Guinea Worm Disease – Causes, Pathogenesis, Symptoms

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Snayuka Roga is a disease which has been explained in the parishishta section of Madhava Nidana Uttarardha. The disease resembles a parasitic infection of guinea worm, popularly known as dracunculiasis or guinea worm disease i.e. GWD.

Table of Contents

Snayuka Roga

Causes, Pathogenesis, Types

Causes –
Excessive drinking of water heavily contaminated by rain water or other reasons is said to be the main cause for snayuka disease.
Read – Ayurvedic Treatment For Worm Infestation

Pathogenesis –
The worms in the contaminated water reach the stomach and contaminate the doshas. The aggravated doshas spreads in the upper and lower limbs like herpes and produce swelling therein. Later the swelling burst open. The heat present in the wound formed due to opening of swelling causes dryness of the tendons. Following this rounded worms appearing like white fibers exit out of the skin surrounding the wound. If the worms are incompletely eliminated or break off, leaving a portion inside the skin, the disease worsens. If the worms come out completely, the disease subsides. But the disease when not treated completely will tend to appear at some other place of the body. Similar sequence of events is repeated.

The tendon / ligament afflicted by the worm in the arm or leg sometimes break off. In such cases there occurs contracture of the concerned limb. Gradually lameness, limp or loss of function of the limbs occurs.

Types of snayuka roga

Depending on the dosha involved, snayuka disease is of 8 types i.e.

Vataja
Pittaja
Kaphaja
Vata-pittaja
Vata-kaphaja
Vata-pittaja
Raktaja
Tridoshaja
Read – Krimighna Gana: Parasites Relieving Herbs: Review, Benefits, Formulations

Sanskrit verses

Symptoms, Treatment

Symptoms according to the predominant dosha

Vataja snayuka – the tendon will be reddish brown in color, dry and associated with severe pain
Pittaja snayuka – the tendon will be of bluish yellow color and associated with severe burning sensation
Kaphaja snayuka – the tendon will be white, stout and associated with heaviness
Raktaja snayuka – the tendon will be of red color and will be associated with burning sensation
Snayuka caused by dual and triple doshas will have combined symptoms of the involved doshas.

If the tendons / ligaments break up, they cause severe complications. Sometimes they may be life threatening.
Read – Tendinitis Causes, Ayurvedic Treatment, Medicines, Remedies

Treatment of snayuka disease
Snayuka disease should be treated on the lines of treating visarpa i.e. herpes.

Guinea Worm Disease

Dracunculiasis is a parasitic infection. It is caused by guinea worm. Therefore it is also called as guinea worm disease i.e. GWD.

Word derivation

The name dracunculiasis is derived from the Latin word ‘affliction with little dragons’. The name guinea worm appeared after Europeans saw the disease on the Guinea coast of West Africa in the 17^th century. This disease is classified as neglected tropical disease.

The Latin name of the parasite Dracunculus medinensis means ‘little dragon from Medina’. This disease once had high incidence in the Saudi Arabia city of Medina.

It is also called as Dracontiasis.

Causes, Diagnosis

How is this caused?

When a person drinks water that contains water fleas infected with larvae of guinea worm, he becomes infected.

The disease is devoid of symptoms initially. About one year later, a painful blister usually occurs in the skin of the lower limb, generally near the foot. It is caused by the female worm. Within 72 hours the blister ruptures. It exposes one end of the worm. There is painful burning sensation around the blister. The person feels difficulty to work or walk and suffers from vomiting and dizziness. The person may immerse his foot in water to get relieved from this burning sensation. When one keeps a blister or open sore submerged in water, the adult female releases hundreds of guinea worm larvae. Thus the water gets contaminated. These larvae are eaten by copepods. These infected copepods live in water for up to 4 months.

An infection doesn’t create immunity. Therefore people can repeatedly experience the disease throughout their lives. Several worms may emerge simultaneously.
Read – Immunity In Ayurveda: Concept, Diet, Herbs, Medicines, Exercise

Cause

Dracunculus medinensis, a worm of 1-2 mm wide and the adult female of 60-100 cm long is the known case of dracunculiasis. Dracunculiasis is caused by drinking the water contaminated by water fleas that host the larvae of this worm. The young form of this worm is said to survive for up to 3 weeks outside human body. During this period they are eaten by water fleas. The larva inside these fleas may survive up to 4 months. For the disease to remain in an area, it must occur each year in humans.
Read – Qualities Of Water Stored In Different Vessels

Diagnosis

The disease is diagnosed based on the signs and symptoms. It is diagnosed by seeing the worms emerging from the lesions on the legs of infected individuals. It is also done by microscopic examination of the larvae.

