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Dracunculus medinensis is a parasitic nematode. It is one of the longest nematodes to infect humans, with adult females reaching up to 1 meter in length. This pathogen belongs to the class Secernentea and is part of the Dracunculidae family. Guinea worm is not classified as a virus, bacteria, fungus, or protozoan, but as a parasitic worm (helminth). Its life cycle is highly specialized, relying on humans and small aquatic crustaceans (copepods) to complete transmission. Dracunculus medinensis causes Guinea worm disease (GWD). The disease primarily affects the skin and subcutaneous tissues, especially of the lower limbs. While not usually fatal, it is extremely painful and can result in secondary infections and long-term disability. Guinea worm disease is classified as a neglected tropical disease due to its prevalence in poor, rural communities and its historical lack of public health attention. Because of intense eradication efforts, it is now close to elimination, with only a few cases reported annually.

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This image shows the subcutaneous emergence of a female Guinea worm (Dracunculus medinensis) from the sole of a patient’s right foot. Prior to emergence, a painful blister forms and ruptures within 24–72 hours, leaving an ulcer. At the base of this lesion, the anterior end of the worm appears. To relieve the burning pain, patients often immerse the affected limb in water. This triggers the worm to release a milky fluid containing millions of larvae, contaminating the water source. For several days, the worm can continue releasing larvae upon water exposure. Note the purulent infection surrounding the rupture site.

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Symptoms of Guinea worm disease begin about one year after infection, when the adult female worm is ready to emerge. The earliest sign is often a painful, burning blister—usually on the lower limbs—caused by the worm pushing toward the surface. This blister ruptures, creating an ulcer, and the worm slowly emerges over the course of several days or weeks. The process is extremely painful and may be accompanied by fever, nausea, and secondary bacterial infections. In some cases, multiple worms may emerge, leading to further disability and complications like sepsis or permanent limb damage.

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Map depicting global cases of Guinea worm disease.

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People at greatest risk for Guinea worm disease are those living in remote, rural areas without access to safe drinking water. Communities that rely on stagnant ponds or open water sources are especially vulnerable. Children are frequently affected because they are more likely to play in and drink from contaminated water sources. Farmers, herders, and other individuals who work outdoors and travel far from treated water supplies also face increased risk. Though the global burden has decreased significantly, at-risk populations remain in countries like Chad, South Sudan, Mali, and Ethiopia.

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Image of a stagnant water source, a common transmission medium.

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Guinea worm infection occurs when a person drinks water contaminated with tiny freshwater copepods (water fleas) that carry infective larvae. Once swallowed, the copepods die and release the larvae, which then penetrate the host’s stomach or intestinal wall and enter the abdominal cavity. Over the next several months, the larvae mature into adult worms, and the fertilized female migrates to the surface of the skin. A painful blister then forms, usually on the legs or feet, and when the person places the affected limb in water, the worm releases larvae, repeating the cycle. Because there is no vaccine or medication to kill the worm inside the body, prevention is centered on interrupting this transmission cycle.

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People become infected with Dracunculus medinensis by drinking unfiltered water containing copepods infected with larvae, or by eating undercooked fish or frogs that harbor the parasite. Once ingested, the copepods die and release larvae, which penetrate the intestinal wall and migrate to the abdominal cavity, where they mature and mate. The male worms die, and the fertilized female migrates under the skin—usually to the lower limbs. About a year after infection, the female creates a painful blister and begins to emerge. When the person immerses the affected area in water to relieve the burning, the worm releases larvae, contaminating the water. Copepods then ingest the larvae, which develop into infective forms, completing the cycle when consumed by another person.

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There is no drug or vaccine to kill or prevent Guinea worm disease, so treatment focuses on manually extracting the worm. This is done by slowly pulling the worm out a few centimeters each day, often wrapping it around a stick or piece of gauze. The process can take several weeks and must be done carefully to avoid breaking the worm, which can cause intense inflammation and infection. Pain relief, wound care, and antibiotics are often used to manage symptoms and prevent secondary infections. In more severe cases, surgery may be needed to remove the worm or treat complications like abscesses or joint damage.

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President Jimmy Carter Assists in Guinea Worm Eradication Effort

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President Jimmy Carter Assists in Guinea Worm Eradication Effort

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This image highlights President Jimmy Carter's pivotal role in the global campaign to eradicate Guinea worm disease. The Carter Center, founded by the former U.S. President, launched an eradication program in 1986 when there were an estimated 3.5 million cases annually across 21 countries in Africa and Asia. Through community education, water filtration, and monitoring, cases were reduced by more than 99.99%, with only 13 reported cases worldwide in 2022, according to the World Health Organization.

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This 2004 image depicts a group of Ghanaian students learning how to protect themselves from Guinea worm disease (GWD) through the instruction of a Red Cross volunteer. The volunteer used a wall mural painted on the side of a Guinea worm case containment center, to describe GWD, its symptoms, and the methods one must practice in order to avoid human infection. The wall mural depicted three people discussing what the infected man in the middle must do in order to treat his Guinea worm infection, as they stood on the banks of a contaminated pond. Note the Guinea worm emerging from the infected man’s left leg, as well as the filter cloth covering a water collection pot, filtering the collected pond water being poured into the pot by the woman to the right. GWD occurs when one ingests contaminated water containing water fleas that harbor the Guinea worm, Dracunculus medinensis, larvae.

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Children in Chad holding filter straws used to prevent D. medinensis infection

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Prevention of Guinea worm disease centers on interrupting the life cycle of the worm by ensuring access to clean water. Filtering drinking water through cloth, pipe filters, or ceramic filters removes copepods and prevents infection. Community education programs teach residents about the dangers of drinking untreated water and encourage reporting of suspected cases. In endemic areas, infected individuals are discouraged from entering water sources to prevent contamination. International eradication campaigns led by The Carter Center and the World Health Organization have successfully reduced cases by over 99.99% since the 1980s.

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Logarithmic scale of reported dracunculiasis cases 1989–2022