Dracunculiasis
1041031
225954434
2008-07-16T04:53:49Z
74.224.119.195
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{{Infobox_Disease
| Name = {{PAGENAME}}
| Image =
| Caption =
| DiseasesDB = 3945
| ICD10 = {{ICD10|B|72||b|65}}
| ICD9 = {{ICD9|125.7}}
| ICDO =
| OMIM =
| MedlinePlus =
| eMedicineSubj = ped
| eMedicineTopic = 616
| MeshID = D004320
}}
'''Dracunculiasis''', more commonly known as '''Guinea worm disease''' ('''GWD''') or '''Medina Worm''', is a [[parasitism|parasitic]] [[infection]] caused by the [[nematode]], ''[[Dracunculus]] medinensis''. The name, dracunculiasis, is derived from the [[Latin language|Latin]] "affliction with little dragons."<ref name="Barry">{{Citation | last= Barry| first= Michele | title=The Tail End of Guinea Worm — Global Eradication without a Drug or a Vaccine | journal=New England Journal of Medicine | volume=356| issue=25| pages=2561-2564| date=[[2007-06-21]]|
url=http://content.nejm.org/cgi/content/full/356/25/2561 |accessdate=2008-07-15}}</ref> The painful, burning sensation experienced by the infected patient has led to the disease being called “the fiery serpent.” Once prevalent in 20 nations in [[Asia]] and [[Africa]], the disease remains [[endemic (epidemiology)|endemic]] in only five countries in [[Sub-Saharan Africa]]. Guinea worm disease will be the first [[parasitic disease]] to be [[disease eradication|eradicated]] and the first disease in history eradicated through behavior change, without the use of [[vaccine]]s or [[medication|medicines]].<ref name="GWEP">{{Citation | author=The Carter Center| title=Guinea Worm Eradication Program | work= The Carter Center | url=http://www.cartercenter.org/health/guinea_worm/index.html | accessdate=2008-07-15}}</ref> Guinea worm disease is contracted when a person drinks stagnant water contaminated with the [[larvae]] of the Dracunculus worm.
==Life cycle==
[[Image:Drac life cycle.gif|thumb|right|400px|The life cycle of ''Dracunculus medinensis''.]]
Guinea worm disease thrives in the world’s poorest areas, particularly those with limited or no access to clean water.<ref name="CDC">{{Citation | author=U.S. Centers for Disease Control and Prevention | title=Dracunculiasis |
url=http://www.cdc.gov/ncidod/dpd/parasites/dracunculiasis/factsht_dracunculiasis.htm#treatment| accessdate=2008-07-15}}</ref> In these areas, stagnant water sources may host microscopic, fresh-water [[arthropods]] known as [[copepods]] ("[[water flea]]s"), which carry the larvae of the Dracunculus worm.
Inside the copepods, the larvae develop for approximately two weeks.<ref name="TropMed">{{Citation | author=Uniformed Services University of the Health Sciences | title=Dracunculiasis | work=Tropical Medicine Central Resource|
url=http://tmcr.usuhs.mil/tmcr/chapter27/intro.htm| accessdate=2008-07-15}}</ref> At this stage, the larvae can cause Guinea worm disease if it is not filtered from drinking water.<ref name="TropMed"/> The male Guinea worm is typically much smaller (1.2–2.9 centimeters, 0.5-1.1 inches long) than the female, which, as an adult, can grow between 2 and 3 feet long and be as thick as a spaghetti noodle.<ref name="TropMed"/><ref name="CDC"/>
Once inside the body, [[stomach acid]] [[digestion|digests]] the water flea, but not the Guinea worm larvae sheltered inside.<ref name="TropMed"/> These larvae find their way to the body cavity, where the female mates with a male Guinea worm.<ref name="TropMed"/> This takes place approximately 3 months after infection.<ref name="TropMed"/> It is unclear what happens to the male worm after mating; some scientists believe it dies and is absorbed into the female.<ref name="TropMed"/>
The female, which now contains larvae, borrows into the deeper [[connective tissue]]s or adjacent to [[long bone]]s or joints of the extremities.<ref name="TropMed"/>
Approximately one year later, the worm attempts to leave the body by creating a [[blister]] in the human host’s [[skin]]—usually on a person’s lower extremities like a [[leg]] or [[foot]].<ref name="MMWR">{{Citation | author=U.S. Centers for Disease Control and Prevention | title=Progress Toward Global Eradication of Dracunculiasis January 2005—May 2007 | journal=Mortality and Morbidity Weekly Report| volume= 56| issue=32| pages=813-817| date= 2007-08-15| url=http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5632a1.htm| accessdate=2008-07-15}}</ref>
This blister causes a very painful burning sensation as the worm emerges. Within 24 to 72 hours, the blister will rupture, exposing one end of the emergent worm.
