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Clinical Summary

Dracunculiasis is a debilitating roundworm infection caused by Dracunculus medinensis, commonly known as the Guinea worm. Dracunculiasis was historically widespread throughout equatorial Africa, the Middle East, and South Asia, but the disease is now isolated to limited areas of Africa due to intensive eradication efforts. Dracunculiasis has a complex life cycle beginning when infected water fleas, or cyclops, are ingested while drinking from unclean water sources. Following ingestion, the larval worm penetrates through the stomach and intestine and migrates to the subcutaneous tissue, where it matures and reproduces. A painful wound develops, usually on the lower extremity, when the female emerges to release larvae. Immersion in water relieves the pain, allowing the worm to release larvae and complete the life cycle.

Emergence of the worm leads to a painful wound that is often accompanied by fever, nausea, vomiting, edema, intense pruritus, ulceration, and eosinophilia, all of which can last for months. The wounds often become secondarily infected, leading to significant disability. Drinking boiled or filtered water prevents dracunculiasis.

Management and Disposition

The worm is carefully extracted, usually around a stick or rolled gauze, in order to avoid retained worm products and the resultant inflammatory reaction. This process can take days to weeks. Daily immersion in water, with proper disposal to avoid larval spread, helps facilitate worm removal. Surgical excision is possible.


  1. The Guinea worm is the largest tissue parasite of humans. While very thin (2 mm in diameter), a full-grown worm is about a meter in length.

  2. Dracunculiasis is rarely fatal, but the wound can cause significant morbidity and economic loss in areas with high infection rates.

  3. It is predicted that dracunculiasis will be the 1st parasitic disease to be fully eradicated, largely through patient education and use of filtered water.

FIGURE 21.23

Dracunculiasis. Gradual extraction of a Guinea worm using rolled gauze in Ghana. (Photo contributor: The Carter Center/Louise Gubb.)

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