1508

ANSWER TO PHOTO QUIZ (SEE PAGE 1361)

Figure 1. A radiograph (left anterior oblique view) of the left kneeof an otherwise asymptomatic patient with pain after minor traumato her knee; findings reveal a curly calcified female Dracunculusmedinensis adult worm in subcutaneous tissue dorsal to the tibialhead. The worm was acquired at least 2 years before admission, whenthe patient left an endemic area in Ivory Coast.

Diagnosis: Infection due to Dracunculus medinensis with water nearly 12 months after having been ingested byits human host. The condition is generally subclinical up to

Dracunculiasis is caused by Dracunculus medinensis orthe time of skin penetration; 90% of affected individuals are

guinea worm, the largest tropical nematode that can live innot aware of harboring a worm [3]. Symptoms typical of

humans [1, 2]. Humans contract the disease by drinking wateranaphylactic hypersensitivity such as nausea, urticaria,

infested with waterfleas, mostly of the genus Cyclops, thatasthma, vomiting, or diarrhea [4], however, may precede the

have fed on D. medinensis larvae. In the human host, theeruption of the nematode, which creates a burning blister that

nematode larvae penetrate the duodenal wall, mesenteric ves-develops into an ulcer. Bacterial superinfection or arthritis

sels, and soft tissue. After maturation 3 –4 months later, malemay become serious complications. The most effective treat-

and female worms mate. The male worm dies after mating;ment is the week-long extraction of the worm, which is ac-

however, the female worm migrates to subcutaneous sites ofcomplished by rolling the worm around a thin stick.

its host’s distal limbs where it resides until it penetrates theCalcification usually occurs when an aberrant worm dies in

skin (causing a blister) and discharges its larvae upon contactdeeper tissues [3]. Four types of calcification have been re-ported [3]: linear, beaded, mottled, and amorphous. D. medi-nensis can be distinguished from other calcified nematodes—

Correspondence: Dr. Peter Wienert, Surgical Clinic Dr. Rinecker, Am Isar- such as Wuchereria bancrofti (80 mm), Onchocerca volvuluskanal 30, D-81379 Munich, Germany. (40 mm), Loa loa (60 mm), and Trichinella spiralis (3–4Clinical Infectious Diseases 1998;27:1508–9 mm)—by its size (60–120 cm for adult females, 2–4 cm forq 1998 by the Infectious Diseases Society of America. All rights reserved.1058–4838/98/2706–0002$03.00 males).

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1509CID 1998;27 (December) Answer to Photo Quiz

ReferencesDracunculiasis, a scourge of humans since the time of Ae-skulap, may hopefully be eliminated soon by breaking the para-

1. McMahon JE, Simonsen PE. Filariases. In: Cook C, ed. Manson’s tropicalsitic life cycle at its most vulnerable point, the site of encounter diseases. 20th ed. London: WB Saunders, 1996:1321–68.of nematode larvae, waterfleas, and humans in times of water 2. Muller R. Worms and disease. A manual of medical helminthology. London:

William Heinemann Medical Books, 1975:114–9.scarcity.3. Reddy CRRM, Sivaprasad MD, Parvathi G, Chari PS. Calcified guinea

Andreas Sing, Peter Wienert, Peter Sabisch, worm: clinical, radiological and pathological study. Ann Trop Med Para-Jurgen Heesemann, and Hans Rinecker sitol 1968;62:399–406.

4. Hunter JM. An introduction to guinea worm on the eve of its departure:Max von Pettenkofer-Institute for Hygiene and Medical Microbiology,dracunculiasis transmission, health effects, ecology and control. Soc SciUniversity of Munich, and Surgical Clinic Dr. Rinecker,

Munich, Germany Med 1996;43:1399–425.

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