An Overview of Guinea Worm Disease

Dracunculiasis, or Guinea worm disease, is an extremely rare neglected tropical disease primarily affecting remote and impoverished communities in parts of Africa. People become infected with the parasitic worm after drinking contaminated water or eating undercooked fish or other aquatic animals. After about a year, the worm breaks through the skin, causing itchy, burning blisters, often on the feet or legs.

The pain caused by the condition can be debilitating, and many are left with lifelong disabilities. Thanks to global efforts to stamp out the disease, however, Guinea worm is now on the brink of eradication.

Symptoms

People infected with Guinea worm don’t typically have any symptoms until about a year after they're first infected. It’s not until the worm is about to erupt from the skin that people start to feel sick. What that happens, the symptoms of Guinea worm disease can include:

• Fever
• Nausea and vomiting
• Diarrhea
• Shortness of breath
• Burning, itching, pain, and swelling where the worm is in your body (often the legs and feet)
• Blister where the worm breaks through the skin

Without proper treatment, wounds caused by the worm can become infected by bacteria, leading to sepsis, septic arthritis, and contractures (when joints lock and deform). In some cases, these infections become life-threatening.

Causes

Guinea worm disease is caused by the parasitic worm Dracunculus medinensis, commonly called Guinea worm. The way the worm gets into the body and makes people sick is fairly complex, and it all starts with water fleas.

These small crustaceans (known as copepods or water fleas) live in stagnant water and eat the Guinea worm larvae. Inside, the larvae go through changes, and after two weeks, they are ready to be infective.

When people drink water that has been contaminated with the copepods, the copepods die and release the larvae into the human digestive tract. There, they make their way through the infected person’s stomach and intestinal walls, eventually reaching subcutaneous tissues (the space just beneath the skin).

The larvae stay in the body for about a year as they mature into adult worms. Female adults can grow to be about 24–39 inches (60–100 centimeters) long. After mating, a worm starts to make its way toward the skin, causing physical discomfort. The itching and burning can become so intense that people rush to submerge the infected part in water to get relief. Every time they do, the female adult worm breaks through the skin to discharge her immature larvae back out into the freshwater, starting the whole cycle again. After about two to three weeks, the female runs out of larvae, and eventually dies and becomes calcified in the body if it's not removed.

The disease is largely seasonal, striking more frequently during the rainy or dry season depending on the area, and is not spread from person to person.

Diagnosis

Guinea worm disease is diagnosed through a simple physical exam. Healthcare providers look for the telltale white, stringy worm poking through the blister once the affected area has been immersed in water.

There are currently no diagnostic tests available to identify those infected before symptoms appear.

Treatment

Like many neglected tropical diseases, there is no cure or specific medication to treat Guinea worm disease. De-worming medications used for other parasitic infections don't appear to work to treat Guinea worm infections or prevent symptoms from occurring. Instead, treatment typically involves removing the worm through a long and painstaking process.

• The infected body part is submerged in water to coax the worm into peeking out of the wound even further.
• The wound and area around it are cleaned to prevent infection.
• Taking great care not to break it, a few centimeters of the worm is wrapped around a stick or piece of gauze. This keeps the worm from going back inside the body and encourages more of it to come out.
• This process is repeated every day for days or weeks until the worm is finally extracted.

Medications like ibuprofen can be given to reduce swelling and relieve pain involved. Antibiotic ointment can also be applied to the affected areas to prevent a bacterial infection.

Prevention

No vaccine exists against Guinea worm, but the disease can be completely prevented by ensuring safe drinking water and not allowing the adult worms to disperse their larvae.

The best way to prevent infection is to drink water only from uncontaminated water sources, like hand-dug wells and boreholes. Many communities affected by Guinea worm disease, however, lack access to clean drinking water. In those instances, any water used for drinking or cooking should be filtered.

The copepods that carry the Guinea worm larvae are too small to be seen without the help of a magnifying glass, but they're big enough to be easily removed from the water using a cloth or pipe filter. Water sources can also be treated using a larvicide that kills the copepods and, as a result, the Guinea worm larvae. To protect drinking water supplies, those with blisters or partially removed worms should steer clear of fresh water drinking sources.

Fish and other aquatic animals coming from potentially contaminated water sources should also be cooked thoroughly before they are eaten. These animals sometimes eat infected copepods. Cooking their meat at a high temperature will kill off the larvae lurking inside. House pets, such as dogs, should never be given uncooked fish entrails or other foods scraps either.

People can become infected with Guinea worm multiple times over the course of their lives. Until Guinea worm is officially eradicated from the planet, communities at risk have to continue to be vigilant to prevent the disease from making a comeback.

Guinea Worm Eradication Programs

Guinea worm disease has been around for thousands of years, but it’s now on the verge of being eradicated. There were just 30 cases of Guinea worm disease in all of 2017—down 99.9 percent from more than 3 million in 1986. While 2018 cases are still preliminary, there were just 11 cases from January 1 through July 31. The disease is currently found in only four countries: Chad, Ethiopia, Mali, and South Sudan.

This steep drop in cases is largely due to efforts spearheaded by the Carter Center and other global partners that began in the 1980s. Since then, public and private agencies throughout the world have launched investigations identifying areas at-risk for the disease, educated families on how to prevent infection, and provided filters and insecticide to protect drinking water sources. These strategies appear to be working, and World Health Organizations plans indicate the disease could be eradicated as early as the year 2020.

One potential holdup is the infection of other animals perpetuating the life cycle of the worm in drinking water sources. Guinea worm affects dogs, for example, much like humans. Dogs take in the infected copepods through contaminated food or water, the larvae grow and mature into adult worms inside the dogs' bodies, and then, ultimately, erupt through the skin to release new larvae into water sources where they can continue to affect humans.

Coping

Guinea worm disease can be excruciating and significantly impact a person's quality of life, but there are things you can do to reduce the pain involved and lower your chances of a permanent disability.

• Remove the worm as quickly and safely as possible. The earlier you are able to remove the worm, the sooner you can start to begin your recovery.
• Keep the affected area clean to prevent infection. Disabilities are often caused due to secondary infections, so it's crucial that you sanitize the wound as best you can.
• Prevent repeat infections. Getting Guinea worm disease once does not make you immune. Protect yourself from becoming infected again by filtering your drinking water supply and/or treating it with larvicide, and cooking fish and other aquatic food thoroughly.
• Keep your community safe. Avoid putting the affected body part into fresh water sources, including ponds or lakes. When possible, talk to your healthcare provider about other ways to manage the swelling and pain, such as using ibuprofen or aspirin.

A Word From Verywell

Guinea worm disease is overwhelmingly a disease of poverty. It disproportionately affects the poorest of the poor who lack access to safe drinking water and adequate medical care, and its debilitating and often lifelong effects keep people from working or going to school—in effect, perpetuating the cycle of poverty.

Eradication efforts have come a long way to reducing the impact of Guinea worm on poor populations, but the fight isn't over yet. Stamping it out for good will take continued and widespread political will from all across the globe, including (and especially) from wealthy nations like the United States.