Dracunculiasis: The Longest Nematodes Infesting

Humans

1
Anita Margaret Wibisono and 2Yudha Nurdian
1
Student, Faculty of Medicine, University of Jember, Indonesia
2
Faculty of Medicine, University of Jember, Indonesia
Corresponding: Anita M. W., anitamargaretw@gmail.com; 152010101131@students.unej.ac.id

Abstract
Background
Dracunculus medinensis or Guinea worm is a nematode that causes dracunculiasis, also
known as guinea worm disease. The disease is caused by the female which, at up to 800 mm
(31 in) in length, is among the longest nematodes infesting humans. The prevalence of
dracunculiasis is a strong indicator of socioeconomic development because communities are
at highest risk where there is inadequate treatment of contaminated water, access to safe
drinking water, and separation of bathing and drinking facilities. Humans are infested by
swallowing fresh water from stagnant pools containing minute fresh water crustaceans
(copepods) harboring infective larvae of D. medinensis. When the copepods are digested in
the acid-pepsin environment of the stomach, larval forms are released from the body of the
crustacean, after which they penetrate the wall of the small intestine and migrate through the
thoracic musculature. Signs and symptoms of dracunculiasis appear approximately 1 year
after infection when fecund adult female worms appear near the surface of the skin. The
parasite causes debilitating skin lesions and secondary bacterial infections. The initial
presentation is a painful papule that enlarges over hours to days to form a blister that allows a
portion of the worm to emerge from the skin. The blister may be accompanied by local
erythema, urticaria, fever, nausea, and pruritus. The entire worm may emerge over a period of
several weeks. Complications include secondary bacterial infections that may lead to sepsis,
local abscesses, and pyogenic arthritis. Affected individuals are incapacitated for
approximately 8 weeks. The vast majority of worms emerge from the lower leg, ankle, and
foot, although aberrant sites of emergence have been reported (e.g., head, neck, genitalia).
Dracunculiasis is diagnosed by the appearance of the skin blister and adult. No anthelmintic
drugs are known to be effective against D. medinensis. Application of wet compresses to the
affected skin, administration of analgesics, and prevention of secondary bacterial infection by
the use of topical antibiotics are recommended. Worms should be slowly and gently extracted
over a period of several days using a small stick because breaking the worm can lead to
allergic reactions and secondary bacterial infection.

Conclusion
This text explains that dracunculiasis is caused by D. medinensis. Signs and symptoms of
dracunculiasis appear approximately 1 year after infestation when fecund adult female worms
appear near the surface of the skin. No anthelmintic drugs are known to be effective against
D. medinensis. Application of wet compresses to the affected skin, administration of
analgesics, and prevention of secondary bacterial infection by the use of topical antibiotics
are recommended.

Reference
1. Bhalla, D., Dumas, M., and Preux, P. M. 2013. Neurological Manifestations of
Filarial Infections. In: Aminoff, M. J., Boller, F. and Swaab, D. F. (Eds.). Handbook
of Clinical Neurology, Vol. 114, Amsterdam: Elsevier. p. 235-242.
2. Cleveland, C. A., Eberhard, M. K., Thompson, A. T., Smith, S. J., Zirimwabagabo,
H., Bringolf, R., and Yabsley, M. J. 2017. Possible Role of Fish as Transport Hosts
for Dracunculus spp. Larvae. Emerging Infectious Disease. Vol. 23. doi:
10.3201/eid2309.161931
3. Gaeta, R., Bruschi, F., and Giuffra, V. 2017. The Painting of St. Roch in the Picture
Gallery of Bari (15th Century): An Ancient Representation of Dracunculiasis?
Journal of Infection. doi: 10.1016/j.jinf.2017.02.002
4. Greenwood, B., Greenwood, A., and Bradley, A. 2017. Guinea Worm Infection in
Northern Nigeria: Reflections on a Disease Approaching Eradication. Tropical
Medicine and International Health, 22: 558-566. doi: 10.1111/tmi.12855
5. James, W. D., Berger, T. G., and Elston, D. M. 2016. Parasitic Infestations, Stings,
and Bites. In: James, W. D., Berger, T. G., and Elston, D. M. (Eds.). Andrews’
Disease of the Skin: Clinical Dermatology, Twelfth Ed., Philadelphia: Elsevier. p.
419-450.
6. Kazura, J. W. 2015. Tissue Nematodes (Trichinellosis, Dracunculiasis, Filariasis,
Loiasis, and Onchocerciasis). In: Bennet, J. E., Dolin, R., and Blaser, M. J. (Eds.).
Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases,
Eighth Ed., Vol. 1, Philadelphia: Elsevier. p. 3208-3215.
7. Mishra, S. And Gomase, V. S. 2017. Study of Hydrophobicity, Surface Accessibility,
and Antigenicity of Protein from Dracunculiasis. Asian Journal of Science and
Technology, 08:5517-5523.
8. Molyneux, D. and Sankara, D. P. 2017. Guinea Worm Eradication: Progress and
Challenges-Should We Beware of The Dog? PLoS Negl. Trop. Dis., 11(4): e0005495.
doi: 10.1371/journal.pntd.0005495
9. Suh, K. N. and Keystone, J. S. 2012. Helminthic Infections. In: Goldsmith, L. A.,
Katz, S. I., and friends (Eds.). Fitzpatrick’s Dermatology in General Medicine, Vol. 2,
United States: The McGraw-Hill Companies. p. 2544-2569.
10. Tayeh, A., Cairncross, S., and Cox, F. E. G. 2017. Guinea Worm: From Robert Leiper
to Eradication. Parasitology. doi: 10.1017/S0031182017000683