Generally, patients show a history of travel to endemic areas. Many of them also remember drinking untreated or unfiltered water, eating of vegetables and fresh fruits washed with such water and bathing in water that is potentially contaminated.

Transmission of the disease comes in seasonal variations. In wet areas, most cases occur in the dry season when drinking water is limited and in dry areas, the rainy season sees an upsurge in infection with the increase in availability of surface water.

After physical examination findings indicate the condition, the history of the patient is used to confirm diagnosis.

A blister is formed in the epidermis around the lower extremity by the female worm. Before the formation of the blister, allergic type symptoms like mild respiratory distress, wheezing, urticaria, pruritus, and periorbital edema is present [9]. During this period, some patients may be febrile. The blister becomes erythematous at its periphery as it grows, following the emergence of the head of the worm. Edema occurs around the site of emergence and the burning pain is caused by inflammation of the papule.

The diagnosis is conclusive as soon as the head of the worm is identified within the ulcer.

• Swelling

  It eventually emerges from the body (through the feet in 90% of cases) causing intensely painful edema ( swelling ), a blister and then an ulcer. [medicine.academic.ru]

  If the worm is not fully removed it can create an intense inflammatory reaction that further exacerbates the pain, swelling, and cellulitis. Etiology Dracunculiasis is caused by the parasitic worm Dracunculus medinensis. [orpha.net]

  Upon rupture, the adult worm slowly begins to emerge from the resultant ulcer over several days, accompanied by extreme burning pain, swelling, dizziness and vomiting. [news-medical.net]

  Person may develop fever, swelling, and pain in the area from where worm/ worms come out. In 90% cases site is usually lower legs and feet. [aimu.us]

• Inflammation

  The worm emerges as a whitish filament (duration of emergence: 1 to 3 weeks) in the center of a painful ulcer, accompanied by inflammation and frequently by secondary bacterial infection. [phsource.us]

  Sometimes the worm migrates to an internal organ or surface, resulting in inflammation, compressive symptoms, or abscesses. [dermnetnz.org]

  Last, and not least, we introduce Schistosoma haematobium to dissect the link between inflammation and cancer. [journals.plos.org]

  Local inflammation and secondary bacterial infection of the lesion are common, potentially causing cellulitis, abscess formation, tetanus (see this term), sepsis, and septic arthritis. [orpha.net]

• Asymptomatic

  In the vast majority of cases (one report cites 89%), patients who were found to have calcified guinea worms were asymptomatic. [radiopaedia.org]

  Symptoms and Signs of Dracunculiasis Dracunculiasis is typically asymptomatic for the first year. Symptoms develop when the worm erupts through the skin. Local symptoms include intense itching and a burning pain at the site of the skin lesion. [merckmanuals.com]

  Many infections are asymptomatic. [cdc.gov]

• Sepsis

  Prognosis Dracunculiasis is not life threatening itself but, rarely, death due to secondary sepsis has been reported. [orpha.net]

  […] through subcutaneous tissue causes pain in joints (arthragia) go to ectopic sites produces abscesses -worm eventually will emerge (may die before emerges) becomes encapsulated and dies in tissues humans (where male and female meet and mate) systemic sepsis [quizlet.com]

  The remainder of the 2014 GWD cases were from Chad, Ethiopia, and Mali. [8] Mortality/Morbidity Death due to dracunculiasis is not caused by the primary infection and occurs only in cases in which secondary infection of the worm's exit site leads to sepsis [emedicine.com]

• Constitutional Symptom

  Symptom Clinical description Clinical manifestations appear 10-14 months after infection and include constitutional symptoms (such as low-grade fever, itchy rash, nausea, vomiting, diarrhea, dizziness) followed by a localized swelling developing into [symptoma.com]

  Clinical description Clinical manifestations appear 10-14 months after infection and include constitutional symptoms (such as low-grade fever, itchy rash, nausea, vomiting, diarrhea, dizziness) followed by a localized swelling developing into a painful [orpha.net]

• Nausea

  Perforation of the skin by the guinea worm, which can be 6 feet long, is accompanied by fever and nausea and vomiting. Infected persons may remain sick for some months. [medicine.academic.ru]

