The peculiar epidemiology of dracunculiasis in Chad.

Dracunculiasis was rediscovered in Chad in 2010 after an apparent absence of 10 years. In April 2012 active village-based surveillance was initiated to determine where, when, and how transmission of the disease was occurring, and to implement interventions to interrupt it. The current epidemiologic pattern of the disease in Chad is unlike that seen previously in Chad or other endemic countries, i.e., no clustering of cases by village or association with a common water source, the average number of worms per person was small, and a large number of dogs were found to be infected. Molecular sequencing suggests these infections were all caused by Dracunculus medinensis. It appears that the infection in dogs is serving as the major driving force sustaining transmission in Chad, that an aberrant life cycle involving a paratenic host common to people and dogs is occurring, and that the cases in humans are sporadic and incidental.

[Unusual association of endomyocardial fibrosis and aberrant migration of Dracunculus medinensis in the pericardium]. / Association inhabituelle d'une fibrose endomyocardique et d'une impasse parasitaire péricardique de Dracunculus medinensis.

We report one case of endomyocardial fibrosis with a relapsing pericarditis, associated with an aberrant migration of Dracunculus medinensis in the pericardium, in a 22-year-old patient from an endemic zone of bilharziasis and dracunculosis in Côte d'Ivoire. The evolution has been marked by the appearance of thrombus in the right atrium. The patient died on the 49th day of hospitalization following an refractory cardiac insufficiency.

Dracunculiasis (Guinea worm disease) eradication.

Since the seminal review by Ralph Muller about Dracunculus and dracunculiasis in this serial publication in 1971, the Centers for Disease Control and Prevention and The Carter Center forged, during the 1980s, a coalition of organizations to support a campaign to eradicate dracunculiasis. Eighteen of 20 countries were known in 1986 to have endemic dracunculiasis, i.e., Benin, Burkina Faso, Cameroon, Chad, Côte d'Ivoire, Ethiopia, Ghana, India, Kenya, Mali, Mauritania, Niger, Nigeria, Pakistan, Senegal, Sudan, Togo, and Uganda. Transmission of the disease in Yemen was documented in 1995, and the World Health Organization (WHO) declared Central African Republic endemic in 1995. As of the end of 2004, a total of 16026 cases of dracunculiasis were reported from 12 endemic countries (91% of these cases were reported from Ghana and Sudan, combined), a reduction greater than 99% from the 3.5 million cases of dracunculiasis estimated in 1986 to occur annually; the number of endemic villages has been reduced by >91%, from the 23475 endemic villages in 1991; disease transmission has been interrupted in 9 of the 20 endemic countries; and WHO has certified 168 countries free of dracunculiasis, including Pakistan (1996), India (2000), Senegal and Yemen (2004). Asia is now free of dracunculiasis.

Bore holes and the vanishing of guinea worm disease in Ghana's upper region.

Ghana's Upper Region provides an excellent example of the beneficial effects of improved water security provided by hand-pump tube wells. Following a Ghana-Canada bilateral development project that installed some 2500 pumps, protection rates against guinea worm disease may be estimated as 88% in the west, and 96% in the east. Survey comparisons between ca 1960 and 1990 show that dracunculiasis declined in 32 of a total of 38 areas. The shadow of guinea worm has been lifted from the land and, in many areas, a true "vanishing" has occurred. The few areas of disease increase are characterized by the lowest population densities, pioneer settlement for cotton farming, and an absence of bore holes. Vagaries of development have inadvertently produced disease transformations or "metamorphoses" from dracunculiasis to elephantiasis (lymphatic filariasis) in one area, and to red water disease (schistosomiasis hematobium) in other areas. Correlative associations between pump densities and guinea worm disease are weakened by the large size of areas for which disease is reported in 1990. One preliminary finding is that geographical distance to the pump is a stronger influence than demographic pressure on pumps, regarding dracunculiasis. Diminishing returns on higher pump densities in many areas support the idea of making fuller, safer use of supplementary non-pump water. Despite crises of fee payment and pump maintenance, the rural bore hole project has struck a mortal blow against guinea worm, and permanently raised the quality of life in the Upper Region.

