Dracunculus

TANGA
SAIMAHESH
medinensis

Taxonomy

Class: Secernentea
Subclass: Spiruria
Order: Spirurida
Superfamily: Drancunculoidea
Family: Dracunculidae

Common names- Guinea Worm,

Medina Worm, Serpent Worm,
Dragon Worm
Disease
dracunculiasis

History

Known as a parasite of
humans since about 1530
B.C.
Guinea worm is thought
to be the "fiery serpent"
referred to in the Bible.
The symbol of a
Physician is the
"Caduceus". The serpents
are believed to represent
the Guinea worm.
Persian physicians
removing the D.
medinensis parasite from
patient during the 9th
century-

Hosts

Definitive: Humans
Intermediate:
Copepod

Distribution
Except for a few remote
villages in the Rajastan
desert of India and in
Yemen, Guinea worm
disease now occurs only in
Africa.
Infected areas in Africa lie
in a band between the
Sahara and the equator.
Presently, only 9 countries
are endemic: Sudan,
Ghana, Nigeria, Mali, Togo,
Burkina Faso, Ethiopia,
Niger, and Ivory Coast.
>50% of all cases of
Guinea worm disease are
reported from southern
Sudan.

Distribution
Smaller numbers of
cases are reported
from Ethiopia, Chad,
Senegal, and
Cameroon.
Most cases occur in
poor rural villages
that are not visited
by tourists.

Morphology

One of the largest

nematodes known.
Adult females have been
recorded up to 800 mm long
Few males known do not
exceed 40 mm.
The mouth is small and
triangular and is surrounded
by a quadrangular,
sclerotized plate.
Lips are absent.
The esophagus has a large
glandular portion
Spicules of the male are
unequal and 490 to 730 um
long. The gubernaculum
ranges from 115 to 130 um
long.

Morphology
A: Adult D. medinensis
worms. (A) The adult
female guinea worm is a
long, slender worm
ranging from 30 to 120
cm in length and from
0.09 to 0.17 cm in width.

B: Three mature guinea

worms.

Note the tiny size of

the mature male (mm)
compared with the
mature female (mf)
and especially the
markedly elongated
and serpiginous,
gravid female worm
(gf). The gravid female
shows an extruded
uterus (eu)

Characteristics

Only helminthic parasite transmitted solely through

water.
But usually occurs during drought
Everyone is forced to drink from the same
stagnant water supplies or pay for well.
Three conditions to be met before D. medinensis
can complete its life cycle.
The skin of an infected individual must come in
contact with water
The water must contain the appropriate species
of microcrustacean
The water must be used for drinking
Believed the parasites feed on blood due to the gut
often being filled with dark brown gut material

Life Cycle

Life Cycle

Humans become infected by drinking unfiltered water

containing copepods (small crustaceans) which are
infected with larvae of D. medinensis
Following ingestion, the copepods die and release the
larvae, which penetrate the host stomach and intestinal
wall and enter the abdominal cavity and retroperitoneal
space.
The worm molts again 20 days and 43 days post infection
Females are fertilized by the third month.
After maturation into adults and copulation, the male
worms die and the females (length: 70 to 120 cm) migrate
in the subcutaneous tissues towards the skin surface
Approximately one year after infection, the female worm
induces a blister on the skin, generally on the distal lower
extremity, which ruptures.
When this lesion comes into contact with water, which the
patient seeks to relieve the local discomfort, the female
worm emerges and releases larvae
The larvae are ingested by a copepod and after two
weeks (and two molts) have developed into infective
larvae

Diagnosis

Diagnosis is made from the local

blister, worm or larvae.
The outline of the worm under the
skin.
Some people claim to be able to
feel the worm moving towards the
surface of the skin.
Finding Calcified worms.

Epidemiology
Dracunculiasis may result in three major
disease conditions
Emergent adult worms
Secondary bacterial infection
Nonemergent worms
When worms do not emerge they
degenerate and release antigens causing
fluid filled abscesses or allergenic
reactions.
If the worms become calcified they can
cause inflammation or if they remain in a
joint, arthritis.
Can cause paraplegia if it worm gets into
the central nervous system.

Pathology

None until the female worms cause an allergic

reaction by releasing metabolic wastes into host.
This occurs at the onset of migration to the skin.

a rash accompanied by severe itching

nausea
vomiting
diarrhea
dizziness
Ruptured
edema
Blister

Blister

Reddish papule-blister (local itching and intense

burning).
Blister ruptures, becomes abscessed-very painful.
Secondary bacterial infections of opening possible.
Retreating worm can draw bacteria under skin as well.

There may be later symptoms

fibrosis of the skin, muscles, tendons and joints (may
interfere with locomotion or use of limbs)

Pathology
Adult in joint

Calcified lesion in
soft tissues

Treatment

Drug TherapyMetronidazole
To help prevent bacterial infections
Anti-inflammatory to help reduce swelling

Treatment includes the extraction of the

adult guinea worm by rolling it a few
centimeters per day
Usually takes weeks or months depending on
how long the worm is.

Exposing area to cold water helps remove

worm faster.
Preferably by multiple surgical incisions
under local anesthesia.
Infection does not make a person immune

Control

Filter, boil, or treat water

with chlorine to kill
intermediate host.
Finely-meshed cloth or,
better still, a filter made
from a 0.15 mm nylon
mesh, is all that is
needed to filter out the
copepods from the
drinking water.

Avoid bathing or wading

in drinking water.
Village-based volunteers
demonstrating the use of
cloth filter on a clay pot to
filter drinking water

Control

Construction of copings around

well heads or the installation of
boreholes with hand pumps.
Borehole is a deep and narrow well.
Coping is a cap/cover over a well
Key is to prevent copepod growth by
controlling sunlight. Light increases
the food source of the copepod.

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