Arun Jnawali

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Dracunculus
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Dracunculuus medinesis

 It is also known as guinea worm, medina worm, dragon worm.

 Uses copepods as its vector.

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Morphology

 One of the largest nematode known.

 They are milky white in colour.

 They are cylindrical and unsegmented.

 Adult females have been recorded to 1.20 m long.

 Males are shorter and some are known to grow to 40 mm.

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Adult female worm

 Length:0.60-1.20 m.

 Thickness: 1-2 mm

 Anterior end is blunt.

 Posterior end is tapering and bent to form hook.

 Viviparous

 Gravid female discharges embryos in batch of millions at a

time .
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Adult male worm

 Length : 0.01 – 0.04 m

 Diameter : 0.4 mm

 Mostly dies after fertilization.

 Posterior end of male is coiled.

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Larva

 500 -650 um in length

 5- 25 um in diameter

 Broad anterior end.

 Has a slender tapering tail

 Larva set free when the gravid female is exposed to water.

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Host factor

 Man is the definitive host.

 Also infects dogs.

 Multiple and repeated infection may occur to same individual.

 No immunity is developed after prior infections

 Habit of bathing and drinking surface water makes them prone

to infections.

 Infection can occur to people of all age but young adults (15-
45)are mostly infected.
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Host factor

 Copepods specially water flea act as the intermediate host.

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Environmental factors

 Season:
 Infection mostly occur during the months from March to May from
the step wells.
 It is dry during this time.
 Contact between guinea worm and the source of drinking water is
very high.
 During June to September the source of infection is ponds
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Environmental factors

 Temperature:
 Larva develop well between the temperature 25 to 30 deg. C.
 It will not develop below temperature 19 deg. C.
 Thus it is limited to tropical and sub tropical regions.
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Prevalence

 In 1986, there were about 3.5 million GWD cases per year in
parts of Africa, Asia, and the Middle East.

 Today, GWD affects poor communities in remote parts of Africa

that do not have safe water to drink.

 Infection per year have decreased to 22 in 2015, and 16 cases

reported till June 2016.

 Ghana, South Sudan, Chad Republic have most cases of

infection with very few cases in Nigeria, Mali.
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Prevalence

 Infections are mostly seen along the Chari river.

 It has not been easy to eradicate the disease completely due to

increasing number of infection to dogs.

 South Asia has been free of guinea worm disease since last
case was reported in India in 1996.
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Lifecycle
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Lifecycle

 First stage larvae are released by female into the water by the
female worm.

 Female releases millions of first stage larva into water.

 They remain in water for up to 1 weeks until they are ingested

by suitable copepods.

 Inside the copepods they moult twice to form third stage larvae
which is its infective form.
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Lifecycle

 Infection to man takes place when the ingest the contaminated

water consisting of infected copepods.

 The copepod is dissolved by the digestive juices in stomach

releasing the third stage larvae.

 It penetrates the tissue through the duodenum and migrate to

the lower limb growing and developing there.
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Lifecycle

 After three months the male mates and dies.

 Female continues to grow and travel down the muscle planes.

 The female emerges after 10 to 14 months to release millions of

larvae in water to complete its lifecycle.
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Pathogenesis

 It is not lethal to the patient but causes pain and discomfort to

patient.

 Intense burning pain localized to the path of travel of worm.

 It causes :
 Fever

 Nausea

 Vomiting

 Allergic reactions
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Pathogenesis

 Arthritis and paralysis may occur due to death of worm in the

joint.

 It forms skin blisters .

 Blister is reddish purple with vascular centre.

 Skin blister ruptures to form an ulcer.

 Secondary infection can occur to the blister.

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Lab diagnosis

 Detection of adult worm:

 Gravid female appears at the surface of skin

 After death gets calcified and can be detected radiologically.

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Detection of larvae:

 Exposure to water releases large amount of larva.

 It is microscopically examined
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Serology

 Antibody seen in serum by ELISA.

 It can also be demonstrated by fluorecents antibody test

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Skin tests

 Antigen is injected intra dermally to see the allergic reactions.

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Treatment

Removal of worm by:

Twisting it around the stick inch by inch for weeks to months.

Surgical removal

Metronidazole, niridazole are found effective in deworming

programmes .

Antibiotics are given to prevent secondary infection in ulcers.

Analgesics are given to reduce the pain.

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Prevention

 Use of boileed water and filtered water.

 Patients should not be allowed to dip their legs in source of

drinking water.

 Use of insecticides to clean the stagnant water sources.

 Early detection and treatment of patients.

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Thank you.