INTRODUCTION:

The parasitic disease Dracunculiasis, commonly called Guinea-worm disease, is brought on by the nematode Dracunculus medinensis. Humans contract the infection by consuming water polluted with copepods, which are tiny crustaceans that harbor D. medinensis larvae.

The primary definitive host is humans, with Cyclops as the intermediate host. The disease is most prevalent in African nations like Chad, South Sudan, Ethiopia, and Mali. It is endemic to rural and impoverished parts of the world. Global efforts are being made to eradicate this illness. Although the disease has a low death rate, it causes a great deal of morbidity and frequently has a catastrophic economic impact on the affected villages. Global health officials classify dracunculiasis as a neglected tropical disease (NTD) and state that it is the first parasitic illness to be eradicated. Mature female worms have a maximum length of one meter and a width of one to two millimeters. Male worms are 0.4 mm wide and range in length from 15 to 40 mm. The largest human-infecting nematode measures 1.6 inches for males and 31 inches for females^1-4. Worldwide cases of dracunculiasis are evident in Table 1 and illustrated in Figure 3.

Figure 1: Dracunculiasis worm⁵

Figure 2: Dracunculiasis worm in human⁶

Worldwide reported cases of Dracunculiasis:

Table 1: worldwide reported cases^6-9

Year	World	India	Chad	Uganda	Mauri-tania	Pakistan
1980	35894	2729	-	-	-	14155
1981	18741	5406	-	-	-	-
1982	51765	42926	-	-	-	-
1983	56520	44819	-	-	-	-
1984	75797	39792	1472	6230	-	-
1985	55173	30950	31	4070	-	-
1986	46043	23010	314	-	-	-
1987	260140	17031	-	-	-	2400
1988	758217	12023	-	1960	-	1111
1989	892055	7881	-	1309	534	447
1990	623579	4798	-	4704	8039	160
1991	543585	2185	-	120259	-	106
1992	374202	1081	156	126369	1557	23
1993	229773	755	1231	42852	588	2
1994	164977	640	640	10425	5029	-
1995	129852	60	149	4810	1762	-
1996	152814	9	127	1455	562	-
1997	77863	-	25	1374	388	-
1998	78557	-	3	1061	379	-
1999	96293	-	1	321	255	-
2000	15223	-	3	96	136	-
2001	63718	-	-	55	94	-
2002	54638	-	-	24	42	-
2003	32193	-	-	26	13	-
2004	16026	-	-	4	3	-
2005	10674	-	-	9	-	-
2006	25217	-	-	2	-	-
2007	9589	-	-	4	-	-
2008	4619	-	-	-	-	-
2009	3190	-	10	-	-	-
2010	1797	-	-	-	-	-
2011	1058	-	10	-	-	-
2012	542	-	10	-	-	-
2013	148	-	14	-	-	-
2014	126	-	13	-	-	-
2015	22	-	9	-	-	-
2016	25	-	16	-	-	-
2017	30	-	15	-	-	-
2018	28	-	17	-	-	-
2019	54	-	48	-	-	-
2020	27	-	12	-	-	-
2021	15	-	8	-	-	-
2022	13	-	6	-	-	-

Figure 3: Graphical representation of worldwide cases^7-9

ETIOLOGY:

Human’s contract dracunculiasis when they drink contaminated water that contains small crustacean copepods, or Cyclops, which are home to Dracunculus medinensis larvae. Humans are the main definitive host, and Cyclops is the intermediate host.

EPIDEMIOLOGY:

AGENT: DRACUNCULUS MEDINENSIS:

The primary definitive host is humans, while the intermediate host is Cyclops. Adult parasites can live in the head and neck, but their primary habitat is the subcutaneous tissue of the legs.

HOST FACTOR:

Man is the ultimate host. an individual may become infected more than once if they frequently use step-wells and wash and bathe in surface water, they are more likely to become ill.

ENVIRONMENTAL FACTORS:

Season: Step-wells supply the water during the dry seasons, which span from March to May when transmission peaks. This is because, during this time, drinking is usually linked to open cases of dracunculiasis. When ponds are used, which happens from June to September when the ponds are full, transmission takes place.

