DracunculosisB72.x0

Velschius, 1674; Rudolphi, 1819; Forbes, 1838; Bastian, 1863;

Nematode infection with the medina worm, which has been known for centuries and belongs to the filarioses.

Dracunculus medinensis, Medina worm, Guinea worm. The male reaches a length of 3-4 cm, the female up to 1 m.

Today, only a few hundred patients are infected worldwide (incidence still decreasing due to an eradication programme of the WHO; the goal of the WHO to completely eradicate intestinal carcinosis seems realistic in the near future).

Occurs preferentially in dry tropical areas. Endemic in Africa (former distribution: especially Sudan, Mali, Ghana), Arabia, Iran, Iraq, Turkey, Afghanistan, India, Myanmar, Russia, Caribbean Islands, South America. Today only cases in South Sudan).

The host of the larvae is the copepod Cyclops.

Transmission of the larvae of the medina worm via unboiled drinking water. They enter the human organism by swallowing the approximately 4mm large crawfish when drinking water is ingested. Spreading of the larvae in the human stomach, penetration of the stomach wall by the females (males die), settlement in the subcutis of the lower extremity and maturation to adult forms. The mature worm reaches a length of up to 100 cm in tissue. 10-14 months after infection, the pregnant female breaks through the skin on contact with water and repels its larvae, causing the end of the worm to rupture. At this point a local inflammation and blistering occurs, later on an ulcer develops.

The process is repeated with renewed contact with water until all larvae are repelled. The worm then dies and can be pulled out of the skin.

In > 90%, feet and lower legs are mainly affected. Mostly infested by 1 worm only, more rarely by 2; maximum up to 50. Unusual localizations are scrotum or eye.

Incubation period 8-12 months. Allergic phenomena with fever, urticaria, nausea, diarrhoea, dyspnoea, eosinophilia, arthritis, sterile abscesses.

Skin lesions: 2-3 cm large, pemphigoid, itchy blisters. After tearing of the blister cover, development of flat ulcerations and oedema of the surrounding area. Chronic ulceration, cysts and calcifications.

Contrast agent imaging to localize the worm, followed by surgical removal of the worm through several incisions. Local application of 5-10% Tiabendazole ointment(e.g. Tiabendazole 10%-Betamethasone 0.1% cream (O/W)facilitates removal.

In some tropical regions the worm, which is sometimes > 1 m long, is slowly wound up from the skin surface with a match over several days up to 2 weeks. If the procedure is too fast, there is a risk of rupture, the remaining worm is then no longer accessible from the outside. If a residue remains, it must be surgically removed. This procedure often leads to secondary infections, which make systemic antibiotics after an antibiogram necessary.

Diagnosis and therapy should be reserved for experienced tropical physicians.

Due to a successful eradication program, darunculosis has been almost completely eradicated today.

1. Cairncross S et al (2002) Dracunculiasis (Guinea worm disease) and the eradication initiative. Clin Microbiol Rev 15: 223-246
2. Centers for Disease Control and Prevention (CDC) (2003) Progress toward global eradication of dracunculiasis, January-June 2003. MMWR Morb Mortal Wkly Rep 52: 881-883.
3. Forbes D (1838) Extracts from the half yearly reports of the diseases prevailing at Dharwar in the 1st Grenadier Regiment, N.I. for the year 1836. Trans Med Phys Soc Bombay 1: 215-225.

4. Rawla P et al (202q) Dracunculiasis. 2020 Jun 2. In: StatPearls. Treasure Island (FL): StatPearls Publishing PMID: 30855819.

5. Rudolphi CA (1819) Entozoorum Synopsis cui accedunt mantissima duplex et indices locupletissima. Sumptibus Augusti Rücker, Berlin

6. Velschius GH (1674) Exercitationes de vena medinensis et de vermiculis capillaribus infantium. Auguste Vindel, Augsburg