Dracunculiasis — DTM&H MCQ

Correct answer: E — Gradual winding around a stick over days to weeks

The correct answer is E, gradual winding around a stick over days to weeks. This describes classic Guinea worm disease (dracunculiasis), caused by Dracunculus medinensis, acquired by drinking water containing infected copepods from step wells or ponds, exactly as in this Ethiopian patient. There is no effective antiparasitic drug against the adult worm, so management remains extraction, winding a few centimetres of the emerging worm around a stick or gauze each day, keeping tension without breaking it, since a ruptured worm provokes severe local inflammation and secondary infection. The wound is kept clean, immersed in water to encourage emergence, and dressed with antiseptic while extraction continues over weeks until the worm is fully removed. Why the other options are wrong: A. Surgical excision under general anaesthesia: The worm tracks subcutaneously and is fragile; attempted surgical removal risks rupturing it, releasing larvae and antigen that trigger intense inflammatory reaction and abscess formation, and is not standard practice. C. Oral ivermectin to kill the worm: Ivermectin and other anthelmintics have no proven direct action against adult Dracunculus medinensis and do not hasten expulsion. B. Application of turpentine to the exit site: This is a traditional folk remedy with no evidence base, does not aid safe extraction, and risks local tissue irritation. D. Oral metronidazole to facilitate expulsion: Metronidazole has occasionally been used for its anti-inflammatory rather than antiparasitic effect but does not kill or reliably expel the worm; it is not the recommended extraction method. Key point: Guinea worm disease has no curative drug; management is slow manual winding of the emerging worm around a stick over days to weeks combined with wound care to prevent secondary infection.

Reference: Cairncross S, Muller R, Zagaria N. Dracunculiasis (Guinea Worm Disease) and the Eradication Initiative. Clinical Microbiology Reviews, 2002 (PMC118073), https://pmc.ncbi.nlm.nih.gov/articles/PMC118073/