To relieve this burning sensation, infected persons often immerse the affected limb in water. Once the blister or open sore is submerged in water, the adult female releases hundreds of thousands of Guinea worm larvae, contaminating the water supply.
During the next several days, the female worm is capable of releasing more larvae whenever it comes in contact with water. These larvae contaminate the water supply and are eaten by [[copepods]], thereby repeating the lifecycle of the disease. Infection does not create immunity, so people can repeatedly experience Guinea worm disease throughout their lifetime.<ref name="CDC"/>
Cases of the disease typically emerge during the rainy seasons, which for many agricultural communities is also the planting or harvesting season. Guinea worm disease outbreaks can cause serious disruption to local food supplies and school attendance (see Social and economic impact section).<ref name="CDC"/>
==Prevention==
[[Image:Guinea worm prevention.jpg|thumb|right|Sudanese boys using pipe filters to prevent Guinea worm disease.]]
Guinea worm disease can only be transmitted from drinking contaminated water. Educating people to follow simple control measures can completely prevent [[illness]] and eliminate [[transmission (medicine)|transmission]] of the disease, leading to the disease’s eradication:
:*Drink only water from underground sources free from contamination, such as a [[borehole]] or hand-dug [[water well|well]]s.
:*Prevent persons with an open Guinea worm ulcer from entering ponds and wells used for drinking water.
:*Always [[water filter|filter]] drinking water, using a fine-mesh [[cloth filter]] like nylon, to remove the Guinea worm-containing water fleas.
:*Water sources can be treated with an approved [[larvicide]] such as [[temefos|ABATE]]®, that kills water fleas, without posing a great risk to humans or other wildlife.<ref name="ABATE">{{Citation | author=BASF| title=Public Health: Products in Action, ABATE®|url=http://www.basfpublichealth.com/products/abate.html| accessdate=2008-07-15}}</ref>
:*Communities can be provided with new safe sources of drinking water, or have existing dysfunctional ones repaired.
==Treatment==
[[Image:Rod of asclepius.png|thumb|300px|The ancient symbol of medicine, the Rod of Asclepius, is believed to also represent the treatment of Guinea worm still used today.]]
There is no vaccine or medicine to treat or prevent Guinea worm disease. Once a Guinea worm emerges, a person must wrap the live worm around a piece of gauze or a stick extracting it from the body in a long, painful process that can take up to a month.<ref name="GWEP"/> This is the same treatment that is noted in the famous ancient Egyptian medical text, the [[Ebers papyrus]] from [[1550 BC|1550 B.C.]].<ref name="TropMed"/> Some people have said that extracting a Guinea worm feels like they are being stabbed or that the afflicted area is on fire.<ref name="WHO">{{Citation | author=World Health Organization| title=World moves closer to eradicating ancient worm disease|date=2007-03-27|url=http://www.who.int/mediacentre/news/notes/2007/np15/en/index.html|accessdate=2008-07-15}}</ref><ref name="NYT">{{Citation | author last=McNeil|author first=Donald| title=Dose of Tenacity Wears Down a Horrific Disease|journal=New York Times|date=2006-03-26|url=http://www.nytimes.com/2006/03/26/international/africa/26worm.html|accessdate=2008-07-15}}</ref>
Although Guinea worm disease, itself, is not fatal, the wound where the worm emerges could develop a secondary, [[bacterial infection]], which may be life-threatening—a concern in endemic areas where there is typically limited or no access to health care.<ref name="ITFDE">{{Citation | author=US Centers for Disease Control and Prevention|title=Recommendations of the International Task Force for Disease Eradication|journal=Mortality and Morbidity Weekly Report|volume=42|issue=RR16|pages=1-25|date=1993-12-31|url=http://www.cdc.gov/mmwr/preview/mmwrhtml/00025967.htm|accessdate=2008-07-15}}</ref>
[[Analgesic]]s can be used to help reduce swelling and pain and [[antibiotic]] ointments can help prevent secondary infections at the wound site.<ref name="CDC"/>
==Endemic areas==
In 1986, there were 3.5 million cases of Guinea worm in 20 endemic nations in Asia and Africa.<ref name="GWEP"/> Due to prevention and health education efforts, as of June 2008, there are fewer than 10,000 cases in five nations in Africa: [[Sudan]], [[Ghana]], [[Nigeria]], [[Niger]], and [[Mali]].<ref name="CCPress">{{Citation | author=The Carter Center|title=Guinea Worm Cases Drop to Fewer Than 10,000|url=http://www.cartercenter.org/news/features/h/guinea_worm/under_10000_cases.html|accessdate=2008-07-15}}</ref> Guinea worm disease is slated to be the next disease after smallpox to have been eradicated.<ref name="WHO"/>