Dracunculosis of the broad ligament. A case of a "parasitic leiomyoma".

This report describes the case of a 29-year-old Nigerian woman with dracunculosis presenting as an adnexal mass. The patient had a history of two second-trimester spontaneous abortions for which she was being evaluated. During the evaluation, she was found to have multiple uterine leiomyomas and a calcified left adnexal mass by pelvic ultrasound and radiography. At laparotomy, the calcified mass was excised from the left broad ligament, and a myomectomy was performed. Histologic examination revealed a calcified, coiled guinea worm embedded in the fibrous tissue of the broad ligament. Only one other case of calcified guinea worm in the broad ligament has been reported in the literature.

Dracunculiasis of the orbit and eyelid. Light and electron microscopic observations of two cases.

Dracunculiasis, an infection caused by the nematode parasite, Dracunculus medinensis, usually affects the skin and subcutaneous tissue. The authors studied two cases of dracunculiasis involving the orbit and eyelid in African children. In the first case, the patient presented with proptosis and the clinical diagnosis was Burkitt's lymphoma. In the second patient, the eyelid lesion was diagnosed as a dermoid cyst. Histopathologically, the orbital lesion showed a degenerated and partially calcified worm within a large intraconal abscess. The eyelid lesion contained a well-preserved gravid female worm filled with larvae. The results of transmission and scanning electron microscopic studies are discussed.

[Epidemiological aspects of dracunculosis in Benin. 1. Incidence, eruption location and incidence of reinfestation]. / Aspects épidémiologiques de la dracunculose au Bénin. 1. Incidences, localisation des émergences et fréquence de réinfestations.

A prospective survey was conducted in five villages in the central part of Benin. Population of these dracunculiasis infected villages was range from 150 to 300 people. A weekly visit led to note dates of worm eruption and to follow up evolution of the disease. 723 patients were observed between 1985 and 1989. Infants were rarely affected. The highest incidence occurred in men from 18 to 45 years old. In other age groups, incidence was not significantly different from group to others. 90% of emergencies were located in lower limbs. Recurrent infections from year to year were observed with a significant higher frequency in 20% of people. These people were not distinctive from others. Such a result could be explained by a special behaviour concerning water supply, conservation or treatment. Average duration of the disease was 106 days. Duration of the disease was not linked to educational or medical equipment nor isolation of village.

Red Dracunculus medinensis.

Two instances of the emergence of a bright-red worm from humans in Pakistan are described. A 25-year-old man and a 26-year-old woman, unrelated and living in separate households, were observed in 1987 and 1988, respectively, to have emergent worms typical in size and location for Guinea worm disease, except for the color of the worms. The posterior end of 1 worm was recovered and appeared to be a female Dracunculus medinensis. Histologic sections provided insufficient information to determine the cause of the red color, although we could exclude blood as the cause.

Onchocerciasis and dracunculosis.

Onchocerciasis is a disease of Africa and Central and South America. It produces severe skin disease and is a leading cause of blindness worldwide. Dracunculosis infection, caused by the guinea worm Dracunculosis medinensis, occurs in tropical Africa. Included in this article are discussions of the vector and transmission, pathology, immunology, diagnosis, and treatment of these two diseases.

[Lumbar dracunculosis. Apropos of a case]. / Dracunculose lombaire. A propos d'un cas.

A young boy of 15 is examined because a swelling of the right lumbar fossa, of which etiology was not established. As a matter of fact, this swelling was the abscess wrapping up the anterior tip of a Medina filaria, which was rooted out by the patient himself in one step and without complication. Delay in diagnosis is explained by the lack of dracunculosis in the area, and by the migratory habits of this young patient who did consider his filariosis as a benign occurrence.