The emergence of a large, creamy-white worm through an ulcer in the skin is highly characteristic of Guinea worm disease, and has served as the standard definition of a case throughout the Guinea worm disease eradication campaign. As the campaign comes closer to the goal of global eradication, examination of residents for signs and symptoms (localized itching, swelling, blisters, and ulcer-like lesions) of Guinea worm disease, as well as for emergent worms, has intensified.
At this stage of eradication, it becomes crucial to ensure that each case is detected promptly and confirmed so that transmission of the infection is prevented, and that worm specimens are collected and preserved, to confirm that all submitted specimens are Dracunculus medinensis. The Centers For Disease Control and Prevention (CDC) serves as the World Health Organization Collaborating Center for Dracunculiasis Eradication, and provides technical assistance to partners and all country eradication programs, but especially those where endemic transmission persists or which have recently interrupted transmission but not yet been certified as free of Guinea worm disease by the World Health Organization. Submitted specimens can be examined microscopically and at the molecular level to facilitate the diagnosis. Over the past 14 years, 189 samples have been submitted to CDC for evaluation, and 100 (53%) of these have been determined to be D. medinensis. The most common non–Guinea worm samples submitted have been female Onchocerca volvulus.1,2 Over the same 14-year period, 31 non–Guinea worm, but other parasitic worms were submitted to the reference lab, and 20 (65%) of these were determined to be O. volvulus.
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Eberhard ML, Ruiz-Tiben E, Korkor AS, Roy SL, Downs P, 2010. Case report: Emergence of Onchocerca volvulus from skin mimicking Dracunculus medinensis. Am J Trop Med Hyg 83: 1348–1351.
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