==Social and economic impact of Guinea worm disease==
The pain caused by the worm’s emergence—which typically occurs during planting and harvesting seasons—prevents many people from working or attending school for as long as 2 to 3 months. In heavily burdened agricultural, villages, fewer people are able to tend their fields or livestock, resulting in food shortages.<ref name="DHop">{{Citation | author last=hopkins|author first=donald|title=Dracunculiasis Eradication: The Final Inch|journal=American Journal of Tropical Medicine|volume=73|issue=4|pages=669-675|url=http://www.ajtmh.org/cgi/content/abstract/73/4/669|accessdate=2008-07-15}}</ref><ref name="GWEP"/> For example, a study in southeastern Nigeria found that rice farmers in a single county lost US$20 million in just one year due to outbreaks of Guinea worm disease.<ref name="GWEP"/>
==Eradication efforts==
===Declaring Guinea worm disease eradicable===
In 1986, former [[President of the United States|U.S. President]] [[Jimmy Carter]] and his not-for-profit organization, [[Carter Center|The Carter Center]], established the [[International Task Force for Disease Eradication]] to determine whether Guinea worm and certain other [[infectious disease]]s could be eradicated.<ref name="GWEP"/>
Carter has said a personal visit to a Guinea worm endemic village in 1988 spurred his efforts to eradicate the disease: “Encountering those victims first-hand, particularly the teenagers and small children, propelled me and Rosalynn to step up the Carter Center’s efforts to eradicate Guinea worm disease.”<ref name="TIME">{{Citation |last1=Carter|first1=Jimmy|last2=Lodge|first2=Michelle|title=A Village Woman's Legacy|journal=TIME|date=2008-03-31|url=http://www.cartercenter.org/resources/pdfs/news/health_publications/guinea_worm/time_village_womans_legacy_mar31_08.pdf|accessdate=2008-07-15}}</ref>
The Task Force determined that since humans were the only host for Guinea worm, the disease could be controlled by identifying all cases and modifying human behavior to prevent it from recurring.<ref name="GWEP"/> Once all human cases are eliminated, the disease cycle would be broken, resulting in its eradication.<ref name="GWEP"/>
In 1991, the Task Force provided its recommendations to the World Health Assembly (WHA), which announced that Guinea worm disease should be the next disease eradicated, after smallpox.<ref name="ITFDE"/> The Carter Center has continued to lead the eradication efforts, primarily through its [[Guinea Worm Eradication Program]].<ref name="GATES">{{Citation |author=Bill and Melinda Gates Foundation|title=2006 Gates Award for Global Health: The Carter Center|date=2006|url=http://www.gatesfoundation.org/GlobalHealth/RelatedInfo/GatesAward/Carter_Center.htm|accessdate=2008-07-15}}</ref> Other actors in the eradication of Guinea worm disease include: [[World Health Organization]], [[Centers for Disease Control and Prevention|U.S. Centers for Disease Control and Prevention]], [[Gates Foundation|Bill & Melinda Gates Foundation]], and [[UNICEF]].<ref name="DHop"/><ref name="GATES"/>
===Barriers to eradication===
The eradication of Guinea worm disease has faced several barriers:
:*inadequate security in endemic countries;
:*lack of political will from endemic country leaders; and
:*the need change behavior rather than distribute a ‘magic bullet’ treatment like a vaccine or medication.<ref name="Barry"/>
One of the most significant challenges facing Guinea worm eradication has been the [[civil war]] in [[southern Sudan]], which was virtually inaccessible to health workers due to violence.<ref name="Barry"/><ref name="Sudan">{{Citation |author=The Carter Center|title=Sudan|url=http://www.cartercenter.org/countries/sudan.html|accessdate=2008-07-15}}</ref> To address some of the humanitarian needs in southern Sudan, in 1995, the longest [[ceasefire]] in the history of the war was achieved through negotiations by Jimmy Carter.<ref name="Barry"/><ref name="Sudan"/> Commonly called the “[[Guinea worm cease-fire]],” both warring parties agreed to halt hostilities for nearly six months to allow public health officials to immunize children and begin Guinea worm eradication programming, among other interventions.<ref name="Sudan"/>
