Dracunculiasis Clinical Presentation

  • Author: Vinod K Dhawan, MD, FACP, FRCP(C); Chief Editor: Russell W Steele, MD   more...
 
Updated: Jul 12, 2011
 

History

  • Travel to or residence in endemic countries is invariably part of the history in patients with dracunculiasis.
  • Recollection of ingestion of unfiltered or untreated water, ingestion of fresh fruits or vegetables washed with such water, or bathing or swimming in potentially contaminated water are all possibly elicited in the patient's history. The transmission of the disease has seasonal variation. In arid areas, the rainy season, with increased availability of surface water, coincides with most cases. In wet areas, the dry season, when sources of drinking water are limited, is associated with most cases.
  • History tends to be useful only to confirm the diagnosis after it has been presumed based on physical examination findings.
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Physical

A blister forms in the epidermis at a site chosen by the female worm, usually in the lower extremity. Immediately before blister formation, allergic-type symptoms, such as mild respiratory distress with wheezing, urticaria, periorbital edema, and pruritus, are often present. Patients may also be febrile during this period. With the emergence of the worm's head, the blister grows and becomes erythematous at its periphery. Edema occurs around the site, and inflammation of the papule causes further pruritus and burning pain. Usually, after a few days, but possibly as long as 2 weeks, the blister erupts, and the worm releases a collection of larvae-containing fluid. The swelling and pain often are markedly decreased after the blister is opened. At this point, an ulcer forms around the blister site as the adult worm continues to emerge.

Definitive diagnosis is made when the head of the worm is identified within the ulcer.

As noted, the ulcer tends to become secondarily infected.

No other particular physical findings are commonly noted, although some degree of lymphadenopathy may be found at any stage of the illness.

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Causes

  • Dracunculiasis is an infection caused by the nematode D medinensis.
  • The larvae from D medinensis are not infective unless a molting process within the copepods occurs. This requires a fresh-water environment; thus, water ingestion is the only identified mode of transmission.
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Contributor Information and Disclosures
Author

Vinod K Dhawan, MD, FACP, FRCP(C)  Professor, Department of Clinical Medicine, University of California, Los Angeles, David Geffen School of Medicine; Chief, Division of Infectious Diseases, Rancho Los Amigos National Rehabilitation Center, Downey, California.

Vinod K Dhawan, MD, FACP, FRCP(C) is a member of the following medical societies: American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and Royal College of Physicians and Surgeons of Canada

Disclosure: Pfizer Inc Honoraria Speaking and teaching

Specialty Editor Board

Michael D Nissen, MBBS, FRACP, FRCPA  Associate Professor in Biomolecular, Biomedical Science & Health, Griffith University; Director of Infectious Diseases and Unit Head of Queensland Paediatric Infectious Laboratory, Sir Albert Sakzewski Viral Research Centre, Royal Children's Hospital

Michael D Nissen, MBBS, FRACP, FRCPA is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society, Royal Australasian College of Physicians, and Royal College of Pathologists of Australasia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Martin Weisse, MD  Program Director, Associate Professor, Department of Pediatrics, West Virginia University

Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi Pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Shuvo Ghosh, MD, to the original writing and development of this article.

References

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