DRACUNCULIASIS 1.docx

**DRACUNCULIASIS/GUINEA WORM DISEASE** **Dracunculiasis**, also called **guinea worm disease or dracontiasis. It** is a parasitic infection by the [guinea worm](http://en.wikipedia.org/wiki/Dracunculus_medinensis), affecting the subcutaneous and deeper tissues. A person becomes infected when he/sh...

**DRACUNCULIASIS/GUINEA WORM DISEASE** **Dracunculiasis**, also called **guinea worm disease or dracontiasis. It** is a parasitic infection by the [guinea worm](http://en.wikipedia.org/wiki/Dracunculus_medinensis), affecting the subcutaneous and deeper tissues. A person becomes infected when he/she drinks water that contains [water fleas](http://en.wikipedia.org/wiki/Water_fleas) infected with guinea worm [larvae](http://en.wikipedia.org/wiki/Larva). **Cause** Dracunculus medinensis **Incubation period** 10 -14 months. **Signs and symptoms** - Presence of an itchy and painful blister. This is formed when the mature female worm emerges through the skin - The blister forms an ulcer which can occur anywhere on the body but the most common body areas affected are those that come in contact with water e.g. feet, legs, genitalia. - The adult worm may be felt beneath the skin - Local redness, tenderness and blister (usually on the foot) at the point where the worm comes out of the skin to discharge larvae into the water - There may be fever, nausea, vomiting, diarrhea and dyspnoea - Generalized urticaria and eosinophilia. - There may be difficulty in walking or working. **Life cycle of *Dracunculus medinensis*** Guinea worm disease is caused by drinking water contaminated by water fleas (microscopic [arthropods](http://en.wikipedia.org/wiki/Arthropod) known as Cyclops or copepods that host the *Dracunculus medinensis* larvae. After ingestion, the cyclops die and are [absorbed](http://en.wikipedia.org/wiki/Digested), thus releasing the larvae, which then penetrate the host\'s [stomach](http://en.wikipedia.org/wiki/Stomach) or [intestinal](http://en.wikipedia.org/wiki/Intestinal) wall, and then enter into the [abdominal cavity](http://en.wikipedia.org/wiki/Abdominal_cavity) and [retroperitoneal space](http://en.wikipedia.org/wiki/Retroperitoneal_space). After maturation, which takes approximately three months, mating takes place; the male worm dies after mating and is absorbed. Approximately one year after mating, the fertilized females migrate in the [subcutaneous tissues](http://en.wikipedia.org/wiki/Subcutaneous_tissue) and induces a blister on the skin, generally on the distal lower extremity which ruptures exposing one end of the emerging worm. The blister causes a very painful burning sensation as the worm emerges, and the sufferer will often immerse the affected limb in water to relieve the burning sensation. When the blister or open sore is submerged in water, the adult female releases hundreds of thousands of guinea worm larvae, thereby contaminating the water. Infected [Cyclops](http://en.wikipedia.org/wiki/Copepods) can live in the water for up to 4 months. **Diagnosis** - Physical examination by looking for the emerging worm from the lesions on the leg of infected individual - Microscopic examinations of the larvae. - **Active larvae can be obtained by immersing protruding female worm in a container with water** - **Radiological tests reveal dead calcified worms.** **Treatment** - There is no specific medication to treat guinea worm disease. - The first step is to do a controlled submersion of the affected area in a bucket of water to try and coax the worm out. Submersion results in relief of the burning sensation and makes subsequent extraction of the worm easier. - Slow extraction of the worm is done, avoid breaking the worm. - Clean and dress the ulcer to prevent secondary bacterial infection such as tetanus. - Give tetanus vaccination. - [Analgesics](http://en.wikipedia.org/wiki/Analgesic) like ibuprofen can be used to help reduce pain and swelling. - Give antibiotics like [metronidazole](http://en.wikipedia.org/wiki/Metronidazole) to prevent secondary bacterial infections. **Prevention** 1\. Prevent people from drinking contaminated water containing the [Cyclops/copepod](http://en.wikipedia.org/wiki/Cyclops_%28copepod%29)s (water flea. - Drink water drawn only from sources free from contamination, such as a [borehole](http://en.wikipedia.org/wiki/Borehole) or [wells](http://en.wikipedia.org/wiki/Water_well). - [Filter](http://en.wikipedia.org/wiki/Water_filter) all drinking water, using a fine-mesh [cloth filter](http://en.wikipedia.org/wiki/Cloth_filter) like [nylon](http://en.wikipedia.org/wiki/Nylon) or sand filters, to remove the guinea worm-containing crustaceans. - Boil the water before drinking it. - Treat water sources with [larvicides](http://en.wikipedia.org/wiki/Larvicide) to kill the water fleas. 2\. Prevent people with emerging Guinea worms from entering water sources used for drinking. - Community-level, case detection and containment is key. For this, staff must go door to door looking for cases, and the population must be willing to help and not hide their cases. - Immerse emerging worms in buckets of water to reduce the number of larvae in those worms, and then discard that water on dry ground. - Discourage all members of the community from setting foot in the drinking water source **Complications** - Arthritis due to death of adult worms within the joints. - Limb deformity e.g. crippling - ulceration - Tetanus infection as a secondary infection. - Abscess formation - Cellulitis due to inflammatory reaction brought about by the worms when they break down.