Public health officials cite the formal end of the war in 2005, as a turning point in Guinea worm eradication because it has allowed health care workers greater access to southern Sudan’s endemic areas.<ref name="DHop"/>
A handful of areas in [[West Africa]] outside of Ghana remain challenging to ending Guinea worm: the contiguous tri-border area of [[Burkina Faso]] ([[Djibo]], [[Gorom Gorom]]), Mali (Ansongo, Gourma Rharous, [[Gao]]), and Niger (Tera, [[Tillaberi]]).<ref name="DHop"/>
===Status of eradication efforts===
The World Health Organization is the international body that certifies whether a disease has been eliminated from a country or eradicated from the world. Endemic countries must report to the [[International Commission for the Certification of Dracunculiasis Eradication]] and document the absence of [[indigenous (ecology)|indigenous]] cases of Guinea worm disease for at least 3 consecutive years to be [[certify|certified]] as Guinea worm-free by the World Health Organization.<ref name="ICFDE2">{{Citation |author=US Centers for Disease Control and Prevention|title=Progress Toward Global Dracunculiasis Eradication, June 2000|journal=Mortality and Morbidity Weekly Report|volume=49|date=2000-10-11|pages=731-735|url=http://jama.ama-assn.org/cgi/content/full/284/14/1778|accessdate=2008-07-15}}</ref>
List of countries that have stopped transmission of Guinea worm or been WHO-certified as having eliminated the disease:<ref name="GWEP Activities">{{Citation | author=The Carter Center| title=Activities by Country - Guinea Worm Eradication Program | work= The Carter Center | url=http://www.cartercenter.org/countries/activities_gw.html | accessdate=2008-07-15}}</ref>
Stopped Transmission
:*[[Benin]] - 2004
:*[[Burkina Faso]] - 2006
:*[[Chad]] - 1998
:*[[Cote d'lvoire]] - 2006
:*[[Ethiopia]] - 2006
:*[[Kenya]] - 1994
:*[[Mauritania]] - 2004
:*[[Togo]] - 2006
:*[[Uganda]] - 2003
WHO Certified
:*[[Cameroon]] - 2007
:*[[Central African Republic]] - 2007
:*[[India]] - 2000
:*[[Pakistan]] - 1996
:*[[Senegal]] - 2004
:*[[Yemen]] - 2004
==Guinea worm through history==
:*The unusually high [[incidence (epidemiology)|incidence]] of dracunculiasis in the city of [[Medina]] led to it being included in part of the disease’s scientific name “medinensis.” A similar high incidence in the country of Guinea in West Africa gave the disease its more commonly used name.<ref name="TropMed"/> Guinea worm is no longer endemic in either location.
:*The [[2nd century BC|2nd century B.C.]], [[Ancient Greece|Greek]] writer [[Agatharchides]], described this affliction as being endemic amongst certain nomads in what is now Sudan and along the Red Sea.<ref name="TropMed"/>
:*Guinea worm has been found in calcified [[Ancient Egyptian|Egyptian]] [[mummy|mummies]].<ref name="GWEP"/>
:*Many believe certain [[symbol]]s of [[medicine]]—the [[caduceus]] and the [[Rod of Asclepius]]—represent the treatment for Guinea worm disease, as they portray either one or two [[snake]]s wrapped around a stick.<ref name="McNeil">{{Citation| last=McNeil| first=Donald|title=Slithery Medical Symbolism: Worm or Snake? One or Two?|journal=New York Times|date=2005-03-08|url=http://www.nytimes.com/2005/03/08/health/08cadu.html?_r=1&oref=slogin|accessdate=2008-07-15}}</ref>
:*Guinea worm may be the “fiery serpent” that plagued the [[Israelites]] in the [[Old Testament]]: “And the Lord sent fiery serpents among the people, and they bit the people; and much people of Israel died.” ([[Book of Numbers|Numbers]] 21:4-9).<ref name="TropMed"/>
==See also==
*[[Infectious disease in the 20th century]]
*[[List of infectious diseases]]
*[[Tropical disease]]
*[[Neglected disease]]
*[[Waterborne diseases]]
*[[Eradication of infectious disease]]
*[[Parasitism]]
*[[Smallpox]]
*[[Polio]]
==Notes==
{{reflist|2}}
==External links==
*[http://www.cartercenter.org/health/guinea_worm/index.html The Carter Center Guinea Worm Disease Eradication Program]
*[http://www.cdc.gov/ncidod/dpd/parasites/dracunculiasis/factsht_dracunculiasis.htm Center for Disease Control information on Dracunculiasis]
*[http://tmcr.usuhs.mil/tmcr/chapter27/intro.htm Tropical Medicine Central Resource: “Guinea Worm Infection (Dracunculiasis)”]
*[http://www.who.int/topics/dracunculiasis/en/ World Health Organization on Dracunculiasis]
{{Helminthiases}}
[[Category:Parasitic diseases]]
[[Category:Water-borne diseases]]
[[Category:Tropical diseases]]
[[Category:Neglected diseases]]
[[de:Dracontiasis]]
[[es:Gusano de Guinea]]
[[it:Dracunculiasi]]
[[fr:Dracunculose]]
[[pl:Drakunkuloza]]