  The female worms move through the person’s subcutaneous tissue, causing intense pain, and eventually emerge through the skin, usually at the feet, producing oedema, a blister and eventually an ulcer, accompanied by fever, nausea, and vomiting. [web.archive.org]

  The infected person may also develop fever, nausea, vomiting, and diarrhea. [ehagroup.com]

  Symptoms include pruritus, nausea, vomiting, diarrhea, or asthmatic attacks Applies To Guinea-worm infection Infection by Dracunculus medinensis ICD-9-CM Volume 2 Index entries containing back-references to 125.7 : [icd9data.com]

  Symptoms include pruritus, nausea, vomiting, diarrhea, or asthmatic attacks. [connects.catalyst.harvard.edu]

• Abdominal Pain

  Most infected individuals show few or no signs of infection, but in some, particularly children, there may be malabsorbtion, diarrhea, and abdominal pain. [cmr.asm.org]

  Infection in humans is often asymptomatic, but it can cause abdominal pain, gallstones, and cancer of the biliary tract. Pigs, dogs, cats, and rats are also reservoirs of this parasite. [cdc.gov]

• Arthritis

  It causes a painful, inflamed skin sore and debilitating arthritis. People become infected by drinking water containing tiny crustaceans infected with the roundworm. [msdmanuals.com]

  arthritic (acute) (chronic) (nonpyogenic) (subacute) M19.90 ICD-10-CM Diagnosis Code M19.90 Unspecified osteoarthritis, unspecified site 2016 2017 2018 2019 Billable/Specific Code Applicable To Arthrosis NOS Arthritis NOS Osteoarthritis NOS due to or [icd10data.com]

• Blister

  The female guinea worm induces a painful blister ( A ); after rupture of the blister, the worm emerges as a whitish filament ( B ) in the center of a painful ulcer which is often secondarily infected. [phsource.us]

  A blister is formed in the epidermis around the lower extremity by the female worm. Before the formation of the blister, allergic type symptoms like mild respiratory distress, wheezing, urticaria, pruritus, and periorbital edema is present [9]. [symptoma.com]

  It eventually emerges from the body (through the feet in 90% of cases) causing intensely painful edema ( swelling ), a blister and then an ulcer. [medicine.academic.ru]

  Systemic symptoms including nausea, vomiting, diarrhoea, dizziness, and fever can coincide with blister development, and settle when the blister bursts. There may be an associated very itchy urticarial rash. [dermnetnz.org]

  When the worm is ready to discharge its larvae it will emerge from the skin causing a blister. This blister is often accompanied by burning and itching of the skin in the area of the lesion. [ehagroup.com]

• Skin Lesion

  Symptoms develop when the worm erupts through the skin. Local symptoms include intense itching and a burning pain at the site of the skin lesion. [merckmanuals.com]

  This blister is often accompanied by burning and itching of the skin in the area of the lesion. The infected person may also develop fever, nausea, vomiting, and diarrhea. [ehagroup.com]

  ‡A case of dracunculiasis is defined as disease in a person exhibiting a skin lesion or lesions with emergence of one or more Guinea worms; each person is counted only once in a calendar year. REFERENCES 8 Available. [jamanetwork.com]

• Pruritus

  [merckmanuals.com] Immediately before blister formation, allergy symptoms often occur, eg wheezing, urticaria, periorbital oedema, giddiness and pruritus, associated with fever. [symptoma.com]

  Symptoms include pruritus, nausea, vomiting, diarrhea, or asthmatic attacks Applies To Guinea-worm infection Infection by Dracunculus medinensis ICD-9-CM Volume 2 Index entries containing back-references to 125.7 : [icd9data.com]

  Symptoms include pruritus, nausea, vomiting, diarrhea, or asthmatic attacks. [connects.catalyst.harvard.edu]

  Adult worm migrates through subcutaneous tissues of the leg and erodes through skin, approximately 1 year after infection[1] Symptoms prior to eruption include: rash, intense pruritus, nausea/vomiting, dyspnea, and diarrhea Differential Diagnosis Papules [wikem.org]

  Pruritus and moderate edema may be accompanied by low-grade fever and urticarial rash, caused by an anaphylactic reaction to the products of the worm. [histopathology-india.net]

• Eruptions

  The skin eruption is usually very painful and the patient eases the pain by bathing. The larvae escape into the water to be eaten by water fleas completing their life cycle 3. [radiopaedia.org]

