Dracontiasis

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Classification according to ICD-10
B72 Dracunculosis
ICD-10 online (WHO version 2019)

The dracunculiasis , Dracunculose or dracunculiasis is by the Guinea worm ( Dracunculus medinensis occurring) caused, especially in the East, heavy parasitosis of humans.

The causative agent of the disease (the larva of the medina worm) and its intermediate host (a small cancer ) described the Russian Alexej P. Fedschenko (1844–1873) in Samarkand after he had discovered both under the microscope. A connection between the transmission and contaminated drinking water was assumed in Egypt, as Rufus of Ephesus reports, as early as the 1st century. The disease is also discussed in the writings of Rhazes and Avicenna (Symptoms and Therapy in the fourth book of the Medical Canon ).

Pathomechanism

The infection occurs mainly during the dry season, as there is usually no regulated drinking water supply and the population is dependent on water retention. There they ingest tiny copepods with their drinking water and at the same time ensure a new infection if they are already infected.

The tiny crustaceans ( hopscotch ) attacked by the larvae of the medina worm are ingested with unfiltered drinking water; the larvae are then released in the small intestine. From there they migrate through the body and drill into the abdominal and chest muscles. This is where the pairing takes place. The male then dies and is encapsulated. The fertilized female continues to grow, becomes up to one meter long and migrates through the tissue to the extremities, usually to the lower legs or feet. There it settles in the connective tissue of the subcutaneous tissue .

The worm's head causes an ulcer the size of a pigeon's egg through excretion . If this comes into contact with water, the thin skin in the center bursts. At the same time, the skin of the worm and its uterus , which is just below it, tear , releasing thousands of larvae into the water. The uterus then withdraws back into the ulcer and the process is repeated when the water is again wetted. The larval shedding begins about a year after the larva is ingested and lasts for two to three weeks, then the worm dies and the ulcer usually heals.

Harmful effect

The migration of worms through the tissues and the formation of ulcers are associated with severe pain. The ulcer usually heals without complications, but it is a gateway for bacteria. Abscesses , joint inflammation or stiffening of the joints can form. No immunity is built up and so with continued exposure there will always be new infections.

Dead, calcified Medina worms are still often discovered on X-rays and mammograms in Saudi Arabia and Central Africa .

Removal of the worm

Removal of the worm

In the past, as it is still today, the up to 120 cm long females are removed with a stick, with which the front end on the head side, which breaks out of the ulcer, is unwrapped more and more every day. The process takes a few days, but usually several weeks. The opening will then generally heal.

Drug therapy is not available. However, the worm can also be removed surgically.

prevention

Solar drinking water treatment for the prevention of dracontiasis in Ghana

By treating the drinking water (for example filtering it through a cloth) or by using tube filters, the larvae can be prevented from entering the body.

extermination

In 1980 the number of new infections a year was 3.5 million cases. By educating the population and taking preventive measures, the number of new infections fell to less than 75,000 within 20 years. In 2004 there were still around 16,000 infected people, exclusively in Africa. Launched by former US President Jimmy Carter launched called Carter Center today has a leading position in the fight against dracunculiasis. The WHO goal of eradicating the parasite by 2009 could not be achieved. In 2009 there were still 3190 registered cases worldwide, which occurred exclusively in the countries of South Sudan , Ghana , Mali and Ethiopia . In 2011 there were a total of 1058 and in 2012 there were still 542 registered cases in Ethiopia , South Sudan , Mali and Chad . A total of 148 infections were counted in 2013, 113 of them in South Sudan, eleven in Mali, the rest in Chad, Ethiopia and on the border between Sudan and South Sudan. Even if the number of new infections has been greatly reduced, it is now to be feared that the civil wars that have broken out in the still endemic areas will prevent or at least greatly delay eradication . In 2014, 126 infections were registered worldwide, 70 of them in South Sudan, 40 in Mali, 13 in Chad and 3 in Ethiopia. In 2015, 22 infections were registered worldwide, 5 of them in South Sudan, 5 in Mali, 9 in Chad and 3 in Ethiopia. In 2016, 25 infections were registered worldwide, 6 of them in South Sudan, 16 in Chad and 3 in Ethiopia. In 2017, 30 infections were registered worldwide, 15 of them in Chad and 15 in Ethiopia. In 2018, 28 infections were registered worldwide, 17 of them in Chad and 10 in South Sudan. In 2018, 53 infections were registered worldwide, 48 of them in Chad and 4 in South Sudan. Extinction is made more difficult by its spread in dogs. Between 2015 and 2018, around 500 to 1000 infections were reported in dogs each year, the vast majority of them in Chad. Some cats and baboons are found among the infected animals in Chad, Mali and Ethiopia. In 2019, the number of dogs in Chad rose to almost 2,000 and 46 infected cats were reported there.

