Arun Jnawali
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Dracunculus
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Dracunculuus medinesis
It is also known as guinea worm, medina worm, dragon worm.
Uses copepods as its vector.
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Morphology
One of the largest nematode known.
They are milky white in colour.
They are cylindrical and unsegmented.
Adult females have been recorded to 1.20 m long.
Males are shorter and some are known to grow to 40 mm.
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Adult female worm
Length:0.60-1.20 m.
Thickness: 1-2 mm
Anterior end is blunt.
Posterior end is tapering and bent to form hook.
Viviparous
Gravid female discharges embryos in batch of millions at a
time .
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Adult male worm
Length : 0.01 – 0.04 m
Diameter : 0.4 mm
Mostly dies after fertilization.
Posterior end of male is coiled.
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Larva
500 -650 um in length
5- 25 um in diameter
Broad anterior end.
Has a slender tapering tail
Larva set free when the gravid female is exposed to water.
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Host factor
Man is the definitive host.
Also infects dogs.
Multiple and repeated infection may occur to same individual.
No immunity is developed after prior infections
Habit of bathing and drinking surface water makes them prone
to infections.
Infection can occur to people of all age but young adults (15-
45)are mostly infected.
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Host factor
Copepods specially water flea act as the intermediate host.
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Environmental factors
Season:
Infection mostly occur during the months from March to May from
the step wells.
It is dry during this time.
Contact between guinea worm and the source of drinking water is
very high.
During June to September the source of infection is ponds
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Environmental factors
Temperature:
Larva develop well between the temperature 25 to 30 deg. C.
It will not develop below temperature 19 deg. C.
Thus it is limited to tropical and sub tropical regions.
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Prevalence
In 1986, there were about 3.5 million GWD cases per year in
parts of Africa, Asia, and the Middle East.
Today, GWD affects poor communities in remote parts of Africa
that do not have safe water to drink.
Infection per year have decreased to 22 in 2015, and 16 cases
reported till June 2016.
Ghana, South Sudan, Chad Republic have most cases of
infection with very few cases in Nigeria, Mali.
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Prevalence
Infections are mostly seen along the Chari river.
It has not been easy to eradicate the disease completely due to
increasing number of infection to dogs.
South Asia has been free of guinea worm disease since last
case was reported in India in 1996.
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Lifecycle
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Lifecycle
First stage larvae are released by female into the water by the
female worm.
Female releases millions of first stage larva into water.
They remain in water for up to 1 weeks until they are ingested
by suitable copepods.
Inside the copepods they moult twice to form third stage larvae
which is its infective form.
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Lifecycle
Infection to man takes place when the ingest the contaminated
water consisting of infected copepods.
The copepod is dissolved by the digestive juices in stomach
releasing the third stage larvae.
It penetrates the tissue through the duodenum and migrate to
the lower limb growing and developing there.
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Lifecycle
After three months the male mates and dies.
Female continues to grow and travel down the muscle planes.
The female emerges after 10 to 14 months to release millions of
larvae in water to complete its lifecycle.
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Pathogenesis
It is not lethal to the patient but causes pain and discomfort to
patient.
Intense burning pain localized to the path of travel of worm.
It causes :
Fever
Nausea
Vomiting
Allergic reactions
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Pathogenesis
Arthritis and paralysis may occur due to death of worm in the
joint.
It forms skin blisters .
Blister is reddish purple with vascular centre.
Skin blister ruptures to form an ulcer.
Secondary infection can occur to the blister.
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Lab diagnosis
Detection of adult worm:
Gravid female appears at the surface of skin
After death gets calcified and can be detected radiologically.
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Detection of larvae:
Exposure to water releases large amount of larva.
It is microscopically examined
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Serology
Antibody seen in serum by ELISA.
It can also be demonstrated by fluorecents antibody test
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Skin tests
Antigen is injected intra dermally to see the allergic reactions.
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Treatment
Removal of worm by:
Twisting it around the stick inch by inch for weeks to months.
Surgical removal
Metronidazole, niridazole are found effective in deworming
programmes .
Antibiotics are given to prevent secondary infection in ulcers.
Analgesics are given to reduce the pain.
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Prevention
Use of boileed water and filtered water.
Patients should not be allowed to dip their legs in source of
drinking water.
Use of insecticides to clean the stagnant water sources.
Early detection and treatment of patients.
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Thank you.
