A parasitic disease affecting mammals, medieval serfs deemed what we now know as dracunculiasis as an invasion of tiny dragons — dragons that eventually burrowed out of the skin. Multiple ancient texts refer to the disease, with the manner for treating dracunculiasis continuing to be a simple one. But how does one become infected with these "tiny dragons", what is the extrusion process like, and how has one group nearly eradicated the disease in a little over 25 years?

Warning: The following contains an image of a guinea worm extraction as well as a Carter Center video detailing the process.

How is this invasion of "little dragons" spread?

The oldest reference to what we now call dracunculiasis is a 1550 B.C.E Egyptian text, the Ebers text, which documents the disease and a form of treatment. The scary-as-hell "little dragons" terminology comes from a Latin origin of the word dracunculiasis.

Modern cases of dracunculiasis are called by a simpler name, guinea worm disease. This change in names is due to an early modern observation of the disease in humans living along the Guinea Coast of West Africa.


Copepods, a tiny crustacean present in stagnant water, is the delivery method of choice for Dracunculus medinensis larvae. One can observe copepods on the surface of water — these arthropods show up as little white specks dancing on the surface. Due to a lack of drinking water in affected areas, this contaminated water often has to be used, allowing a plethora of these Dracunculus medinensis-carrying copepods to build up the body.


When swallowed, the copepods are broken apart in the digestive tract, releasing the Dracunculus medinensis larvae into the intestines and beginning a year of pain.

Moving from the intestines throughout the body, the grown worm often settles in subcutaneous tissue. Within humans, the white worm grows to up to a meter in length and to a thickness of up to 2 millimeters over the course of a year — about the same width as angel hair pasta.


At the end of a year, the worm begins to exit the human host. The worm typically leaves through the leg or foot, but cases of exit through the testes or the tissue around the eye are on record.

New larvae are introduced into the water supply when the afflicted seek to numb the pain brought about by a guinea worm by submerging the exit wound in water. This begins the cycle again, introducing more Dracunculus medinensis larvae into the water supply, which latch onto copepods.


Due to the long incubation period, a human host will go the better part of a year without symptoms. When symptoms do arise, they are often debilitating, taking the person out of work and family life for the excruciatingly painful 2-3 month peroid as the worm makes its exit or is delicately teased out. This downtime is particularly detrimental to children, as the young are often taken out of school to work and provide for their family if a parent or provider is infected.

Extraction must be carried out slowly. The patient's extruded worm is often wrapped around a small stick, with oils used to help physically aid removal, a process that can only extrude centimeters of a worm at a time. If forceful removal of the worm is attempted, its 1 milimeter body can snap, leaving a long segment inside of the body to putrefy, damaging the tissue around it, or calcify.


Eradicating this gruesome disease
In the mid-1980s, former United States President Jimmy Carter, through the Carter Center, pushed for eradication of dracunculiasis through education of at-risk populations.

By posting security personnel around inland water supplies, doling out information as to how to filter copepods in drinking water, and encouraging at-home treatment of exiting worms using a piece of equipment as simple as a plastic bucket filled with water, the number of afflicted has decreased from 3.5 million cases in the mid-1980s to less than a few thousand cases a year worldwide.

The bucket of water is used to provide the same relief to the patient as that sought by dipping the exposed area in nearby bodies of drinking water. The water is then spread along the ground away from a body of water, leading to the death of larvae as the solution dries.


Thanks to these practices, the Carter Center, which currently receives financial aid for the effort from the Bill and Melinda Gates Foundation, is close to eradicating this gruesome disease worldwide.

Top image via the Carter Center. Additional images from Uwe Kils/CC, the WHO , the CDC.


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