Dracunculiasis (guinea worm disease) is caused by the nematode (roundworm) Dracunculus
Humans become infected by drinking unfiltered water containing copepods (small crustaceans) which
are infected with larvae of D. medinensis. Following ingestion, the copepods are killed and release
the larvae, which penetrate the host stomach and intestinal wall and enter the abdominal cavity and
retroperitoneal space. After maturation into adults and copulation, the male worms die and the
females (length: 70 cm to 120 cm) migrate in the subcutaneous tissues towards the skin surface.
Approximately one year after infection, the female worm induces a blister on the skin (generally on
the distal lower extremity), which ruptures. When this lesion comes into contact with water (a
contact that the patient seeks to relieve the local discomfort), the female worm emerges and
releases larvae into the water. The larvae are ingested by a copepod and after two weeks (and two
molts) have developed into infective larvae. Ingestion of the copepods closes the cycle.
An ongoing eradication campaign has dramatically reduced the incidence of dracunculiasis, which is
now restricted to rural, isolated areas in a narrow belt of African countries and Yemen.
The clinical manifestations are localized but very incapacitating. 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. In endemic countries, the annual
incapacitation of a substantial proportion of the population, at a period of intense agricultural
activity, has serious economic consequences.
The female guinea worm induces a painful blister (Cover Photograph); after rupture of the blister, the worm emerges as a whitish filament (Photograph, Top Of Page) in the center of a painful ulcer which is often secondarily infected.
(Images contributed by Global 2000/The Carter Center, Atlanta, Georgia).
The clinical presentation of dracunculiasis is so typical, and well known to the local population, that
it does not need laboratory confirmation. (In addition, the disease occurs in areas where such
confirmation is unlikely to be available.) Examination of the fluid discharged by the worm can show
rhabditiform larvae. No serologic test is available.
Local cleansing of the lesion and local application of antibiotics. Mechanical, progressive extraction
of the worm over a period of several days. No active antihelminthic treatment is available. The
Medical Letter recommends metronidazole, not as a curative drug, but as a drug that decreases
inflammation and facilitates removing the worm.