MAKITA NA ANG

SLIDE?
DRACUNCULUS
MEDINENSIS
GUINEA WORM
 TABLE OF CONTENTS
1. INTRODUCTION
2. HISTORY AND DISTRIBUTION
3. HABITAT
4. MORPHOLOGY
5. LIFE CYCLE
6. PATHOGENESIS
7. CLINICAL MANIFESTATION
9. LABORATORY DIAGNOSIS
10 . TREATMENT
11. EPIDEMIOLOGY
 01
INTRODUCTIO
N
in·tro·duc·tion
/ˌintrəˈdəkSH(ə)n/
 Introduction
 Also known as guinea worm disease.
 Caused by nematode parasite
 Transmitted exclusively when people
drink stagnant water contaminated with
parasite infected water fleas.
 Involves subcutaneous tissues(leg and
foot).
 It affects people in rural, deprived and isolated
communities who depend mainly on open
water sources such as ponds and wells.
 Its not lethal but disable its victim
temporarily
 02
HISTORY & DISTRIBUTION
DRACUNCULUS MEDINENSIS
 1550 BCE

Earliest known evidence of guinea 1674

worm disease comes from the Ebers
Following years, Swedish naturalist
Papyrus, an ancient Egyptian
Carolus Linnaeus assigned the latin
compilation of medical texts dated to
Italian physician Georgius name “Dracunculus medinensis” to
about 1550 BCE.
Hieronymus Velschius published the guinea worm.
Exercitatio de Vena Medinensis.
 1870
1986

Russian scientist Aleksey P. Fedchenko

confirmed suspicions with his description of 1980s former U.S. president  2010
the guinea worm life cycle and the Jimmy Carter initiated a
involvement of water fleas as intermediate campaign for the complete
hosts. eradication of the disease from the
By 2010, the disease was
world.
Guinea worm disease was prevalent endemic in just four African
primarily in sub-Saharan Africa, countries.
Pakistan, and India.
 03
HABITAT
hab·i·tat
/ˈhabəˌtat/
 These habitats are
reservoirs for copepods

Dracunculus medinensis favors freshwater

habitats mainly stagnant waters such as
ponds, cisterns, pools in dried up
riverbeds, and temporary hand-dug wells
 04
MORPHOLOGY
mor·phol·o·gy
/môrˈfäləjē/
 DRACUNCULUS MEDINENSIS

 Dracunculus medinensis is one of the larger nematodes. The

female is usually 60 cm in length, and has been reported up to
3 m.
 The males, which are much smaller, are usually 1.2 to 2.9 cm
long.
 Both male and female worms have a small, triangular mouth
surrounded by a quadrangular, sclerotized plate, but no lips.
 Females have anterior and posterior branches to their uterus
and when the female is gravid, the intestine becomes
squashed and nonfunctional.
 Juveniles (larvae) tend to range from 500 to 700 µm long.
 DRACUNCULUS MEDINENSIS

 Both sexes live in the connective tissue of various organs of

the host.
 Females may live for 10 to 14 months.
 The female bores close to the skin surface, at which point a
blister develops and finally bursts.
 D. medinensis is a non-filarial parasite as it only has one
uterus whereas filarial worms have two.
 To make a comparison of size, Ascaris lumbricoides is about
30 cm in length, while D. medinensis can be up to meter long.
 DRACUNCULUS MEDINENSIS

 While nematodes vary considerably in size, they exhibit

conservatism of structure and all adults have a similar basic
morphology.
 05
LIFE CYCLE
life cy·cle
/ˈlīf ˌsīkəl/
 D. Medinensis Life Cycle

