As dracunculiasis a parasitosis located on the way back is referred to, which is caused by the Medina- or Guinea worm. The disease manifests itself about a year after the consumption of infected tiny copepods in the form of pigeon-egg-sized ulcers that burst on contact with water. The uterus of the roundworm, which shows itself together with its head end in the ulcer, also bursts and releases thousands of larvae.
What is Dracontiasis?
Dracontiasis is a parasitosis caused by a roundworm called medina or guinea worm. The pathogen needs the generation change between humans or other mammals and a tiny copepod that lives in fresh water. The disease has been greatly reduced in recent years through hygiene measures, especially with regard to the observance of certain hygienic standards when handling drinking water.
Infected copepods contain so-called L3 larvae of the worm, which corresponds to the last larval stage. After consumption by humans or another mammal, the larvae develop into female or male medina worms. Dracontiasis becomes visible about a year after the L3 larvae have been taken in, which have since developed into worms and mated. In the female specimens, thousands of larvae grow in their bodies.
After they have matured, the worms secrete a substance that causes the skin to develop an ulcer the size of a pigeon’s egg, which bursts when it comes into contact with water and releases the larvae into the water. The disease is only visible on the basis of the typical ulcers, in which the uppermost part of the worm can also be seen after it has burst.
Dracontiasis is caused exclusively by the female medina worm (Dracunculus medinensis). The ulcers of dracontiasis with the typical circular shape arise due to a secretion of the female worm, which it excretes at its head end when the larvae in its uterus have reached the stage of maturity. The secretion of the nematode not only ensures the typical shape of the ulcer.
It also ensures that when they come into contact with water, they burst from the center. The worm, whose head end is then visible, releases thousands of its larvae within two to three weeks in several bursts whenever the ulcer comes into contact with water.
Symptoms, ailments & signs
In the early stages, dracontiasis is symptom-free. The first symptoms appear when the ingested larvae have developed into mature worms and the fertilized female nematodes move towards the target tissue. They cause uncomfortable pain on their “wandering” in the connective tissue in the direction of extremities such as the lower legs and feet.
The later formation of ulcers is also associated with pain. The reddish swollen surrounding tissue of the ulcer itches and burns and makes an inflamed impression. It is also very sensitive to pain. The substances the worm releases to make the ulcer can also cause allergic reactions, which can lead to difficulty breathing, itchy rashes, or vomiting.
Diagnosis & course
A definite diagnosis can be made when a typical ulcer has formed and the head of the white nematode is visible after the ulcer has ruptured. This means that about a year may have passed since the infected copepods were ingested. In addition to humans, other mammals can also be used as intermediate hosts.
The copepods larvae initially enter the digestive tract – usually together with the drinking water. They are able to penetrate the intestinal mucosa and into connective tissue. Here they grow into small male and longer female nematodes and mate. After mating, the male worm dies and is encapsulated by the surrounding tissue.
The female worm continues to grow and gradually migrate into the subcutaneous connective tissue of the extremities, preferably in the lower legs and feet. The female medina worm can grow to be over a meter in length and, after larvae mature in its uterus near its head, it causes its host’s skin to develop an ulcer which, on contact with water, will burst, revealing the top of the worm leaves.
In the visible upper part of the worm is the uterus with thousands of larvae in the first larval stage (L1). They are excreted in batches and released into the water. If left untreated, the female nematode dies after the larval birth has ended. The ulcers recede unless one of the common secondary infections has formed there.
As a rule, there are no complications or symptoms with dracontiasis in the first few months after infection. The patient is usually not aware that he is sick. The pain occurs when the larvae mature and move around in the tissue.
The patient suffers from pain, which mainly occurs in the extremities. In many cases, there is also itching and burning and a severe rash on the skin. It is not uncommon for patients to suffer from permanent vomiting, which can greatly reduce their quality of life. Treatment is usually done by removing the worm from the tissue. Usually the worm is removed a few inches a day, so treatment can last a few months.
During this time, the patient suffers from the symptoms described. Alternatively, surgery can also be carried out. Life expectancy is not affected by dracontiasis. However, dracontiasis can occur again in the life of the person affected. After the successful treatment, there are no further complaints or complications.
When should you go to the doctor?
No drug treatment is available for infection with the medina worm. Since the parasite dies even if left untreated after the larvae have been released and the skin ulcers caused by the worm usually heal, there is usually no medical treatment of those affected in the risk areas.
