eMedicine Specialties > Pediatrics: General Medicine > Parasitology

Dracunculiasis: Differential Diagnoses & Workup

Author: Vinod K Dhawan, MD, FACP, FRCP(C), Professor, Department of Clinical Medicine, University of California, Los Angeles, David Geffen School of Medicine; Professor of Medicine, Charles Drew University of Medicine and Science; Chief, Division of Infectious Diseases, MLK-Harbor Hospital
Contributor Information and Disclosures

Updated: Nov 24, 2009

Differential Diagnoses

Filariasis

Other Problems to Be Considered

Onchocerciasis

Workup

Laboratory Studies

The following studies are indicated in dracunculiasis:

  • CBC count with differential
    • The WBC count is likely elevated, even if only slightly.
    • The differential commonly indicates eosinophilia.
  • Serum immunoglobulin levels
    • Immunoglobulin E (IgE), immunoglobulin G1 (IgG1), and immunoglobulin G4 (IgG4) levels are usually elevated, with variability depending on the stage of disease.
    • Patent infections (immediately following blister eruption but before ulcer formation) cause the greatest elevation of the 2 IgG subclasses, whereas both are relatively less elevated with postpatent (ulcerated) or prepatent (blister in formative stage) infections.

Imaging Studies

  • A radiologic examination (plain-film roentgenography) of the lower extremity may prove useful in the identification of calcified worms in the rare case when surgery is considered. Incidental identification of calcified lesions from dracunculiasis has also been reported after radiographic evaluation of a painful lower extremity.

More on Dracunculiasis

Overview: Dracunculiasis
Differential Diagnoses & Workup: Dracunculiasis
Treatment & Medication: Dracunculiasis
Follow-up: Dracunculiasis
Multimedia: Dracunculiasis
References
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References

  1. Progress toward global eradication of dracunculiasis, January 2008-June 2009. MMWR Morb Mortal Wkly Rep. Oct 16 2009;58(40):1123-5. [Medline].

  2. CDC. Progress toward global eradication of dracunculiasis, January-June 2003. MMWR Morb Mortal Wkly Rep. Sep 19 2003;52(37):881-3. [Medline].

  3. CDC. Progress toward global eradication of dracunculiasis, January 2004-July 2005. MMWR Morb Mortal Wkly Rep. Oct 28 2005;54(42):1075-7. [Medline].

  4. Adewale B, Mafe MA, Sulyman MA. Impact of guinea worm disease on agricultural productivity in Owo local government area, Ondo state. West Afr J Med. May-Jun 1997;16(2):75-9. [Medline].

  5. Behbehani K. Candidate parasitic diseases. Bull World Health Organ. 1998;76 Suppl 2:64-7. [Medline].

  6. Bimi L, Freeman AR, Eberhard ML, et al. Differentiating Dracunculus medinensis from D. insignis, by the sequence analysis of the 18S rRNA gene. Ann Trop Med Parasitol. Jul 2005;99(5):511-7. [Medline].

  7. Bloch P, Simonsen PE. Immunoepidemiology of Dracunculus medinensis infections I. Antibody responses in relation to infection status. Am J Trop Med Hyg. Dec 1998;59(6):978-84. [Medline]. [Full Text].

  8. Greenaway C. Dracunculiasis (guinea worm disease). CMAJ. Feb 17 2004;170(4):495-500. [Medline]. [Full Text].

  9. Hopkins DR, Ruiz-Tiben E, Downs P, et al. Dracunculiasis eradication: the final inch. Am J Trop Med Hyg. Oct 2005;73(4):669-75. [Medline].

  10. Hopkins DR, Ruiz-Tiben E, Ruebush TK. Dracunculiasis eradication: almost a reality. Am J Trop Med Hyg. Sep 1997;57(3):252-9. [Medline].

  11. Hunter JM. An introduction to guinea worm on the eve of its departure: dracunculiasis transmission, health effects, ecology and control. Soc Sci Med. Nov 1996;43(9):1399-425. [Medline].

  12. Levinson WE, Jawetz E. Nematodes: Dracunculiasis. In: Medical Microbiology and Immunology. 1994;285-286.

  13. Menon T. Incidental finding of Dracunculus medinensis in Australia. Med J Aust. Jul 4 2005;183(1):51-2. [Medline].

  14. MMWR Morb Mortal Wkly Rep. Imported dracunculiasis--United States, 1995 and 1997. Mar 27 1998;47(11):209-11. [Medline].

  15. Muller R. Guinea worm disease--the final chapter?. Trends Parasitol. Nov 2005;21(11):521-4. [Medline].

  16. Sam-Abbenyi A, Dama M, Graham S, Obate Z. Dracunculiasis in Cameroon at the threshold of elimination. Int J Epidemiol. Feb 1999;28(1):163-8. [Medline].

  17. [Guideline] Watts SJ. The comparative study of patterns of guinea worm prevalence as a guide to control strategies. Soc Sci Med. 1986;23(10):975-82. [Medline].

  18. WHO. Dracunculiasis (guinea-worm disease) eradication. Wkly Epidemiol Rec. Apr 16 2004;79(16):154-5. [Medline].

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Further Reading

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Keywords

dracunculiasis, dracontiasis, dracunculosis, guinea worm infection, guinea fire worm, Medina worm, serpent worm, dragon worm

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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; Professor of Medicine, Charles Drew University of Medicine and Science; Chief, Division of Infectious Diseases, MLK-Harbor Hospital
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 None None

Medical Editor

Michael D Nissen, MBBS, BMedSc, 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, BMedSc, 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.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

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.

CME Editor

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

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: None None None

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