eMedicine Specialties > Pediatrics: General Medicine > Parasitology

Dracunculiasis: Follow-up

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

Follow-up

Further Outpatient Care

  • Close follow-up monitoring is necessary to track progression of extraction in patients with dracunculiasis.
  • Initially, warm compresses may be useful in relieving pain.
  • Diligent cleaning of the wound site is necessary during and following extraction of the worm.
  • Topical antibiotic ointments, such as bacitracin or mupirocin (Bactroban), can be applied to wounds to prevent secondary infection.

Deterrence/Prevention

  • Prevention of the disease is through management of water supplies in endemic areas.
    • Treatment of potentially contaminated water with the larvicide temephos (ABATE) is useful in controlling the spread of the infection. Additional preventative steps include filtering water through a finely woven cloth (to strain larvae), drinking water from only a borehole or hand-dug wells, and avoiding passive transmission by educating infected persons to avoid entering water sources.
    • Areas with known outbreaks or more frequent infections must be identified, and equipment must be made available to clear drinking water in those areas.
    • Unfortunately, civil unrest and governmental lapses have prevented clearance of many water supplies in several endemic nations. Numerous positive social and political steps are also important to create conditions for the interruption of disease transmission.

Complications

Prognosis

  • With treatment, prognosis is very good. Without treatment, prognosis is still very good as long as serious secondary infection does not occur and remain untreated.

Patient Education

  • Distribute information regarding the disease in endemic areas.
  • Assist communities in maintaining clean drinking water supplies.

Miscellaneous

Medicolegal Pitfalls

  • Incorrect diagnosis
    • Initially missing the diagnosis of dracunculiasis is possible because of the infrequency of cases throughout the world, particularly in the western hemisphere.
    • Major complications in this scenario include late diagnosis, resulting in an increased degree of individual patient morbidity and failure of timely epidemiologic notification of a case.
    • In suspicious lesions, a travel history must be obtained and remembered to avoid this pitfall.
  • Inappropriate treatment
    • Although this scenario is much less likely than the one above, inappropriate treatment of dracunculiasis could be a potential issue, even if the diagnosis is made correctly.
    • Consult an infectious disease specialist in any and all cases of suspected dracunculiasis outside of endemic nations to prevent inappropriate treatment or management.
  • Reaction to treatment
    • Care must be taken to ascertain whether the patient with dracunculiasis has ever taken any antiparasitic drugs and if they were ever noted to cause problems.
    • A failure to do so with a resultant adverse reaction to prescribed medication is a clear-cut legal pitfall that should be eliminated in practice by following the standards of care and obtaining an appropriate patient history.

Special Concerns

  • Patients with dracunculiasis are at risk for other parasitic infections because areas endemic for Dracunculus also are endemic for other parasites. During and after treatment for dracunculiasis, patients should be monitored for other symptomatology characteristic of parasitic infections.
 
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.



More on Dracunculiasis

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