DRACUNCULIASIS

An infestation of the subcutaneous and deeper tissue with the guinea worm. It is a notifiable disease.

Cause

  • Dracunculus medinensis, transmitted to man by drinking water containing cyclops (waterflea or small crustacean) infected with larvae of the guinea worm

Clinical features

  • Adult worm may be felt beneath the skin
  • Local redness, tenderness, and blister (usually on the foot) at the point where the worm comes out of the skin to discharge larvae into the water
  • There may be fever, nausea, vomiting, diarrhoea, dyspnoea, generalised urticaria, and eosinophilia before vesicle formation
  • Complications may include cellulitis, septicaemia, and aseptic or pyogenic arthritis; tetanus may also occur

Differential diagnosis

  • Cellulitis from any other causes
  • Myositis

Investigations

  • Recognition of the adult worm under the skin
  • X-ray may show calcified worms

Management

There is no known drug treatment for guinea worm

All patients:

  • To facilitate removal of the worm, slowly and carefully roll it onto a small stick over a period of days
  • Dress the wound occlusively to prevent the worm passing ova into the water
  • Give analgesics for as long as necessary

If there is ulceration and secondary infection give:

  • Amoxicillin 500 mg every 8 hours for 5 days
    Child: 250 mg every 8 hours for 5 days
  • Or cloxacillin 500 mg every 6 hours for 5 days

Prevention

  • Filter or boil drinking water
  • Infected persons should avoid all contact with sources of drinking water