Graveyard Shift The Guinea Worm Is One Of The Most Invasive And Painful Parasites On The Planet  

Beth Elias
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The Guinea worm is on its way to being eradicated, but the 30-year path to get there hasn't been an easy one. Difficulty in combating this debilitating disease has been compounded by the fact that it's difficult to know if you have a Guinea worm - symptoms don't appear for a year after infection. Among the diseases you can catch from water, this painful worm may be among the worst. Sadly, it affects the poorest people in the world, mostly in rural communities in Africa without access to clean drinking water.

Through millions of dollars in private and government funding, along with substantial support from the Carter Center, Guinea worm is on its way out. The tropical parasite, which rarely kills but often disables, involves a fertilized female worm bubbling to the top of the skin, where it bursts out - which is as painful as it sounds. Removing the worm is difficult and, again, painful. 

There is no rhyme or reason as to who the worm affects - people of all ages, races, and gender can be affected, as anyone who drinks infected water is at risk. The pervasiveness of the worm is only intensified by its recurrence, as there is no immunity, no vaccine, and no medication. The only solution? Remove the worm. The only real solution? Get clean drinking water to remote communities in Africa.

The Guinea Worm's Entire Lifecycle Is Painful For Those Infected

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Photo: Wellcome Images/Wikimedia Commons/CC BY 4.0

Guinea worm disease is caused by a nematode called Dracunulus medinensis. After someone drinks water that has been infected with copepods (crustaceans that have larvae in them), the copepods die after being ingested and larvae enter the stomach and intestines. At this point, the larvae reproduce in the stomach and intestinal wall - this is, unfortunately, also where they mature. Female worms, after they have been fertilized, head back up to the skin, creating a painful blister. These blisters are especially painful in the joints. 

The worm is "smart" in some sense, as the painful blister becomes hot and makes the host want to put their limb in water. In water, the blister can release the female worm, who then infects water with larvae all over again. And when the blister bursts, it can release hundreds of thousands of larvae that were previously living in the body. It's not called the "fiery serpent" for nothing. And it's not just one worm, either - there can be multiple worms anywhere on the body (usually the feet or legs). 

Removing the worm so as to not infect more water - or infect the person who has the worm - is an arduous process. The worm can break as it is being removed, thus decomposing in the body. If the wound itself becomes infected, anything from sepsis to lockjaw can occur.

The Parasite Only Affects The Poorest 10% Of The World

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Photo: CDC Global/Wikimedia Commons/CC BY 2.0

Guinea worm only affects the poorest areas of the world - mostly areas in Africa that lack clean drinking water. In these areas, Guinea worm remains present year after year, as limited sources of water get contaminated over and over again. No one is safe from the Guinea worm, and no one develops immunity. However, some people do seem to get the worm repeatedly, while others do not; those who are farmers, herders, or otherwise leave the home to get drinking water are at a higher risk, as they are forced to drink infected water. 

The poorest 10% of the world are the only ones who suffer from Guinea worm, and it is important to note that though Guinea worm disease is caused by poverty - not having clean water - it can also perpetuate poverty, as communities struggle to thrive when people can't work and are unhealthy. 

30 Years Has Seen Amazing Progress In Eradicating The Guinea Worm

As painful and debilitating as the Guinea worm can be, the good news is that the Center for Disease Control and Prevention is getting closer and closer to eradicating the worm. In 1986, 20 countries were plagued with the Guinea worm, totaling about 3.5 million cases per year. In the 1990s, it's estimated that half of the people in some remote areas suffered from Guinea worm. 

Since then, incredible progress has been made in 30 years. Only a few countries still have Guinea worm present, and there are only four countries where the worm is still endemic (Chad, Ethiopia, Mali, and South Sudan). But the real progress lies in the numbers - in 2014, there were only 126 cases of Guinea worm, while in 2015, there were 22 cases worldwide. In 2016, there could have been as few as two cases.

Removing A Guinea Worm Can Take Weeks

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Photo: CDC/Wikimedia Commons/Public Domain

The only treatment for Guinea worm disease is to remove the worm entirely. There is no drug and no vaccine. To remove the worm, the person must immerse the blister in water, enticing the worm to leave the body. After cleaning the wound, the worm is slowly pulled out. Because the worm can be so long - a meter! - this can take weeks. Weeks to pull a worm out of someone's body - let that sink in for a second. 

Throughout the removal process, the worm is wrapped around a stick so that it doesn't wiggle back into the body. After the worm is fully removed (it is especially important not to break any of the worm off in the body), the final step is to make sure the wound does not become infected and create further problems.