J Korean Assoc Oral Maxillofac Surg.  2016 Apr;42(2):67-76. 10.5125/jkaoms.2016.42.2.67.

Dracunculiasis in oral and maxillofacial surgery

• Kim SM

• KMID: 2351728
• DOI: http://doi.org/10.5125/jkaoms.2016.42.2.67

Abstract

Dracunculiasis, otherwise known as guinea worm disease (GWD), is caused by infection with the nematode Dracunculus medinensis. This nematode is transmitted to humans exclusively via contaminated drinking water. The transmitting vectors are Cyclops copepods (water fleas), which are tiny free-swimming crustaceans usually found abundantly in freshwater ponds. Humans can acquire GWD by drinking water that contains vectors infected with guinea worm larvae. This disease is prevalent in some of the most deprived areas of the world, and no vaccine or medicine is currently available. International efforts to eradicate dracunculiasis began in the early 1980s. Most dentists and maxillofacial surgeons have neglected this kind of parasite infection. However, when performing charitable work in developing countries near the tropic lines or other regions where GWD is endemic, it is important to consider GWD in cases of swelling or tumors of unknown origin. This paper reviews the pathogenesis, epidemiology, clinical criteria, diagnostic criteria, treatment, and prevention of dracunculiasis. It also summarizes important factors for maxillofacial surgeons to consider.

Keyword

Dracunculiasis; Dracunculus medinensis; Guinea worm disease; Neglected tropical diseases; Swelling of unknown origin

MeSH Terms

Copepoda
Dentists
Developing Countries
Dracunculiasis*
Dracunculus Nematode
Drinking Water
Epidemiology
Fresh Water
Humans
Larva
Minocycline
Parasites
Ponds
Surgery, Oral*
Drinking Water
Minocycline

Figure

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  Fig. 1 Schematic drawing of the transmission cycle of Dracunculus medinensis. 1) A person drinks well or pond water containing water fleas (Cyclops) that are infected with mature thirdstage larvae. 2) Stomach gastric juices digest the water fleas, thus releasing worm larvae that move to the abdominal tissue, where they grow and mate. 3) Fertilized female worms migrate to various body regions, usually the lower extremities. 4) At 10 to 14 months after migration, the worm begins to emerge through the skin at a painful blister site. 5) Upon contact with water, the emerging worm releases immature first-stage larvae into the water source. 6) Water fleas consume worm larvae that resist digestion. 7) In two weeks, the larvae mature to third-stage infected larvae within the water flea, which can infect humans.

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  Fig. 2 Skin penetration of the guinea worm through the face (A), ankle (B), arm (C), and abdomen (D). Figures were obtained through Google search16.

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  Fig. 3 Endemic status of dracunculiasis in 2012, including precertification and certification countries. Data from the annual reports of World Health Organization (WHO) (Geneva: WHO; 2013)12 and the article of Callahan et al. (PLoS Negl Trop Dis 2013;7:e2160)15.

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  Fig. 4 Recently reported endemic countries in Africa, including Mali, Niger, Ghana, Nigeria, Sudan, and South Sudan. Data from the annual reports of World Health Organization (WHO) (Geneva: WHO; 2013)12 and the article of Callahan et al. (PLoS Negl Trop Dis 2013;7:e2160)15.

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  Fig. 5 An example poster of reward programs for guinea worm eradication that was circulated throughout Ghana.

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  Fig. 6 Winding of a worm around a small stick near the skin penetration wound. Figure was obtained through Google search16

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  Fig. 7 Basic chemical formulas of eight representative antihelminthic drugs.

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  Fig. 8 Ascaris worms emerging from the mouth and nose (A) or mouth (B). Figures were obtained through Google search16.

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