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

Dracunculiasis typically has a low mortality rate, although significant morbidity may occur. Death occurring in this setting is not caused by the primary worm infestation but rather from a secondary bacterial infection at the worm's exit site that can lead to sepsis. Secondary infection of the lesions can be severe. The appearance of cellulitis or the formation of an abscess at the worm's exit site requires prompt attention. Morbidity also includes pain at the exit sites, which occurs frequently and can incapacitate patients for long periods of time, especially those patients with multiple worms (typically, individuals experience multiple worm extrusions simultaneously), as well as patients who rely on their ability to stand or walk for their livelihood.

Significant loss of productivity with a resultant negative socioeconomic burden on individuals and communities has been documented; for example, farmers with untreated dracunculiasis in Nigeria have been found to miss work for up to 3 months at a time. Another debilitating complication of dracunculiasis is the development of chronic pain and intermittent swelling of the extremities secondary to the calcified encapsulation of the adult worm upon its death. In a small percentage of individuals, permanent scarring or deformity of the lower extremity may occur.

Of related interest, the universal symbols of medicine (ie, the asklepios, the snake wrapped around a rod that is attributed the Greek god of healing and medicine, as well as the similar caduceus) are likely a representation of dracunculiasis and its treatment. To this day, accepted treatment remains the same. The adult Guinea worm is wrapped around a stick a few centimeters a day to coax it from a person's skin. Removal of the entire worm may take days to weeks. Metronidazole or thiabendazole may be used as an adjunct to stick therapy. These medications, however, have not been proven effective in controlled clinical trials and may be associated with aberrant migration of the worm; consequently, they should be used with caution. The worm may also be removed surgically, if such facilities are available. Diagnosis of dracunculiasis outside of endemic areas requires consultation with an infectious disease specialist and epidemiologic investigation to prevent additional cases.

Special thanks are extended to Dr J. Walls, MBChB, FRCS, for his contributions to the publication of this case.

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