 In the lifecycle of the Dracunculus medinensis, the female worms are found in, or just under, the skin of the human
host, most often in the legs, ankles, or feet and sometimes the abdomen.
 As the female becomes gravid, her body fills with developing embryos.
 Eventually, the female's body wall ruptures, and the juvenile worms are released into the human's skin.
 This causes an intense allergic reaction and extreme discomfort.
 A blister will then form on the skin where it eventually breaks open and allows the juvenile worms to escape into
the water.
 The human often seeks water as a comfort to the painful blister.
 The juveniles must be ingested by an intermediate host, a copepod, a small crustacean, within three days.
 A human is then infected when it drinks water containing infected copepods.
 In the human, the juvenile worms migrate from the intestinal tract, through the abdominal cavity, where they
develop into second and then third stage juveniles.
 They then migrate into the deep subcutaneous tissue where they develop into adult nematodes.
 Here the females are fertilized by the males, the males die and the females migrate to the skin to produce juveniles.
 In the human host, complete development of the parasite requires about one year.
 D. Medinensis Life Cycle

 In the lifecycle of the Dracunculus medinensis, the female worms are found in, or just under, the skin of the human
host, most often in the legs, ankles, or feet and sometimes the abdomen.
 As the female becomes gravid, her body fills with developing embryos.
 Eventually, the female's body wall ruptures, and the juvenile worms are released into the human's skin.
 This causes an intense allergic reaction and extreme discomfort.
 A blister will then form on the skin where it eventually breaks open and allows the juvenile worms to escape into
the water.
 The human often seeks water as a comfort to the painful blister.
 The juveniles must be ingested by an intermediate host, a copepod, a small crustacean, within three days.
 A human is then infected when it drinks water containing infected copepods.
 In the human, the juvenile worms migrate from the intestinal tract, through the abdominal cavity, where they
develop into second and then third stage juveniles.
 They then migrate into the deep subcutaneous tissue where they develop into adult nematodes.
 Here the females are fertilized by the males, the males die and the females migrate to the skin to produce juveniles.
 In the human host, complete development of the parasite requires about one year.
 D. Medinensis 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

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, a contact that the patient seeks to relieve the local discomfort, the
female worm emerges and releases larvae 
 D. Medinensis Life Cycle

The larvae are ingested by a copepod

and after two weeks (and two molts) have developed into infective larvae

Ingestion of the copepods closes the cycle

 06
PATHOGENESIS
path·o·gen·e·sis
/ˌpaTHəˈjenəsəs/
 Pathogenesis
The mature female worms migrate to the skin and
provoke the formation of a papule then a blister.

Infections generally produce three types of lesions:

 subcutaneous or deep abscesses
 Skin lesions
 Secondary Bacterial Infection
 07
CLINICAL FEATURES
DRACUNCULUS MEDINENSIS
CLINICAL
FEATURES:
Disease – Dracunculosis

 Intense burning pain localized

to path of travel of worm (the
fiery serpent).
 Fever, Nausea, Vomiting
 Allergic reaction
 Arthritis and paralysis (due to
death of adult worm in joint)
 CLINICAL FEATURES

Clinical features develop

an year after infection
following the migration
of worm to the BLISTER
subcutaneous tissue of ULCERATION
the leg
FORMATION
rupture of blister when release of larvae by
in contact with water adult female worm