  Adult worm migrates through subcutaneous tissues of the leg and erodes through skin, approximately 1 year after infection[1] Symptoms prior to eruption include: rash, intense pruritus, nausea/vomiting, dyspnea, and diarrhea Differential Diagnosis Papules [wikem.org]

  The blister can be painful and takes up to several days to erupt. [medic8.com]

  Symptoms develop when the worm erupts through the skin. Local symptoms include intense itching and a burning pain at the site of the skin lesion. [merckmanuals.com]

  For untold generations here, yardlong, spaghetti-thin worms erupted from the legs or feet — or even eye sockets — of victims, forcing their way out by exuding acid under the skin until it bubbled and burst. [web.archive.org]

• Papule

  When the mature female Dracunculus medinensis approaches the skin surface, a papule forms usually on the foot or lower leg below the knee. A burning pain precedes the appearance of the papule. [dermnetnz.org]

  The papule eventually ulcerates (breaks open), exposing the female worm and providing a means of escape for the juvenile worms. [web.archive.org]

  A female worm ready to release larvae produces stinging elevated spots (papules), causing redness and itching of the skin. These symptoms may be an allergic reaction to the parasite. [rarediseases.org]

  Adult worm migrates through subcutaneous tissues of the leg and erodes through skin, approximately 1 year after infection[1] Symptoms prior to eruption include: rash, intense pruritus, nausea/vomiting, dyspnea, and diarrhea Differential Diagnosis Papules [wikem.org]

  A small papule appears, which later becomes a vesicle with a small ulceration in the center through which the embryo are liberated. [histopathology-india.net]

• Giddiness

  The initial symptoms, which appear a year after infection, result from the migration of the worm to the skin surface and include itching, giddiness, difficulty in breathing, vomiting, and diarrhoea. [oxfordreference.com]

  [merckmanuals.com] Immediately before blister formation, allergy symptoms often occur, eg wheezing, urticaria, periorbital oedema, giddiness and pruritus, associated with fever. [symptoma.com]

Some of the studies common with dracunculiasis include:

• Serum immunoglobulin levels: Immunoglobulin E (IgE), immunoglobulin G1 (IgG1), and immunoglobulin G4 (IgG4) levels are usually increased. The variability is dependent on the stage of disease.
• CBC count with differential: The WBC count will show elevation even if is slight. The differential common indicator of eosinophilia.
• In rare cases where surgery is considered, a radiologic examination of the lower extremity is important. It helps in identifying calcified worms.

• Tissue Nematode

  Dracontiasis Guinea worm infection Dracunculus medinensis Dracunculiasis or guinea or Medina worm infection is caused by the tissue nematode Dracunculus medinensis. This worm has an indirect life cycle with small copepods as intermediate hosts. [parasite-diagnosis.ch]

  [documents.worldbank.org] Other Pathologies Tissue Nematode Dracontiasis Guinea worm infection Dracunculus medinensis Dracunculiasis or guinea or Medina worm infection is caused by the tissue nematode Dracunculus medinensis. [symptoma.com]

  KAZURA, Tissue Nematodes, Including Trichinellosis, Dracunculiasis, and the Filariases, Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 10.1016/B978-0-443-06839-3.00288-5, (3587-3594), (2010). José Angelo L. [doi.org]

There is no vaccine to prevent dracunculiasis nor is there any medication to treat the disease. However prevention is possible.

Prognosis for this condition is often positive even without treatment. The only danger is when the infection is left untreated.

The disease is caused by drinking water that is contaminated by microscopic arthropods known as copepods. At its peak, the disease was most active in areas that were regarded as some of the poorest in the world which did not have clean water for the inhabitants. Within these areas, stagnant water may still host copepods and these carry larvae of the guinea worm [7].

As at 1986, over 3.5 million individuals spread over 20 countries were infected with guinea worm. By the end of 2004, the entire continent of Asia got rid of the disease [3].

In Australia and North America, there were sporadic cases of the condition predominantly amongst African immigrants from 2000-2005. Many African nations have also reported sporadic cases of the condition since 2006.

