DIAGNOSTIC TESTS / MANAGEMENT & THERAPY

DIAGNOSTIC TESTS:

Diagnosis is done usually by the apparent formation of a blister from the itching, pain, and allergic reaction which occurs on mainly legs, feet, shoulders and the trunk. Once the blister has popped, cold water encourages the spread of larvae, which can be seen under low-powered microscopy. Immuno-diagnostic methods are actually not useful since they cannot detect pre-patent infections due to lack of pre-patent serum samples. According to Cairncross, “antibodies can be detected in patent infections by enzyme-linked immunosorbent assay or dot-enzyme-linked immunosorbent assay, using whole-worm antigens. The most specific reaction appears to be for detection of immunoglobulin G4 . This test might be able to detect prepatent infections up to 6 months before emergence , in which case it could have practical importance. No evidence was found for the presence of circulating antigen.”(4) Therefore, it is not necessary for lab tests because clinical symptoms are so well-known to endemic populations and are likely to be unavailable in such areas. Larvae can be seen in the fluid from the blister.

MANAGEMENT AND THERAPY:

The ancient treatment of removing the worm by winding it around a stick is still used today. Only a few centimeters can be wound a day, and care must be taken that the worm does not break in two. If the worm is broken, secondary infection almost always develops. Surgical removal is also possible.

http://www.who.int/ctd/dracun/strategies.htm

Metronidazole is often used as an anti-inflammatory. In addition to its anti-inflammatory properties, it can ease the removal of the worm. (5) The required dosage for adults is 250 mg three times a day for 10 days, and for children, it is 25 mg/kg body weight in 3 divided doses, and not to exceed the daily adult dose.
Thiabendazole can be used 50 mg/kg daily for 2 days, but side effects are more common than metronidazole. Neither drug kills the worm, but facilitates its removal. (2)

References

(4) Cairncross, S., Muller, R., & Zagaria, N., (2002, April). Dracunculiasis (Guinea Worm Disease) and the Eradication Initiative. Clinical Microbiology Reviews. Vol. 15, No.2, pg. 223-246

(5) Brown, H., & Neva, F. (1983). Basic Clinical Parasitology: Fifth edition. Norwalk: Appleton-Century-Crofts.

(2) Markell, John, & Krotoski, (1999). Markell and Voge’s: Medical Parasitology, Eighth Edition. Philadelphia: Saunders Company