Dracunculiasis

Background

• Also known as Guinea Worm disease
• Caused by Dracunculus medinensis - infection due to drinking contaminated water
• Generally limited to central Africa
  • Effort underway to eradicate disease in endemic countries

Clinical Features

• Adult worm migrates through subcutaneous tissues of the leg and erodes through skin, approximately 1 year after infection
• Symptoms prior to eruption include: rash, intense pruritus, nausea/vomiting, dyspnea, and diarrhea

Differential Diagnosis

Helminth infections

Cestodes (Tapeworms)

• Taenia saginata
• Taenia solium (Cysticercosis)
• Diphyllobothrium latum
• Hymenolepis nana
• Echinococcus granulosus

Trematodes (Flukes)

• Fasciola hepatica
• Fasciolopsis buski
• Opistorchis viverrini
• Schistosoma spp
  • Schistosomiasis
• Chlonorchis sinensis
• Paragonimus spp.

Nematodes (Roundworms)

• Ascaris lumbricoides
• Enterobius vermicularis (Pinworm)
• Filarial worms
  • Loa Loa
  • Onchocerciasis
  • Lymphatic filariasis (Elephantiasis)
    • Wuchereria bancrofti
    • Brugia malayi
    • Brugia timori
• Hookworm
  • Necator americanus
  • Ancylostoma duodenale
  • Cutaneous larva migrans (Ancylostoma braziliense)
• Dracunculus medinensis
• Strongyloides stercoralis
• Trichuris trichiura (Whipworm)
• Anisakis
• Toxocara spp.
• Trichinosis

Evaluation

• Clinical diagnosis

Management

• Metronidazole 750mg TID x 5-10 days OR thiabendazole 50-75mg/day divided BID x 3 days
• Must also extract adult worm from skin
• Patients with active skin lesions should avoid contact with potable water

Disposition

• Discharge

See Also

• Helminth infections
• Parasitic diseases
• Travel medicine

Authors:

Claire, Michael Holtz, Neil Young, Daniel Ostermayer, Ross Donaldson