Between 2007 and 2008, indigent infections only occurred in specific areas in Niger, Mali, Ghana and Sudan. The disease is endemic in the following countries: Sudan, Mali and Ethiopia. Less than 1,800 cases were reported across the world in 2010 [4].

Today, South Sudan is the major guinea worm disease hotspot. 94% of current cases occur there.

Morbidity/Mortality

Dracunculiasis doesn’t lead to death after primary infection. Death only occurs in instances where secondary infection occurs at the site of the worm’s exit. This often leads to sepsis5. The mortality rate is very low but morbidity remains a major concern in areas where secondary infection is common. Formation of abscess or cellulitis requires immediate attention. The pain from the exit sites of the parasites is often very painful and can leave a patient incapacitated over a few weeks.

The larvae of the parasite develop in Cyclops copepod (water flea). The larvae cause dracunculiasis if the infected Cyclops copepods are not filtered from the water before drinking.

These larvae move to the host's body cavities where the female mates with a male guinea worm. The male dies and is absorbed by the host's body. All of this is completed within 3 months of drinking infected water. The female which contains larvae at this stage, finds its way to the extremities [8].

12 months from the time of drinking the infected water a blister appears in the skin of the host, formed by the female worm. This blister is often seen on the leg or foot and it ruptures within 72 of formation exposing the worm as it emerges.

Dracunculiasis can be transmitted only by drinking contaminated water, so only water free from contamination should be consumed in endemic areas.

Dracunculiasis is a nodular dermatosis that is produced when the Dracunculus parasite develops in the subcutaneous tissue of an individual. It is commonly referred to as the guinea worm disease. Dracunculus medinensis is a parasite which has humans as its only reservoir [1].

The parasite is a very thin and long nematode or roundworm. The parasite enters a host when the individual drinks stagnant water which contains copepods infested with the guinea worm larvae.

One year after the larvae finds a human hosts, the individual begins to feel a painful burning sensation as the female worm forms a blister around the lower limb. Dracunculus medinensis is found in the order Spiruridia which is an order of parasites which include Loa Loa, Brugia Malayi and Wuchereria Bancrofti [2].

Patients and individuals going to endemic areas need to understand that the condition is caused entirely, by drinking contaminated water and this can be prevented by drinking water from sources free from contamination such as boreholes or wells, filtering drinking water with ceramic or sand filters, boiling drinking water and treating water sources with larvicides which kill the copepods [10].

Also, people with emerging guinea worms must be prevented from entering water sources meant for drinking.

1. Centers for Disease Control and Prevention (CDC). Progress toward global eradication of dracunculiasis, January 2005 – May 2007. MMWR Morb. Mortal. Wkly. Rep. 56 (32): 813–7. PMID 17703170.
2. Hopkins D, Richards Jr F, Ruiz-Tiben E, Emerson P, Withers Jr. "Dracunculiasis, onchocerciasis, schistosomiasis, and trachoma". Annals of the New York Academy of Sciences 2008 1136: 45–52. Bibcode:2008NYASA1136...45H.
3. World moves closer to eradicating ancient worm disease". World Health Organization. 2007-03-27.
4. McNeil DG. Dose of Tenacity Wears Down a Horrific Disease. New York Times. 2006.
5. Bimi L, Freeman AR, Eberhard ML, et al. Differentiating Dracunculus medinensis from D. insignis, by the sequence analysis of the 18S rRNA gene. Ann Trop Med Parasitol. Jul 2005;99(5):511-7.
6. Bloch P, Simonsen PE. Immunoepidemiology of Dracunculus medinensis infections I. Antibody responses in relation to infection status. Am J Trop Med Hyg. Dec 1998;59(6):978-84.
7. CDC. Progress toward global eradication of dracunculiasis, January 2004-July 2005. MMWR Morb Mortal Wkly Rep. Oct 28 2005;54(42):1075-7.
8. Greenaway C. Dracunculiasis (guinea worm disease). CMAJ. Feb 17 2004;170(4):495-500.
9. Hopkins DR, Ruiz-Tiben E, Downs P, et al. Dracunculiasis eradication: the final inch. Am J Trop Med Hyg. Oct 2005;73(4):669-75.
10. Hunter JM. An introduction to guinea worm on the eve of its departure: dracunculiasis transmission, health effects, ecology and control. Soc Sci Med. Nov 1996;43(9):1399-425.