Sunday, November 9, 2008

Words and worms: dracunculiasis and Dracula

It started with a cute name in a news brief that happened to coincide with Halloween: Dracunculiasis. It ended up teaching me about a grisly illness, the core symbol of the medical profession, and Dracula.

Last year I had a fellowship with the Association of Health Care Journalists. Among other way cool experiences, we toured the Centers for Disease Control and Prevention, where I signed up for their email new service.

Just before Halloween, I received a news brief from the CDC: "Strong progress continues to be made towards the eradication of dracunculiasis." It was a report about the success of an eradication program that assumed knowledge of the disease being eradicated. I knew nothing of dracunculiasis, but thought it was a cute word, what with Halloween in the air and "Dracula" buried in the name.

I set the report aside, with plans to get a story out of it. Then I didn't think about much other than the election of Barack Obama. Hallelujah, we elected Barack Obama. I then began a long excavation process on neglected emails, came across dracunculiasis from the CDC and looked it up.

Turns up its the damn guinea worm - a nasty parasite that gets into the gut via the drinking of infected water and grows to a worm of two to three feet in length that makes its way through the body, causing excruciating pain, until it grinds its way out of a foot. Ow!

The ancient symbol of medicine - the staff of Asklepios, the serpent wrapped around a stick - is believed to represent the treatment of Guinea worm still used today. You twine it out of the body on a stick, like coiling spaghetti on a fork. The worms are even about the size of a nice sized spaghetti noodle.

The name "dracunculiasis," I learned, is derived from the Latin, meaning "affliction with little dragons." That's where the Dracula echo comes in. "Dracula" in Romanian means, literally, "son of the Dragon." The historical figure behind Count Dracula, Vlad Tepes ("the Impaler") Dracula, was the son of Vlad Dracul, the governor of Transylvania and a Knight of the Order of the Dragon.

This is something of a bookish worm that winds its way through history. It is believed that the "fiery serpent" mentioned in the Old Testament referred to guinea worm. It even makes a cameo as a mummy. A calcified male guinea worm (ca. New Kingdom Egypt) was found in the Manchester Egyptian Mummy Project. It is sometimes called the Pharaoh Worm.

Back to the news. From the CDC:

Insecurity in endemic areas of the remaining endemic countries is a great concern and poses the greatest challenge to the success of the global dracunculiasis eradication program. The global dracunculiasis eradication program reduced cases from an estimated 3.5 million cases in 1986 in 20 countries (17 in Africa and 3 in Asia) to 9,585 cases in 2007 in nine countries (all in Africa). Four countries (Burkina Faso, Cote d'Ivoire, Ethiopia and Togo) stopped transmissions during 2006 and reported zero cases in 2007. Dracunculiasis is currently endemic in only five countries (Sudan, Ghana, Mali, Nigeria and Niger). From January-June 2007 to the same period in 2008 the number of cases decreased by 64 percent (from 6,374 to 2,308). An unexpected outbreak of dracunculiasis in Ethiopia (first reported during March-June 2008) raises concerns about that country's claim of having stopped transmission of the disease in 2006.

The reason war (what the CDC calls "insecurity") stifles eradication effort is that it stifles education in general, and the eradication effort is largely one of education. Dracunculiasis larvae enter the water supply in large numbers when someone suffering from the intense pain of the worm exiting their foot puts their foot into water that is used as a source of drinking water. The larvae then enter water fleas (an intermediate host, where they mature to the infective stage) and later enter the human digestive tract when water fleas are ingested with unfiltered water.

So if people can be taught to stop putting their infected feet in public water supplies and to start filtering water before they drink it, this painful disease can be eradicated.


Picture of Guinea worm extraction from the Parasites and Pestilence group at Stanford University.

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