 Secondary bacterial infection of ulcer

 CLINICAL FEATURES
• After ingestion of an infected copepod, no specific pathologic changes are
associated with larval penetration into the deep connective tissues and
maturation of the worms.
• Once the gravid female begins to migrate to the skin, there may be some
erythema and tenderness in the area where the blister will form.
• Several hours before blister formation, the patient may exhibit some systemic
reactions, including an urticarial rash, intense pruritus, nausea, vomiting,
diarrhea, or asthmatic attacks.
• The lesion develops as a reddish papule, measuring 2 to 7 cm in diameter.
• Symptoms usually subside when the lesion ruptures, discharging both the larvae
and worm metabolites.
 08
CLINICAL MANIFESTATION
DRACUNCULUS MEDINENSIS
 CLINICAL MANISFESTATION
 Clinical manifestations appear 10-14 months after infection and include
constitutional symptoms (such as low-grade fever, itchy rash, nausea,
vomiting, diarrhea, dizziness) followed by a localized swelling developing
into a painful blister, most often on a lower limb.
 The symptoms are manifested during parturition of the female and are
due to the liberation of a toxic substance causing allergic manifestation
and blister formation.
 Septic infection can occur as a result of contamination by secondary
organisms drawn in by the worm at the time of retraction.
 Blister formation appears wherever the female worms make an attempt to
come to the surface of the body where it can readily discharge its larva.
 CLINICAL MANISFESTATION
 The blister is usually found on the lower extremities of the body
especially between the metatarsal bones, sole of the feet or on the
ankle and less frequently in arms, buttock, scrotum, head, neck and
female breast.
 CLINICAL MANISFESTATION
 Blister formation is accompanied by intense burning pain, ‘fiery
serpent.
 The worm is often visible in the opening of ulcer.
 If the female worms break during the attempts of extractions the larva
remain trapped in the subcutaneous tissue and may give rise to
cellulitis and abscesses.
 In uncomplicated cases, lesions may only last for several weeks until
the worm is completely expelled.
 CLINICAL MANISFESTATION
 On contact with water, the adult female worm (70-100 cm)
bursts through the blister, depositing her larvae in the water
where they are consumed by copepods, starting the cycle
anew.
 Local inflammation and secondary bacterial infection of the
lesion are common, potentially causing cellulitis, abscess
formation, tetanus, sepsis, and septic arthritis.
 CLINICAL MANISFESTATION
 Cellulitis
common, potentially serious
bacterial skin infection. The
affected skin appears swollen
and red and is typically painful
and warm to the touch. Cellulitis
usually affects the skin on the
lower legs, but it can occur in the
face, arms and other areas.
 CLINICAL MANISFESTATION
 Abscess formation
Abscess, a localized collection of
pus in a cavity formed from tissues
that have been broken down by
infectious bacteria. An abscess is
caused when such bacteria as
staphylococci or streptococci gain
access to solid tissue (e.g., by
means of a small wound on the
skin).
 CLINICAL MANISFESTATION
 Tetanus
also called lockjaw, is a serious
infection caused by Clostridium
tetani. This bacterium produces a
toxin that affects the brain and
nervous system, leading to stiffness
in the muscles.
 CLINICAL MANISFESTATION
 Sepsis 
is when your body has an unusually
severe response to an infection. It's
sometimes called septicemia.
During sepsis, your immune system,
which defends you from germs, releases
a lot of chemicals into your blood. This
triggers widespread inflammation that
can lead to organ damage.
 CLINICAL MANISFESTATION
 Septic arthritis
is a painful infection in a joint that can
come from germs that travel through your
bloodstream from another part of your
body. Septic arthritis can also occur when
a penetrating injury, such as an animal
bite or trauma, delivers germs directly
into the joint.
 CLINICAL MANISFESTATION

 If the lesion is near a joint, this may lead to joint contractures

and permanent disability.
 If the worm is not fully removed it can create an intense
inflammatory reaction that further exacerbates the pain,
swelling, and cellulitis.
CLINICAL MANISFESTATION
 However, many cases infection of the
worm track with persistence of the
lesions, chronic ulceration and possible
sequelae, involving disseminated
infection, phlegma of limbs,
contractures of tendons, fibrous
ankylosis or arthritis in the joints, die
prematurely and calcify. The calcified
worms can be trigger arthritis, locked
joints or permanent clipping and
deformations.
 09
LABORATORY DIAGNOSIS
DRACUNCULUS MEDINENSIS
 LABORATORY DIAGNOSIS

