A 42-Year-Old Woman Undergoing a Renal Transplant Evaluation

Heather Kesler DeVore, MD; Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP; Sirhan Alvi, MBChB, MRCS(Ed), MRCS(Glasg)

Disclosures

May 12, 2016

Discussion

Dracunculiasis, or Guinea worm disease, results from infection by the nematode Dracunculus medinensis. The mammogram shows a coiled, whorled-type calcification in the subcutaneous tissues; this finding is characteristic of a dead Guinea worm. In 1986, more than 3.5 million cases of dracunculiasis occurred worldwide.[1] Ten years later, the worldwide annual incidence had declined significantly, with only 152,000 new cases annually, mostly occurring in Sudan. As of 2003, the US Centers for Disease Control and Prevention reported the annual incidence at fewer than 33,000 cases, again mostly originating in the Sudan.[2] This decline was a result of the Global Dracunculiasis Eradication Campaign. Dracunculiasis now occurs in only 13 countries in Africa, the Middle East, and in South Asia, including Nigeria, Cameroon, Ghana, Sudan, India, and Pakistan. Infected areas in Africa lie in a band between the Sahara and the equator.[1,2,3]

People acquire dracunculiasis by drinking fresh water contaminated with D medinensis larvae. Exposure can also occur from ingestion of fresh fruits or vegetables washed with contaminated water or from bathing or swimming in infected water. Small water fleas present in the water swallow the D medinensis larvae. The worms continue to mature within the flea. Humans contract the infection by ingesting water that is contaminated with these water fleas. Once inside the body, the stomach acid dissolves the water flea but not the Guinea worm. During the next year, the worms mature to adult size; they mate, and the male dies. At the end of that year, the female worms migrate toward the surface of the body, into the subcutaneous tissue. As a worm migrates, a blister develops on the skin above where the worm resides. The female adult worm eventually emerges from the blister, rupturing the skin. When an infected person comes into contact with water, exposed worms release a milky, white liquid containing millions of immature larvae; these larvae contaminate the water supply. Seasonal variation in exposure to the organism correlates with periods of increased exposure to contaminated water.[3]

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