Individual evidence

  1. ^ Gotthard Strohmaier : Avicenna. Beck, Munich 1999, ISBN 3-406-41946-1 , pp. 111-114.
  2. ^ Maurice C. Haddad, Mohammed E. Abd El Bagi, Jean Claude Tamraz: Imaging of Parasitic Diseases . Springer, London 2007, ISBN 978-3-540-49354-9 , pp. 168 .
  3. ↑ SK Barry, WG Schucany: Dracunculiasis of the breast: radiological manifestations of a rare disease. In: Journal of radiology case reports. Volume 6, Number 11, November 2012, ISSN  1943-0922 , pp. 29-33, doi: 10.3941 / jrcr.v6i11.1137 , PMID 23372866 , PMC 3558262 (free full text).
  4. ↑ Centers for Disease Control and Prevention : Guinea Worm Disease Frequently Asked Questions (FAQs): What is the treatment for Guinea worm disease?
  5. ↑ Donald R. Hopkins: Dracunculiasis Eradication: The final Inch. (PDF; 784 kB) 73 (4). In: The American Society of Tropical Medicine and Hygiene. 2005, pp. 669–675 , accessed April 10, 2013 (English).
  6. ↑ Michele Barry: The Tail End of Guinea Worm - Global Eradication without a Drug or a Vaccine. Vol. 356, No. 25, ISSN  1533-4406 , doi: 10.1056 / NEJMp078089 . In: The New England Journal of Medicine . 2007, pp. 2561-2564 , accessed April 10, 2013 (English).
  7. ^ Guinea Worm Eradication Program. (Status of the worm eradication program). Retrieved April 10, 2013 .
  8. ↑ CARTER CENTER: 148 Cases of Guinea Worm Disease Remain Worldwide
  9. ^ WHO Collaborating Center for Research, Training and Eradication of Dracunculiasis, CDC on March 6, 2015: Guinea worm wrap-up # 232
  10. ↑ CDC - Guinea Worm Disease. # 238 - 1/11/2016 English - PDF . In: www.cdc.gov. Retrieved January 30, 2016 (American English).
  11. ↑ CDC - Guinea Worm Disease. ( Direct link to PDF ) Retrieved June 15, 2017 (American English).
  12. ↑ CDC - Guinea Worm Disease. ( Direct link to PDF ) Retrieved January 30, 2018 (American English).
  13. ↑ CDC - Guinea Worm Disease. ( Direct link to PDF ) Retrieved March 16, 2019 (American English).
  14. ↑ a b CDC - Guinea Worm Disease. January 24, 2020, accessed on February 6, 2020 (American English, direct link to PDF ).
  15. ↑ Dogs save the Guinea worm www.spektrum.de from January 5, 2016, accessed on January 6, 2016.
  16. ↑ CDC - Guinea Worm Disease. ( Direct link to PDF ) Retrieved January 30, 2018 (American English).
  17. ↑ Guinea worm: The riddle of the Shari River
  18. ↑ CDC - Guinea Worm Disease. ( Direct link to PDF ) Retrieved March 16, 2019 (American English).

Web links

Commons : Dracontiasis  - Collection of images, videos and audio files