 Diagnosis can be confirmed at the time the cutaneous lesion

forms, with subsequent appearance of the adult worm. Infected
lesions must be distinguished from carbuncles, deep cellulitis,
focal myositis or periostitis, and even rheumatism.
 Calcified worms may also be found in subcutaneous tissues by
radiography.
 They may appear as linear densities (up to 25 cm), tightly
coiled structures, or sometimes nodules.
 Depending on the site, they can also be misdiagnosed as
possible breast cancer.
 LABORATORY DIAGNOSIS

 Detection of  Detection of first  Intradermal test:

adult worms: stage larva: Infection
This is possible Specific diagnosis is of Dracunculus antigens
when the female made by the microscopic intradermally causes a
worm appears at demonstration of the first wheal to appear in the
the surface of the stage larva in the course of 24 hours in
skin. discharge fluid. positive cases.
 LABORATORY DIAGNOSIS
 X-ray examination:
Worms in deeper tissue after
the death either become
calcified or absorbed. The
position of calcified worm may
be located by skiagraphy.
 Blood  Intradermal test:
examination Infection
of Dracunculus antigens
intradermally causes a
wheal to appear in the
course of 24 hours in
positive cases.
 LABORATORY DIAGNOSIS
 X-ray examination:
Worms in deeper tissue after
the death either become
calcified or absorbed. The
position of calcified worm may
be located by skiagraphy.
 Blood  Intradermal test:
examination Infection
of Dracunculus antigens
intradermally causes a
wheal to appear in the
course of 24 hours in
positive cases.
 10
TREATMENT
treat·ment
/ˈtrētmənt/
One successful treatment that goes back to
ancient days is slowly winding the protruding
worm on a stick . Because the worm protrudes
only a few centimeters per exposure to water,
this procedure takes, on average, three months
to completely remove the worm. The worm can
also be removed surgically.
 Metronidazole - is
effective in killing
the worm.
HOW CAN GUINEA
WORM DISEASE BE
PREVENTED?
-Drink only water from protected sources
that are free from contamination.
-if this is not possible, always filter drinking
water from unsafe sources using a special
Guinea worm cloth filter or a Guinea worm
pipe filter to remove the copepods (tiny
“water fleas” too small to be clearly seen
without a magnifying glass) that carry the
Guinea worm larvae.
 - Unsafe water sources include stagnant water
ponds, pools in drying riverbeds, and shallow hand-
dug wells without surrounding protective walls.

- cook fish and other aquatic animals (e.g., frogs)

well before eating them. Bury or burn fish entrails
left over from fish processing to prevent dogs
from eating them.
 -Avoid feeding fish entrails to dogs. Avoid
feeding raw or undercooked fish or aquatic
animals to dogs.
-Prevent people with blisters, swellings,
wounds, and visible worms emerging from their
skin from entering ponds and other water
sources.
 -Tether dogs that have blisters, swellings,
wounds, and visible worms emerging from
their skin to prevent the dogs from entering
ponds and other water sources.
PUBLIC HEALTH
& ERACDITION
- Task Force for Child Survival and Global
2000.

3 componets of a successful Guinea worm

eracdition
1. Education
2. Water Purification
3. Disease treatment
 - BASF provided $2million of the
larvae, Abate Jhonson donated
medical supplies like aspirin
forceps and gauze to treat more
3,000 villages and hydro Polymers
save 9million pipes to provide
personal water filters.
 11
EPIDEMIOLOGY
ep·i·de·mi·ol·o·gy
/ˌepəˌdēmēˈäləjē/
 EPIDEMIOLOGY
Four cyclopoid species were found for the first time acting as natural
intermediate hosts of Dracunculus medinensis.

Thermocyclops inopinus was the most frequently infected cyclopoid, and

small man-made ponds are the preferred habitats of this species.

Occurrence of Thermocyclops inopinus is confined to the first half of the

rainy season, coinciding with peak transmission.
 EPIDEMIOLOGY

The epidemiology of dracunculiasis in dry and humid regions of West

Africa is compared with regard to seasonality.

The use of protective water filters proved to be the only adequate method
for guinea worm control in the project area