Not every worm wrapped around a stick is a guinea worm: a case of Onchocerca volvulus mimicking Dracunculus medinensis

Abstract

BackgroundDespite being certified guinea worm free in 2007, Cameroon continues surveillance efforts to ensure rapid verification of any suspected reoccurrence. This includes the investigation of every rumor and confirmation of each suspicious expulsed worm. This paper presents fieldwork carried out to investigate a guinea worm rumor in Cameroon which turned out to be an Onchocerca volvulus mimicking Dracunculus medinensis.MethodsThe investigation included a field visit to the subsistence farming community where the rumor was reported. During the visit, interviews were conducted with health staff who managed the case and the elderly farmer from whom the worm was retrieved. An investigation of any potential missed guinea worm cases was also conducted through interviews with community residents and reviews of the health facility’s medical records. This was combined with laboratory analyses of water samples from the community’s water sources and the retrieved worm which was removed from the patient via wrapping it around a stick.ResultsMicroscopy and molecular analyses of the retrieved worm revealed a female Onchocerca volvulus whose expulsion strongly mimicked guinea worm. In addition to presenting findings of our investigation, this paper discusses distinguishing elements between the two parasites and gives an overview of guinea worm eradication efforts in Cameroon as well as current challenges to the worm’s eradication globally.ConclusionsThe investigation findings suggest the evolving Onchocerca volvulus worm tropisms’ adaptive survival behavior worth further investigation. Strategies used to successfully control guinea worm in Cameroon could be adapted for Onchocerca volvulus control.

Population genomic evidence that human and animal infections in Africa come from the same populations of Dracunculus medinensis

“…The long incubation time may make it particularly easy for Guinea worm to take advantage of human movement to spread, leading to these kinds of sporadic cases. It is also likely that incorrect reports of emerging worms will appear post-eradication [ 73 ]: given the paucity of morphological features defining D . medinensis , molecular tools will be key in providing certainty about the pathogen involved, and thus ultimately in allowing the WHO to declare that the world is free of Guinea worm.…”

Guinea Worm Disease: A Neglected Diseases on the Verge of Eradication

“…In addition, in countries where the two parasites are coendemic, differential diagnosis with Onchocerca spp is needed, because of their similar clinical presentation and to inform public health officals in charge of both Guinea worm and onchocerciasis control campaigns. In addition, clinicians should not miss the opportunity to provide correct treatment for Onchocerca infections [22][23][24]. Furthermore, when available, species identification allows for better surveillance.…”

“Cytochrome B”- Analysis of Hydrophobicity, Surface Accessibility, Antigenicity and Prediction of MHC I and MHC II Binders from Dracunculiasis

“…Failures in surveillance and containment, lack of clean drinking water, insecurity in Mali and parts of South Sudan, and an unusual epidemiologic pattern in Chad are the main remaining challenges to dracunculiasis eradication [7,8]. A case of Onchocerca volvulus has been reported in the Cameroon which is mimicking Dracunculus medinensis [9]. More than two decades after the International Drinking Water Supply and Sanitation Decade (IDWSSD) implemented by the United Nations (1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988)(1989)(1990) [10], the disease still lingers, underscoring the daunting challenge of disease control, as has been the case of the failure of previous attempts to eradicate diseases like malaria, hookworm and yaws [11].…”