TEMPERATURE:

Larvae prefer temperatures between 25 and 30°C to develop, and they cannot develop below 19°C. The disease only affects tropical and subtropical regions.^10-14

SIGNS AND SYMPTOMS:

The first signs of dracunculiasis manifest about a year after infection, at which point the fully developed female worm is preparing to exit the infected person's body. Hives, fever, dizziness, nausea, vomiting, and diarrhea are some of the allergic reactions that some people experience when the worm migrates to its exit site, which is typically the lower leg, though it can appear anywhere on the body. When the worm reaches its target, it burrows beneath the skin to form a fluid-filled blister. Over one to three days, the blister gets bigger, begins to burn intensely, and eventually bursts, leaving a tiny opening in the skin. When the worm comes into contact with water, it spews a white substance that contains thousands of larvae. The open blister becomes infected with bacteria when the worm breaks through; this can result in swelling and redness, abscesses, or in more severe cases, gangrene, sepsis, or lockjaw. A secondary infection near a joint, most commonly the ankle, can harm the joint and result in stiffness, arthritis, or contracturesInfected individuals can have up to 40 worms emerge at once from multiple blisters, with an average of 1.8 worms per person. Worms exit the feet or legs in 90% of cases. On the other hand, worms can grow anywhere on the body.

The following are possible early signs of Guinea worm disease: fever, itchy, rash, vomiting, diarrhea, and/or vomiting along with dizziness. ^2,15-20

LIFE CYCLE OF DRACUNCULIASIS:

Consuming water contaminated with copepods, or microcrustaceans, can expose people to diseases. After being released, the larvae puncture the intestinal wall, and after about a year, they develop into adult worms inside the abdominal cavity. When stomach juice breaks the copepod inside the human host, the infecting Guinea worm larvae are freed. The male worms perish after developing and the female worms become pregnant. After nine to fourteen months, female worms can attain full maturity and grow up to one meter in length. Worms pass through the tissue beneath the skin. The female worms emerge from the skin, generally the feet, after approximately a year of infection because they are drawn to the skin's cooler surface. They create a painful blister at the skin's surface before they emerge. To alleviate the discomfort, patients typically submerge or bathe their legs in cold water, which allows the worm to escape the blister and surface. There is localized skin site soreness and itching during this period. The first-stage larvae are discharged into the water during this period when they are consumed by cyclops and go through two molts to become the third-stage larvae. Humans can resume the life cycle if they consume water contaminated by third-stage Cyclops larvae. It was recently proposed that the life cycles of dogs and fish are different. Dogs may become infected if they consume raw fish that have guinea worm larvae in it.

Humans can get the sickness by eating raw fish; this supposed cyclical spread has made the disease's elimination difficult, particularly in Chad.^21-27The life cycle of dracunculiasis is illustrated in Figure 4.

Figure 4: Life cycle of dracunculiasis²⁸

PREVENTION AND CONTROL^29-32

DRACUNCULIASIS ERADICATION PROGRAM INTERVENTIONS

Global eradication of dracunculiasis (Guinea worm disease) is the goal of the Guinea Worm Eradication Program (GWEP), a consortium of national and international partners. The basics of dracunculiasis prevention are as follows

· Provision of safe drinking water

· Surveillance (case detection) and case isolation (prevention of contamination of drinking water sources for animals or infected people)

· Vector control (destroying the teeth involved in the Guinea worm life cycle using an approved chemical tact)

· Health literacy and community outreach.

· Many of these interventions are carried out by village volunteers, individuals chosen by the community to work with GWEP. The core of the program is the village and volunteer work. They identify, treat, and keep dracunculosis patients out of their community's drinking water sources (a process known as "case containment." They also educate the community about health issues and provide water filters.

INVESTIGATION AND CASE-CONTROL:

GWEP village volunteers regularly search their communities for cases of dracunculiasis. Inspectors receive a monthly report from them detailing all the cases found in their communities. That information is then collated and forwarded to the national GWEP headquarters. This information is then communicated to the World Health Organization (WHO) and the Carter Center. GWEP uses this information to locate ongoing infections and understand the disease and its spread. One of the most important strategies to prevent the spread of dracunculosis is to limit its impact. In several countries, residential centers were built in key locations. These facilities help prevent dracunculosis patients from contaminating water sources while providing care and support to those affected.

