Dracunculiasis is considered as eradicated from India. The cases presented here are rare and were difficult to diagnose and physcians may not have seen such case for many years.
Dracunculiasis (GWD) is a parasitic disease caused by the parasite worm Dracunculus medinensis commonly known as guinea worm.
The mode of transmission is by drinking stagnant water containing copepods that carry Gunieworm Larvae. Person is infected with Guinea worm by drinking such stagnant water. Guinea worm larvae are eaten by the copepods that live in these stagnant water sources. The larvae mature in 2 weeks in the copepods before they can infest humans.
After ingestion, the copepods die and release the larvae, which penetrate the host stomach and intestinal wall and enter the abdominal cavity and retroperitoneal space. After maturation into adults and copulation, the male worms die and the females migrate in the subcutaneous tissues towards the skin surface. They are 70 to 120 cm long. About a year after infection, the female worm induces a blister on the skin, generally on the distal lower extremity, which ruptures when it comes into contact with water, a contact that the patient seeks to relieve the local discomfort. The female worm emerges and releases larvae into water. The larvae are ingested by a copepod, which completes the life-cycle.
The clinical features include slight fever, itchy rash, nausea, vomiting, diarrhoea, and dizziness. A blister develops most commonly on lower extremity. It enlarges and cause severe pain and burning sensation, which relieves on submerging the part in water. Acute stage complications include cellulitis, abscesses, septic shock, septic arthritis, while in late stage calcification of worm and joint deformities can occur. Acute stage is treated with local care of ulcer, combined with slowly removal of the worm. Systemic antibiotics are given to prevent secondary infection. In chronic stage, rarely the calcified worm may cause recurrent problems as in our case and need surgical removal.
The radiological diagnosis can be made easily when the characteristic long linear, serpiginous or coiled, whorled “chain mail” types of calcification are present in the soft tissues.[4
] Several filarial worms, particularly Loa loa
and Onchocerca volvulus
, may calcify but these are much smaller and almost always seen in the hands and feet. Either may cause small, coiled masses of calcification and occasionally may be linear, but neither is as large or extensive as the guinea worm.
In summary, although considered eradicated long ago, occasional cases of calcified guinea worm can occur. Physicians should be aware of this rare diagnosis and should have high index of suspicion for early diagnosis and treatment. The calcified worm, if it causes recurrent problems, should be removed surgically.