Dracunculus medinensis

Taxonomy
 Class: Secernentea
 Subclass: Spiruria
 Order: Spirurida
 Superfamily: Drancunculoidea
 Family: Dracunculidae
 Common names- Guinea Worm, Medina
Worm, Serpent Worm, Dragon Worm
 History
Known as a parasite of
humans since about 1530
B.C.

Persian physicians
removing the D.
medinensis parasite from
patient during the 9th
century
 Hosts

•Definitive: Humans
•Intermediate: Copepod
Distribution
•Except for Rajastan desert of
India and Yemen, Guinea worm
disease now occurs only in Africa.

•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.
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.
 Morphology
A: Adult D. medinensis
worms
B: Three mature guinea
worms.

•Note the tiny size of the

mature male (mm)
compared with the mature
female (mf)
 Characteristics
 Only helminthic parasite transmitted solely through
water.
– usually occurs during drought
– everyone is forced to drink from the same stagnant
water supplies or pay for well
 Three conditions for completion of life cycle
– the skin of an infected individual must come in
contact with water
– the water must contain the appropriate species of
crustaceans
– the water must be used for drinking
Life Cycle
Pathology

 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.
Clinical Manifestations
 Clinical disease is a direct result of the adult
female worm which migrates in the
subcutaneous tissue
 individuals may notice a palpable or migrating
worm
 Allergic symptomatology
– urticaria,
– infra-orbital edema
– fever
– dyspnea
Clinical Manifestations……..
 Emergent lesions are primarily located in the lower
extremities (> 90%)
 Also
– upper extremity
– Trunk
– Head
 Errant worms-unusual locations
– epidural space-dura matter
– testicle
– orbit
– eyelid
Adult in joint 
Clinical Manifestations……..
 1-3 cm sized blister- usually painful
 open wound- worm emergence
 inflammatory response to dying worm leads
abscess formation
 Worm emergence near or in a joint(knee or
ankle)-arthritis
 Non emergent worms remain in the tissues
calcification
 Ruptured
Blister Blister
 Clinical Manifestations……..

 common complication- secondary infection

 Infections may be caused by

– skin flora (e.g staphylococci or streptococci)

– enteric organisms (Escherichia coli)

 Chronic skin ulcers of the extremities- ideal

portal of entry for Clostridium tetani
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.
Treatment
 Drug Therapy—Metronidazole
– 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.
 Control
•Filter, boil, or treat water
with chlorine to kill
intermediate host.
–A filter made from a
0.15 mm
•Village-based volunteers
demonstrating the use of
cloth filter on a clay pot to
filter drinking water