Dracunculiasis Dracunculiasis Terry L Dwelle Dwelle MD MPHTM MD - - PowerPoint PPT Presentation
Dracunculiasis Dracunculiasis Terry L Dwelle Dwelle MD MPHTM MD MPHTM Terry L Classification of Nematodes Classification of Nematodes Subclass Order Superfamily Genus and Probable Subclass Order Superfamily Genus and Probable
Subclass Subclass Order Order (suborder) (suborder) Superfamily Superfamily Genus and Genus and Species Species Probable Probable prevalence prevalence in man in man
Secernentea Secernentea Spirurida Spirurida ( (Camallanina Camallanina) ) Dracunculoidea Dracunculoidea Dracunculus Dracunculus medianesis medianesis 10 million 10 million
Ingestion of an infected Cyclops Deep connective tissues Migrate for about 1 year Gravid female moves to skin Discharges larvae through cutaneous ulcer (into water) Cyclops L3 larvae in 10d – 2w
From A Color Atlas of Tropical Medicine and Parasitology, 2nd edition, Peters and Gilles, Year Book Medical Publishers, 1981 From A Color Atlas of Tropical Medicine and Parasitology, 2nd edition, Peters and Gilles, Year Book Medical Publishers, 1981
From A Color Atlas of Tropical Medicine and Parasitology, 2nd edition, Peters and Gilles, Year Book Medical Publishers, 1981
A Colour Atlas of Tropical Medicine and Parasitology, 2nd Edition, Year Book Medical Publishers, 1981, pp 257
► ►
Generally no symptoms in the Generally no symptoms in the prepatent prepatent period period
► ►
Prodrome Prodrome stage stage – – few hours prior to skin lesions an few hours prior to skin lesions an erythematous erythematous urticarial urticarial rash is seen with rash is seen with pruritus pruritus, nausea, , nausea, diarrhea, diarrhea, dyspnea dyspnea, syncope, giddiness , syncope, giddiness
► ►
Skin lesion Skin lesion – – red papule, vesicle with red papule, vesicle with indurated indurated margin margin (1.5 (1.5-
2.0 cm) mainly on feet and ankles. With rupture some of the symptoms abate but may recur with removal some of the symptoms abate but may recur with removal
► ►
Sterile abscess Sterile abscess – – if the worm fails to reach the skin surface if the worm fails to reach the skin surface and dies and dies
► ►
Secondary infection is common Secondary infection is common
► ►
When close to joints may cause a debilitating arthritis When close to joints may cause a debilitating arthritis
► ►
Can rarely migrate to critical organs Can rarely migrate to critical organs
From A Color Atlas of Tropical Medicine and Parasitology, 2nd edition, Peters and Gilles, Year Book Medical Publishers, 1981 From A Color Atlas of Tropical Medicine and Parasitology, 2nd edition, Peters and Gilles, Year Book Medical Publishers, 1981 From A Color Atlas of Tropical Medicine and Parasitology, 2nd edition, Peters and Gilles, Year Book Medical Publishers, 1981
► ► Slow extraction of the worm combined with wound
► ► Metronidazole
Adults – – 250 mg 250 mg tid tid X 10 days X 10 days
Children – – 25 mg / kg / day (maximum 750 mg) divided 25 mg / kg / day (maximum 750 mg) divided into 3 doses X 10 days into 3 doses X 10 days
Not curative but decreases inflammation and facilitates worm removal worm removal
Metronidazole 400 400-
800 mg / day for 6 days has been reported to kill the worm directly reported to kill the worm directly
The Medical Letter, August 2004, Drugs for Parasitic Infections, pp 1-12
► ►
Avoid Avoid – – 1 1st
st trimester
trimester
► ►
Use with caution CNS disease, blood Use with caution CNS disease, blood dycrasias dycrasias, severe liver , severe liver
mL/min) /min)
► ►
Adverse reactions Adverse reactions – – nausea, diarrhea, nausea, diarrhea, urticaria urticaria, dry mouth, , dry mouth, leukopenia leukopenia, vertigo, metallic taste, peripheral neuropathy , vertigo, metallic taste, peripheral neuropathy
► ►
May worsen May worsen candidiasis candidiasis
► ►
May cause May cause disulfirim disulfirim type reaction with alcohol type reaction with alcohol consumption within 24 consumption within 24-
48 hours after dose given
► ►
May increase levels of toxicity of May increase levels of toxicity of phenytoin phenytoin, lithium, and , lithium, and warfarin warfarin. .
► ►
Phenobarbital and Phenobarbital and rifampin rifampin may decrease may decrease metronidazole metronidazole metabolism metabolism