There is no medication to treat guinea worm disease or a vaccine to prevent infection. Treatment can only begin when the wound is formed on the skin and the adult worm emerges through it. Treatment involves removing the worm manually by a healthcare professional. When a part of the worm begins to emerge out of the wound, a stick is placed around the wound. The worm is carefully pulled out only a few centimeters each day by winding it around the stick. Pulling out the worm too much and too fast, can cause the worm to break, leaving part of the worm back in the body. Remnants of the worm can cause secondary infections and severe local reactions. Removal of the entire worm can take a few days to several weeks. The procedure is very painful. Painkillers and anti-inflammatory medication may be prescribed. Oral antibiotics and antibiotic ointment may be advised to prevent secondary bacterial infections.
What is Guinea worm?
Dracunculiasis is also called guinea worm disease (GWD). It is an infection caused by a parasite called Dracunculus medinensis (guinea worm). This parasite is an organism that survives by deriving nutrients and feeding off another organism. GWD spreads through drinking contaminated water. It is presently eradicated in most parts of the world. It is still seen in remote parts of Africa and some remote rural areas in the world where there is no access to clean drinking water. GWD is considered endemic in three African countries, Sudan, Ethiopia, and Mali. In recent years, a few cases of GWD in animals, especially dogs, have been reported in developed countries as well. GWD is a serious condition, causing debilitating pain and complications, affecting the quality of life.
How does guinea worm disease occur?
GWD can occur after drinking contaminated water from ponds or other stagnant water containing small water fleas called copepods. These fleas are not visible without using a magnifying glass. The copepods in the water ingest Guinea worm larvae (early stage of the worm when it just comes out of the egg). When people drink contaminated water, they swallow the copepods that have ingested Guinea worm larvae. The disease can also be acquired by consuming raw or undercooked fish and other seafood that have swallowed the infected copepods.
Once the infected copepods have entered the digestive system of humans or animals, the copepods die, and the Guinea worm larvae are released. The larvae enter the stomach and intestinal wall of the host and then move into the tissues of the abdomen where they mate. Over the next 10-14 months, the male worm dies, and the pregnant female worm continues to grow 2-3 feet long and has the width of cooked spaghetti.
Around this time, the adult female worm becomes ready to release the larvae and migrates to just beneath the skin forming a blister on the skin. The blister bursts 24 to 72 hours after formation, forming a wound through which it emerges. Contact of the affected area with water triggers the Guinea worm to release a whitish fluid into the water containing immature larvae. Copepods in the water swallow the larvae and the cycle repeats again.
What are the signs and symptoms of guinea worm disease?
There are usually no signs and symptoms until about a year after the initial infection.
- The first signs are fever, swelling, and blister formation, commonly occurring in the legs or feet that is painful and burns.
- Blisters burst after 24 to 72 hours of formation forming a wound. The adult female Guinea worm emerges through this and is very painful.
- Swelling, warmth, and redness in the affected area.
- Contact of the affected area with water triggers the Guinea worm to release a milky white fluid into the water containing immature larvae.
- A wound caused by the Guinea worm can develop a secondary bacterial infection, presenting with worsening pain, oozing, and pus formation.
- Joint underlying the affected area can get infected, causing pain, restriction of movement, and permanent damage.
- If a worm remains inside the tissue and dies, it can cause serious allergic reactions.
How to prevent guinea worm disease?
The following measures and educating others of them can help control the spread of disease:
- Drinking water only from protected sources, such as boreholes or protected wells or packaged water.
- Filtering water with a warm fabric filter and boiling water before drinking if the source of water is safe or unsafe (ponds and stagnant water).
- Giving pets clean drinking water.
- Avoiding swimming or allowing pets in unsafe water sources.
- Cooking fish and sea animals before eating.
- Avoiding feeding raw seafood to pets.
- Burning, burying, or safely disposing of raw seafood remnants to prevent pets and stray animals from consuming them.
- Human beings and pets need to be treated immediately for blisters and wounds that appear suspicious or if there is a worm emerging from a wound.
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Paniker’s Textbook of Microbiology (8th ed)