Signs and Symptoms

Formation of painful blister
Allergic reactions during blister formation – rashes, nausea, diarrhea, dizziness, local edema etc, and these symptoms subside when the blister bursts
Worm emerging from the skin near the foot
Intense pain localized in the path of travel of the parasite in the lower leg
Burning sensation – therefore the disease is called ‘fiery serpent’
Fever
Nausea
Vomiting
Read – Burning Sensation – Ayurvedic Understanding And Treatment

Complete healing occurs only when the worm is removed completely. Death of adult worms in the joints can lead to arthritis and paralysis in the spinal cord.

Incidences, Epidemiology

Guinea worm disease has been known since ancient times. Dracunculiasis once plagued a wide band of tropical countries in Africa and Asia. The method of removal of the worm is described in the Egyptian medical Ebers Papyrus dating from 1550 BC.

22 cases were reported in 2015 and 30 cases in 2017. The number has come down from an estimated 3.5 million cases in 1986.

In 2016, the disease was reported from three countries. All are from Africa. In 1980’s cases were reported from almost 20 countries.

By May 2018, only 3 human cases had been reported worldwide. All three were in Chad. According to WHO, as of 31^st October 2018, the number has increased to 21 human cases in 18 villages of Africa.

Read what WHO has to say about GWD

Dracontiasis was also reported in Barmer district, Western Rajasthan in 1982

Shortly it will be the first parasitic disease to be globally eradicated. Guinea worm is no longer endemic in either location.

Prevention, Treatment

Preventive measures

GWD can be transmitted only by drinking contaminated water. It can be completely prevented through the below mentioned measures.

Principles of prevention

Early diagnosis of the disease
Keeping the person away from putting his wound in drinking water, to decrease spreading of the parasite
Improving access to clean water
Measures to filter the water
Removal of the worm slowly by rolling it over a stick
Prevention of infection of the ulcers formed by the emerging worm

At personal level

Prevent people from drinking water contaminated with water flea. They can be seen as swimming white specks in clear water.
People should be advocated to drink water only from those sources which are free of contamination.
All drinking water should be filtered. A fine mesh-cloth filter should be used. Alternatively a regular cotton cloth folded over many times can be used. Water can be filtered through ceramic or sand filters.
Water should be boiled before consumption.
New sources of drinking water devoid of parasites should be developed. The dysfunctional water sources should be repaired.
The water should be treated with larvicides to kill the fleas.
Read – Benefits Of Drinking Hot Water, Contra Indications

At community level

The people with emerging worms should be prevented from entering water sources meant for drinking.
The cases should be detected at community level and contained. For this survey should be conducted.
The emerging worms shall be put into buckets of water. This would reduce the number of larvae in them. The water should then be discarded on dry ground.
All members of the community should be discouraged from setting foot in the drinking water source.
The local water sources should be guarded to prevent people with emerging worms from entering those sources.
Read – How Much Water Should You Actually Drink? Ayurveda Opinion

Treatment

There is no vaccine or medicine which could be used to prevent or treat GWD.

The consequences of untreated cases may be –

Once the worm emerges, the affected part should be submerged in a bucket of water. With this, the worm discharges the larvae. The worm thus becomes less infectious. Discard this water on dry ground far away from water sources. Submersion also relieves burning sensation associated with the blister. This also makes the worm extraction easier.

How to remove the worm?

The live worm should be wrapped around a piece of gauze or stick. The process may take several weeks. The worm may be loosened by gently massaging the area around the blister. It can also be surgically removed in a medical facility.

The wound from where the worm emerges could develop a secondary bacterial infection which may become life threatening.

Analgesics may be used to reduce swelling and pain. Antibiotic ointments can help prevent secondary infections at the site of wound. Lubricants can be used which may aid worm extraction. It is important not to break the worm when pulling it out. Broken worms tend to putrefy or petrify. Putrefaction leads to sloughing of skin around the worm. Petrifaction is a problem if the worm is in a joint or wrapped around a vein.

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