DracunculiasisDracunculiasis
TerryTerry LL DwelleDwelle MDMD MPHTMMPHTM ClassificationClassification ofof NematodesNematodes
Subclass Order Superfamily Genus and Probable (suborder) Species prevalence in man Secernentea Spirurida Dracunculoidea Dracunculus 10 million (Camallanina) medianesis GeneralGeneral
►►EtiologyEtiology -- DracunculaDracuncula medianensismedianensis causingcausing GuineaGuinea WormWorm InfectionInfection ►►GeographicGeographic distributiondistribution –– AfricaAfrica (12(12 countriescountries West,West, CentralCentral andand EastEast AfricaAfrica ►►32,00032,000 casescases withwith 63%63% inin SudanSudan (2003)(2003) GeneralGeneral RecognitionRecognition FeaturesFeatures
►►SizeSize –– FemaleFemale 6060--120120 cm,cm, malemale 1.21.2--2.92.9 cmcm ►►LarvaeLarvae –– 500500--750750 umum longlong LifeLife CycleCycle
►►DefinitiveDefinitive hosthost –– manman ►►WhereWhere thethe adultsadults livelive inin thethe bodybody –– deepdeep connectiveconnective tissuestissues ►►StageStage leavingleaving thethe bodybody –– L1L1 larvaelarvae fromfrom anan adultadult wormworm inin aa skinskin lesionlesion ►►IntermediateIntermediate hosthost –– CyclopsCyclops (copepod)(copepod) smallsmall crustaceoncrustaceon ►►InfectiousInfectious stagestage forfor thethe definitivedefinitive hosthost –– ingestioningestion ofof anan infectedinfected cyclopscyclops
LifeLife CycleCycle
Ingestion of an infected Cyclops
Deep connective tissues Migrate for about 1 year Cyclops L3 larvae in 10d – 2w
Gravid female moves to skin
Discharges larvae through cutaneous ulcer (into water) LifeLife CycleCycle
►►PrepatentPrepatent periodperiod –– 1212 monthsmonths A Colour Atlas of Tropical Medicine From A Color Atlas of Tropical Medicine and Parasitology,and Parasitology, 2nd 2edition,nd Edition, Year From A Color Atlas of Tropical Medicine and Parasitology, 2nd From A Color Atlas of TropicalBook Medicine Medical Publishers,and Parasitology, 1981, pp2nd edition,Peters Peters and and Gilles, Gilles, Year Book Year Medical Book Publishers, Medical 1981 Publishers,edition, Peters and Gilles,1981 Year257 Book Medical Publishers, 1981 DiseaseDisease CharacteristicsCharacteristics
► Generally no symptoms in the prepatent period ► Prodrome stage – few hours prior to skin lesions an erythematous urticarial rash is seen with pruritus, nausea, diarrhea, dyspnea, syncope, giddiness ► Skin lesion – red papule, vesicle with indurated margin (1.5-2.0 cm) mainly on feet and ankles. With rupture some of the symptoms abate but may recur with removal of the worm. ► Sterile abscess – if the worm fails to reach the skin surface and dies
► Secondary infection is common ► When close to joints may cause a debilitating arthritis ► Can rarely migrate to critical organs
From A Color Atlas of Tropical Medicine and Parasitology, 2nd edition, Peters and Gilles, Year Book Medical Publishers, 1981
From A Color Atlas of Tropical From A Color Atlas of Tropical Medicine and Medicine and Parasitology, 2nd Parasitology, 2nd edition, Peters and Gilles, Year Book edition, Peters and Gilles, Year Book Medical Publishers, 1981 Medical Publishers, 1981 DiagnosisDiagnosis
►►ClinicalClinical suspicionsuspicion –– prodromeprodrome followedfollowed byby thethe classicclassic skinskin lesion.lesion. TreatmentTreatment
► SlowSlow extractionextraction ofof thethe wormworm combinedcombined withwith woundwound carecare ► MetronidazoleMetronidazole Adults – 250 mg tid X 10 days Children – 25 mg / kg / day (maximum 750 mg) divided into 3 doses X 10 days Not curative but decreases inflammation and facilitates worm removal Metronidazole 400-800 mg / day for 6 days has been reported to kill the worm directly
The Medical Letter, August 2004, Drugs for Parasitic Infections, pp 1-12
MetronidazoleMetronidazole AdverseAdverse ReactionsReactions
► Avoid – 1st trimester ► Use with caution CNS disease, blood dycrasias, severe liver or renal disease (GFR < 10 mL/min)
► Adverse reactions – nausea, diarrhea, urticaria, dry mouth, leukopenia, vertigo, metallic taste, peripheral neuropathy
► May worsen candidiasis ► May cause disulfirim type reaction with alcohol consumption within 24-48 hours after dose given
► May increase levels of toxicity of phenytoin, lithium, and warfarin.
► Phenobarbital and rifampin may decrease metronidazole metabolism
ControlControl MeasuresMeasures
►►ProtectedProtected wellswells andand waterwater suppliessupplies ►►TemphosTemphos (Abate)(Abate) treatmenttreatment ofof waterwater suppliessupplies ►►AppropriateAppropriate treatmenttreatment ofof infectedinfected individualsindividuals ►►BoilingBoiling oror filteringfiltering ((egeg nylonnylon filter)filter) ofof potentiallypotentially infectedinfected waterwater