Infection occurs when the parasitic guinea worm resides within the body. Infection is not apparent until a pregnant female worm prepares to expel embryos. The infection is rarely fatal, but the latter stage is painful. The infection is also referred to as dracunculiasis, and less commonly as dracontiasis.
Description
Before the early 1980s, guinea worms infected 10–15 million people annually in central Africa and parts of Asia. By 1996, worldwide incidence of infection fell to fewer than 153,000 cases per year. Complete eradication of guinea worm infection is a goal of international water safety programs.
To survive, guinea worms require three things: water during the embryo stage, an intermediate host during early maturation, and a human host during adulthood. In bodies of water, such as ponds, guinea worm embryos are eaten by tiny, lobster-like water fleas. Once ingested, the embryos mature into larvae.
Humans become hosts by consuming water containing infected water fleas. Once in the human intestine, larvae burrow into surrounding tissue. After three to four months, the worms mate. Males die soon after, but pregnant females continue to grow. As adults, each threadlike worm can be three feet long and harbor three million embryos. More than one guinea worm can infect a person at the same time.
About eight months later, the female prepares to expel mature embryos by migrating toward the skin surface. Until this point, most people are unaware that they are infected. Extreme pain occurs as the worm emerges from under the skin, often around the infected person's ankle. The pain is temporarily relieved by immersing the area in water, an act that contaminates the water and starts the cycle again.
Causes and symptoms
Dracunculus medinensis, or guinea worm, causes infection. Symptoms are commonly absent until a pregnant worm prepares to expel embryos. By secreting an irritating chemical, the worm causes a blister to form on the skin surface. This chemical also causes nausea, vomiting, dizziness, and diarrhea. The blister is accompanied by a burning, stabbing pain and can form anywhere on the body; but, the usual site is the lower leg or foot. Once the blister breaks, an open sore remains until the worm has expelled all the embryos.
Diagnosis
Guinea worm infection is identified by the symptoms.
Treatment
Most people infected with guinea worm rely on traditional medicine. The worm is extracted by gently and gradually pulling the worm out and winding it around a small strip of wood. Surgical removal is possible, but rarely done in rural areas. Extraction is complemented by herbs and oils to treat the wound site. Such treatment can ease extraction and may help prevent secondary infections.
Modern medicine offers safe surgical removal of the guinea worm, and drug therapy can prevent infection and pain. Using drugs to combat the worms has had mixed results.
Prognosis
If the worm is completely removed, the wound heals in approximately two to four weeks. However, if a worm emerges from a sensitive area, such as the sole of a foot, or if several worms are involved, healing requires more time. Recovery is also complicated if the worm breaks during extraction. Serious secondary infections frequently occur in such situations. There is the risk of permanent disability in some cases, and having one guinea worm infection does not confer immunity against future infections.
Prevention
Guinea worn infection is prevented by disrupting transmission. Wells and other protected water sources are usually safe from being contaminated with worm embryos. In open water sources, poisons may be used to kill water fleas. Otherwise, water must be boiled or filtered.
PERIODICALS
Hunter, John M. "An Introduction to Guinea Worm on the Eve of Its Departure: Dracunculiasis Transmission, Health Effects, Ecology and Control." Social Science and Medicine 43, no. 9 (1996): 1399.
OTHER
World Health Organization. 7 June 1998 <http://www.who.int/home-page/index.en.shtml>.
Julia Barrett
KEY TERMS
Guinea worm embryo—The guinea worm at its earliest life stage prior to or shortly after being expelled from an adult female worm.
Guinea worm larvae—The guinea worm during its middle life stage as it matures within a water flea. The larvae can only grow to adulthood within a human host.
Host—With regard to guinea worm infection, either the water flea or human from which the worm gets nourishment and shelter as it matures.
Secondary infection—An illness—typically caused by bacteria—that follows from a guinea worm infection.
