Medical Care
The mainstay of treatment is the extraction of the adult worm from the patient using a stick at the skin surface and wrapping or winding the worm a few centimeters per day. Because the worm can be as long as one meter in length, full extraction can take several days to weeks. This slow process is required to avoid breakage and leaving behind a portion of the worm.
Each day, the affected body part is immersed in a container of water to encourage more of the worm to come out. The wound is cleaned and gentle traction is applied to the worm to slowly pull it out. Pulling stops when resistance is met to avoid breaking the worm. The worm is wrapped around a stick to maintain some tension on the worm and encourage more of the worm to emerge. Topical antibiotics are applied to the wound to prevent secondary bacterial infections and the affected body part is then bandaged with fresh gauze to protect the site. These steps are repeated every day until the whole worm is successfully pulled out.
Analgesics, such as aspirin or ibuprofen, are given to help ease the pain of this process and reduce inflammation.
No specific drug is used to treat dracunculiasis. Metronidazole or thiabendazole (in adults) is usually adjunctive to stick therapy and somewhat facilitates the extraction process. However, one study found that antihelminthic therapy was associated with aberrant migration of worms, resulting in infection in areas other than the lower extremity. Therefore, such medications should be used with caution.
Surgical Care
See the list below:
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The worm also can be excised surgically where such facilities are available.
Consultations
See the list below:
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Suspicion of dracunculiasis based on history or examination findings warrants consultation of an infectious disease specialist for involvement in management and follow-up care. This also allows for initiation of epidemiologic protocol if the patient presents in a nonendemic country.
Diet
See the list below:
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No particular dietary changes are required during the extraction process, regardless of the time involved.
Activity
See the list below:
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Activity is usually self-restricted because of discomfort. Recommendations are tailored for the individual, with no particular general guidelines.
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A method used to extract a guinea worm from the leg vein of a human patient.
