Dracunculiasis: Guinea Worm Disease

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Dracunculiasis

Disease caused by Dracunculus medinensis

History:

Documented since antiquity

--“fiery serpent” mentioned in Old Testament

--Calcified worm found in Egyptian mummies

Picture: Egyptian Mummy Source

--Sanskrit verses allude to the worm (14^th century BC)

--Called “dracontiasis” during the Graeco-Roman period

--Arab-Persian physicians described in 9^th century AD

 A little more recently…

1624-1677: Persian physicians remove worm from patients’ legs

Through 18^th century: varying opinions on the nature of the condition (nerve vs. dead tissue)

1870: Role of intermediate host in life cycle determined by Alesaj Pavlovich Fedchenko

End of 19^th century: Scientific community aware of how it was transmitted; protective measures taken

1905: Life cycle also demonstrated by Robert Thomas Leiper

1913: Life cycle documented yet again by Dyneshvar Atmaran Turkhud

1926-1931: Eradicated in Uzbekistan

1972: Eradicated in Iran

1984-1991: Eradication in India

1986-present: Cooperation of Carter Center, WHO, CDC, and UNICEF

Symptoms of Infection

--No symptoms for up to one year

Symptoms preceding emergence of worm:

--Chills/fever and vomiting

--Swelling

--During emergence of worm

--Burning sensation

--Secondary bacterial infections

--Locked joints

Treatment     

Picture: Emerging worm being wrapped around a stick Source

Wind the worm around a small stick -- a few centimeters (of up to 100) a day.  That can take weeks to months but…anaphylaxis is likely if the worm breaks.

--No medication to end/prevent infection

--Analgesics for pain/swelling

--Antibiotic ointment to prevent secondary infections

--Surgical removal is possible before ulcer formation

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Who is most affected?

Rural communities in sub-Saharan Africa 

Map: Countries in sub-Saharan Africa Source

--Limited access to medical care

--Secondary bacterial infections common

--Incapacitated for several months

--Can lead to permanent crippling

--Usually emerges during planting or harvesting season

--Huge negative impact on the local economies

Impacts of Infection

--Heavy crop losses

--Parents unable to care for children

--Children unable to attend school

--Financial problems

--Resultant economic and social burden on affected communities

*For example, $20 million lost in one year by rice farmers in Nigeria

Problems still faced…local resistance to treatment   

Picture: A sacred pond Source

2001: Jacob Ogebe (field officer for Carter Center) was trying to treat all ponds in the village of Ogi with Abate.  The villagers lied about on of the ponds because it was sacred to them.  His life was threatened, but he offered payment to those that would secretly treat the pond.  In another instance, a dog was killed and put in pond so the villagers would consider it unclean.  The villagers did not drink the water anymore, and the Guinea worm cases went down.

Prevention          

--Education about transmission

--Drink only water from underground sources

--Prevent people with open ulcers from entering potential drinking water

--Filter drinking water (removes disease vector)                         

Picture: Filtering water through cloth Source

--Carter Center donation: $30 = 100 portable filters

--Treat unsafe sources with larvicides such as Abate ® 
 

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