For Europeans, however, this is not an option. Since the worm reproduces very aggressively and there is a risk of infection for third parties, a doctor should be consulted immediately if dracontiasis is suspected. The symptoms of the disease do not show up immediately, however, but usually only around a year after contamination.
After mating, the female roundworms then migrate through the connective tissue and cause pain, especially in the lower legs and feet, for which no cause can be identified. Anyone who has been in a risk area should see a doctor immediately if they notice such symptoms.
The next step is the formation of ulcers, which can reach the size of pigeon eggs and are filled with thousands of larvae. Now at the latest, those affected should consult a specialist, preferably a doctor for tropical medicine. If left untreated, not only is there a significant risk of contagion to the community, but the ulcers caused by the worm can become infected, which can lead to secondary infections.
Treatment & Therapy
There is no known direct drug therapy to combat the parasitic medina worm. A method that has been used since ancient times to carefully remove worms is still widely practiced today. After the upper part of the worm shows up inside the ulcer, the upper end is wrapped on a thin wooden stick – such as a matchstick – without tearing it off.
The method requires some practice, skill and patience, because it can only be mastered about ten centimeters per day in this way. This means that the wrapping method can drag on for two or more weeks. As an alternative to the wrapping method, there is also the option of surgical removal of the worms.
However, not all endemic areas have the necessary technical prerequisites, and for many of those affected the costs of an operation are beyond their financial means. Even after an infection has been overcome, no immune protection is built up, so that a new infection can occur at any time.
Outlook & forecast
The prognosis for dracontiasis is favorable in most cases. About 50 percent of all sick people heal without consequences after the medina worm has left the body. However, the worm creates itchy and painful blisters that act as a gateway for bacteria to enter.
Various bacterial infections are possible, which can lead to the defect healing later. In some cases, tendons and joints that are near such a blister are damaged. This damage is caused by joint inflammation and persistent abscesses in the affected areas. As a result, the joints can stiffen.
Furthermore, an infection with the media worm does not guarantee that new infections will no longer occur. The person concerned can become infected again and again with the roundworm Dracunculus medinensis because immunity against the worm is not built up. In the endangered areas, for example, there are constant new infections during drought if the population is dependent on unfiltered water from water accumulations with an unsafe drinking water supply.
In contrast to most of the population, the disease in newborns is usually fatal. In surviving infants, it leads to very serious health problems. Although the disease often heals without consequences in adulthood, serious consequential damage can also occur here in some cases. This is especially true if meningoencephalitis occurs as a complication of the infection.
The best and most effective preventive measure consists in observing simple hygiene measures when handling drinking water in the few remaining endemic areas. For example, it is sufficient to filter the drinking water through a cheesecloth or to boil it.
In the case of dracontiasis, the follow-up measures are very limited in most cases. The patients are dependent on a comprehensive examination and subsequent treatment so that there are no further complications and complaints. The focus of this disease is therefore on the early detection and investigation of the disease so that the symptoms do not worsen further.
In most cases, dracontiasis can be treated relatively easily, and surgery is not always necessary. After removal, the wound should be cleaned permanently to prevent re-infection. In the event of a surgical procedure, it is advisable for those affected to rest after the procedure and not expose themselves to strenuous or physical activities.
As a rule, the affected person can get sick again even after the dracontiasis has healed, so that the trigger of this disease should be avoided in any case so that there is no renewed infection. With early detection and rapid treatment of the disease, there is also no reduction in the life expectancy of the patient. No further follow-up measures for dracontiasis are then necessary.
You can do that yourself
If dracontiasis is detected, the most important measure is to remove the worm quickly. With less aggressive worms, those affected can remove the parasites themselves. To do this, the visible end of the worm is wrapped on a wooden stick without tearing the worm off.
This process must be repeated daily until all of the worm has been pulled out of the body. The parasite can then be disposed of and the procedure repeated on other ulcers. It usually takes a few days to weeks for a medina worm to be completely removed. It is therefore advisable to have the treatment supervised by a doctor.
If you experience severe pain or itching, some naturopathic remedies can be used. Preparations with arnica or devil’s claw have proven effective, but homeopathic remedies such as belladonna can also be used.
If the worm does not resolve itself, a doctor should be consulted. The parasite must then be surgically removed. For the patient, the procedure is usually not very stressful. The wound should be healed after one to two weeks. Due to the increased risk of re-infection, regular preventive medical examinations are then indicated.