DracunculosisB72.x0

Author:Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 11.04.2021

Dieser Artikel auf Deutsch

Synonym(s)

Dracontiasis; Dracunculiasis; Dracunculosis; Dracunculus medinenesis; Guinea worm infection; Medina worm; Medina worm infection

Requires free registration (medical professionals only)

Please login to access all articles, images, and functions.

Our content is available exclusively to medical professionals. If you have already registered, please login. If you haven't, you can register for free (medical professionals only).


Requires free registration (medical professionals only)

Please complete your registration to access all articles and images.

To gain access, you must complete your registration. You either haven't confirmed your e-mail address or we still need proof that you are a member of the medical profession.

Finish your registration now

HistoryThis section has been translated automatically.

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

DefinitionThis section has been translated automatically.

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

PathogenThis section has been translated automatically.

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

Occurrence/EpidemiologyThis section has been translated automatically.

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).

EtiopathogenesisThis section has been translated automatically.

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.

LocalizationThis section has been translated automatically.

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.

Clinical featuresThis section has been translated automatically.

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.

External therapyThis section has been translated automatically.

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.

Internal therapyThis section has been translated automatically.

The oral administration of metronidazole 2 times/day 5 mg/kg bw for 10-20 days or 2 times/day 25 mg/kg bw tiabendazole (mintezole) for 3 days facilitates the removal of the worm. Think about tetanus vaccination!

ProphylaxisThis section has been translated automatically.

Boil or filter the drinking water with close-meshed filters.

Note(s)This section has been translated automatically.

Diagnosis and therapy should be reserved for experienced tropical physicians.

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

LiteratureThis section has been translated automatically.

  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

Authors

Last updated on: 11.04.2021