinea worm larvae.

    Once ingested, the stomach acid digests the water fleas, but not the Guinea worm larvae. These larvae find their way to the small intestine, where they penetrate the wall of the intestine and pass into the body cavity. During the next 10-14 months, the female Guinea worm larvae grow into full size adults, 60-100 centimeters (2-3 feet) long and as wide as a cooked spaghetti noodle. These adult female worms then migrate and emerge from the skin anywhere on the body, but usually on the lower limbs.

    A blister develops on the skin at the site where the worm will emerge. This blister causes a very painful burning sensation and it ruptures within 24-72 hours. Immersion of the affected limb into water helps relieve the pain but it also triggers the Guinea worm to release a milky white liquid containing millions of immature larvae into the water, thus contaminating the water supply and starting the cycle over again. For several days after it has emerged from the ulcer, the female Guinea worm is capable of releasing more larvae whenever it comes in contact with water.

    What are the signs and symptoms of Guinea worm disease?

    Infected persons do not usually have symptoms until about one year after they become infected. A few days to hours before the worm emerges, the person may develop a fever, swelling, and pain in the area. More than 90% of the worms appear on the legs and feet, but may occur anywhere on the body.

    People, in remote, rural communities who are most commonly affected by Guinea worm disease (GWD) frequently do not have access to medical care. Emergence of the adult female worm can be very painful, slow, and disabling. Frequently, the skin lesions caused by the worm develop secondary bacterial infections, which exacerbate the pain, and extend the period of incapacitation to weeks or months. Sometimes permanent disability results if joints are infected and become locked.

    What is the treatment for Guinea worm disease?

    There is no drug to treat Guinea worm disease (GWD) and no vaccine to prevent infection. Once the worm emerges from the wound, it can only be pulled out a few centimeters each day and wrapped around a piece of gauze or small stick. Sometimes the worm can be pulled out completely within a few days, but this process usually takes weeks or months. Analgesics, such as aspirin or ibuprofen, can help reduce swelling; antibiotic ointment can help prevent bacterial infections. The worm can also be surgically removed by a trained doctor in a medical facility before an ulcer forms.

    Where is Guinea worm disease found?

    Dracunculiasis now occurs only in 4 countries in sub-Saharan Africa. Transmission of the disease is most common in very remote rural villages and in areas visited by nomadic groups. In 2011, only four countries reported cases of GWD: Chad, Ethiopia, Mali, and South Sudan, with the majority of cases in South Sudan.

    Asia is now free of the disease. Transmission of GWD no longer occurs in several African countries, including Benin, Burkina Faso, Cameroon, Central African Republic, Cote d'Ivoire, Kenya, Mauritania, Senegal, Togo, and Uganda. No locally acquired cases of disease have been reported in these countries in the last year or more. The treatment of case importations from the remaining endemic countries requires that surveillance be maintained in formerly endemic areas until official certification. The World Health Organization has certified 180 countries free of transmission of Dracunculiasis, including six formerly endemic countries: Pakistan (in 1996), India (in 2000), Senegal and Yemen (in 2004), Central African Republic and Cameroon (in 2007).

    How does Guinea worm disease spread?

    Approximately 1 year after a person drinks contaminated water, the adult female Guinea worm emerges from the skin of the infected person. Persons with worms protruding through the skin may enter sources of drinking water and unwittingly allow the worm to release larvae into the water. These larvae are ingested by microscopic copepods (tiny "water fleas") that live in these water sources. Persons become infected by drinking water containing the water fleas harboring the Guinea worm larvae.

    Once ingested, the stomach acid digests the water fleas, but not the Guinea worm larvae. These larvae find their way to the small intestine, where they penetrate the wall of the intestine and pass into the body cavity. During the next 10-14 months, the female Guinea worm larvae grow into full size adults, 60-100 centimeters (2-3 feet) long and as wide as a cooked spaghetti noodle. These adult female worms then migrate and emerge from the skin anywhere on the body, but usually on the lower limbs.

    A blister develops on the skin at the site where the worm will emerge. This blister causes a very painful burning sensation and it ruptures within 24-72 hours. Immersion of the affected limb into water helps relieve the pain but it also triggers the Guinea worm to release a milky white liquid containing millions of immature larvae into the water, thus contaminating the water supply and starting the cycle over again. For several days after it has emerged from the ulcer, the female Guinea worm is capable of releasing more larvae whenever it comes in contact with water.

    What are the signs and symptoms of Guinea worm disease?

    Infected persons do not usually have symptoms until about one year after they become infected. A few days to hours before the worm emerges, the person may develop a fever, swelling, and pain in the area. More than 90% of the worms appear on the legs and feet, but may occur anywhere on the body.

    People, in remote, rural communities who are most commonly affected by Guinea worm disease (GWD) frequently do not have access to medical care. Emergence of the adult female worm can be very painful, slow, and disabling. Frequently, the skin lesions caused by the worm develop secondary bacterial infections, which exacerbate the pain, and extend the period of incapacitation to weeks or months. Sometimes permanent disability results if joints are infected and become locked.

    What is the treatment for Guinea worm disease?

    There is no drug to treat Guinea worm disease (GWD) and no vaccine to prevent infection. Once the worm emerges from the wound, it can only be pulled out a few centimeters each day and wrapped around a piece of gauze or small stick. Sometimes the worm can be pulled out completely within a few days, but this process usually takes weeks or months. Analgesics, such as aspirin or ibuprofen, can help reduce swelling; antibiotic ointment can help prevent bacterial infections. The worm can also be surgically removed by a trained doctor in a medical facility before an ulcer forms.

    Where is Guinea worm disease found?

    Dracunculiasis now occurs only in 4 countries in sub-Saharan Africa. Transmission of the disease is most common in very remote rural villages and in areas visited by nomadic groups. In 2011, only four countries reported cases of GWD: Chad, Ethiopia, Mali, and South Sudan, with the majority of cases in South Sudan.

    Asia is now free of the disease. Transmission of GWD no longer occurs in several African countries, including Benin, Burkina Faso, Cameroon, Central African Republic, Cote d'Ivoire, Kenya, Mauritania, Senegal, Togo, and Uganda. No locally acquired cases of disease have been reported in these countries in the last year or more. The treatment of case importations from the remaining endemic countries requires that surveillance be maintained in formerly endemic areas until official certification. The World Health Organization has certified 180 countries free of transmission of Dracunculiasis, including six formerly endemic countries: Pakistan (in 1996), India (in 2000), Senegal and Yemen (in 2004), Central African Republic and Cameroon (in 2007).

    Source: http://www.rxlist.com

    There is no drug to treat Guinea worm disease (GWD) and no vaccine to prevent infection. Once the worm emerges from the wound, it can only be pulled out a few centimeters each day and wrapped around a piece of gauze or small stick. Sometimes the worm can be pulled out completely within a few days, but this process usually takes weeks or months. Analgesics, such as aspirin or ibuprofen, can help reduce swelling; antibiotic ointment can help prevent bacterial infections. The worm can also be surgically removed by a trained doctor in a medical facility before an ulcer forms.

    Source: http://www.rxlist.com

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