The dracunculose is a Filariose, parasitic Maladie also called worm of Guinea , worm of Africa or filariose of Médine .

The Ver parasitizes responsible for this disease is called Dracunculus medinensis . The name of Dracunculus comes from the Latin “small dragon”. It is present in microscopic shellfish, the cyclops, alive in stagnant water. This parasite is largest which can be placed in human tissues, it can measure up to one meter length and 2 mms in diameter.

Life cycle of the parasite

The not filtered water ingestion can involve the ingestion of this parasite lodged by the cyclops. The gastric Acide digests shellfish, but not the larvae of the worm of Guinea sheltered inside. These larvae gain then the small intestine then are disseminated inside the body.

During the 10 to 14 months following, the females couple themselves with a worm of male Guinea. The male of small size (1,2 to 2,9 centimetres length) disappears inside the female much larger. The female with its maximum growth reaches a size from 60 to 100 centimetres and a low width equivalent to that of spaghetti. After having copulated, the female gives rise to thousands of tiny larvae.

Approximately a year after ingestion, the parasite moves inside the body before leaving, generally on the level of the foot or by the bottom of the legs. It then causes the formation of an extremely painful edema, then of a blister and an ulceration. The perforation of the skin is accompanied by fever, nauseas and vomiting. The disease can often last of the months. The superinfection which can be formed after the exit of the parasite can immobilize the patient up to one year. Complications can occur like the Tétanos.

To relieve itself, the patient will join a water point to immerse his painful foot there. Fresh water at the same time as it alleviates the pain causes the contraction of the worm Femelle which involves the expulsion of hundred thousands of Embryon S which will be introduced by tiny a Crustacé, the cyclops. It is this shellfish infected in its turn which perpetuates the cycle of contamination water point which is often only available to all the community. The dracunculose reappears each year in the villages touched during the season of the cultures and there exists neither remedy, nor vaccine to treat this disease but its prevention is rather simple (filtering of water).

Treatment

The traditional method which is still that which is most usually used to treat the draconculose consists in rolling up the worm around a stick. The adult worm is extracted from the patient using a stick on the surface of skin and is rolled up around the stem of some Centimètre S per day. This slow process can take several days and, in certain cases, until a few weeks, but it requires to avoid the rupture of the parasite, to leave in place part of the worm.

There exist drugs which can treat the patient like Thiabendazole (Mintezol®, Métronidazole (Flagyl®) Mébendazole (Vermox®).

The Metronidazole or the Thiabendazole (in the adults) is usually used in complement of the method of the stick and slightly facilitates the process of extraction. However, a study noted that the treatment Anthelminthique was associated with an abnormal migration of the worms, having for result the infection in other zones that the lower extremities. Consequently, such drugs should be used with prudence.

The worm can also be excized surgically when the equipment necessary is available.

A Prévention is easy to set up: it is enough to filter water (through a linen), or to make it boil, before drinking it. It is also possible to build deep wells.

Practical problems

The significance of an infection reported in a country considered as free from dracunculose depends on the Espèce on the parasite. From time to time, of the species which infect the animals such as normally D.insignis can infect human. These cases of animal transmission are regarded as atypical, and are not a subject of concern. The infection by D.medinensis in a place considered as free from draconculose is the measurement object important of eradication. Consequently, capacity to distinguish the human parasite, D.medinensis , and other species of Dracunculus is important. This can be made by the reconstitution of the history of the voyages of the victim and by the print DNA of the worm itself

Actions of eradication

In the whole world, there was approximately 3,5 million cases brought back in 1986, against only 25.000 in 2006, the essence of the case being located in four countries. The the World Health Organization was fixed like drank the eradication of the disease in 2009, which would make of it the first parasitic disease in this case.

The eradication campaigns which were the proof of their effectiveness, initially seek to quickly detect the people reached to render comprehensible to them the dangers which they make run to their community if they plunge the legs in the backwaters or rivers. In certain countries like the Ethiopia or the Uganda, one founded a premium for the patients who go in the “houses of the worm of Guinea” in order to be made look after quickly. Treatment consisting in essentially avoiding a superinfection at the exit point and extracting the worm. The relief of the pain brought by the agents of health, prevents the patients from soaking their lesions in the backwaters and thus stops the cycle of the transmission. The other effective actions are the filtering of water through a fine fabric, the chemical treatment of water (or its boiling before consumption), the creation of deep wells. The eradication campaigns began in the years 1980 and continue until our days.

In January 2005, the president Malian Amadou Toumani Touré expressed its disappointment of the results of its country in the fight for the eradication of the worm of Guinea . The Mali knew a reduction ratio of 58  % of the cases, the Togo of 63  %, the Nigeria of 66  % and the Burkina Faso of 73  %. The Senegal is the first African country to have éradiqué this disease according to the the World Health Organization.

Unfortunately the lack of financial liabilities and policy (multiples conflicts in the endemic zones) against this disease risks to make it re-appear.

Localization of the disease

The dracunculose remains now in 12 countries only in sub-Saharan Africa. The transmission of the disease is more widespread in the villages of the zones Rural are very isolated and in the zones where move groups Nomade S. With, in ancient Greece the writer Agatharchide describes this affection as endemic among certain nomads in what is now the Sudan and along the Red Sea.

The dracunculose is a disease present in intertropical Africa. More half of the cases are recorded with the Sudan but the Burkina Faso, the Ivory Coast, the Ethiopia, the Ghana, the Mali, the Niger, the Nigeria, and the Togo are also touched.

In 2004 the three areas of stronger endémie were the Ghana, Sudan, and the Nigeria with respectively 7275,7266 and 495 reported cases of draconculose. The other endemic countries announcing of the cases of GWD into 2004 were: the Benign (3 cases), the Burkina Faso (60 cases), the Ivory Coast (21 case), the Ethiopia (17 cases), the Mali (357 cases), the Mauritania (13 case), the Niger (293 cases), and the Togo (278 cases). The Kenya (7 cases) and the Uganda (4 cases) brought back imported cases of Sudan.

The transmission of the draconculose was stopped in several African countries, including/understanding the Kenya, the Senegal, the Cameroun, the Chad, and the Central African Republic. No case acquired locally of the disease was reported in these countries during the last year or more. The the World Health Organization declared 168 countries free from transmission of Dracunculose, including five formerly endemic countries: the Pakistan (in 1996), the India (1996), the Senegal and the Yemen (in 2004) and the Central African Republic (in 2007).

The armed conflicts with the Sudan make very difficult the interventions against the parasite.

External bonds

• Course draconculose

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