If all of the following criteria are met, a case of dracunculiasis can be considered cured.

1. The person is identified either before the worm appears or within 24 hours after the worm appears.

2. Man has not come into contact with any source of water since the appearance of the worm.

3. The case was properly treated by a village volunteer or other health care provider who cleaned and bandaged the wound until the worm was completely removed and provided health education to prevent contamination of the patient's water sources. (if there are two or more emerging worms, the case is not saved until the last worm is removed).

4. The GWEP supervisor will confirm within seven days of the appearance of the worm that the above requirements have been met and that it is a true dracunculiasis.

5. If there is uncertainty about the contamination of drinking water sources, if it is known that the drinking water source is contaminated, and if the water in question meets some additional practical requirements, the approved treatment chemical temefos (ABATE®*) is used. potentially contaminated surface water. The same criteria applied to humans should be used to determine the isolation of an animal infected with tapeworm.

SAFE WATER:

Safe sources of drinking water include boreholes and deep, hand-dug wells with protective walls around them to prevent contaminated water from flowing back into the well (eg after a rain or flood, or when someone pours/pours water near the well). Running water, such as a stream or river, is also safe for guinea worms. GWEP supports the development and maintenance of safe drinking water sources. It also encourages the treatment of potentially contaminated drinking water. Households are equipped with fine-mesh fabric filters that filter fleas (tiny "water fleas" too small to see clearly without a magnifying glass) from contaminated drinking water that is not safe. Individual in-line filters are provided for people who travel or work outside the household and may not have filtered water. These devices are used as straws to drink water from unsafe water sources.

VECTOR CONTROL

A vector is an organism that carries or transmits a disease. DRACUNCULIASIS vector is an arthropod. To control this vector, GWEP applies a measured amount of an approved temeph (ABATE®*) to water sources suspected or known to be contaminated with Guinea worm-infected rubber-legged animals. This chemical kill infected arthropods and prevents people from contracting DRACUNCULIASIS when they drink the water.

· Health Education and Community Mobilization

· Health education and community mobilization are important aspects of DRACUNCULIASIS eradication. The activity includes:

· Educate communities about the disease and its spread.

· Educate people during home visits by GWEP volunteers and staff and through organized events such as worm weeks.

· Help villagers fight diseases

· Worms cannot enter water bodies such as lakes and ponds to prevent contamination of drinking water supplies.

· Using water filters to protect against DRACUNCULIASIS

· Burying or burning fish salts left over from fish processing to prevent dogs from eating them and to prevent fish guts from being fed to dogs.

· Carefully cook fish and other aquatic animals before eating them to avoid contamination.

· Confinement of infected or suspected dogs in collaboration with GWEP until their worms are completely removed or infection is eliminated.

· We help villagers understand the need for safe chemical treatment (temephos) in the water supply.

ERADICATION OF DRACUNCULIASIS:

Fig. 5 Eradication of dracunculiasis ³³

Since humans are the primary host of Guinea worms and there is no evidence that Dracunculusmedinensis has ever been reintroduced to humans from non-human infections in previously endemic countries, the disease can be controlled by identifying all cases and modifying it in humans. behavior to prevent its recurrence Once all human cases are eliminated, the disease cycle is broken, leading to its eradication.

Removing Guinea worm encountered several challenges: 1) Inadequate security in some endemic countries, 2) Lack of political will of leaders in some endemic countries, 3) The need to change behavior without a magic cure such as a vaccine or drug, 4) Insufficient funding at times.

In January 2012, the most ambitious and largest coalition health project ever, known as the London Declaration on Neglected Tropical Diseases, was launched at the WHO meeting at the Royal College of Physicians in London, to end/control dracunculosis, among others. neglected tropical diseases, by 2020. This project is supported by all major pharmaceutical companies, the Bill and Melinda Gates Foundation, the governments of the United States, the United Kingdom DFID, the United Arab Emirates, and the World Bank.

In August 2015, when Jimmy Carter discussed his diagnosis of melanoma that had metastasized to his brain, he said he hoped the last sea worm would die before him. As of 2018, the disease has been eradicated in 19 of the 21 countries where it was previously present. By the time the London Declaration Program ended, only 15 cases had been registered worldwide. The Kigali Declaration on Neglected Tropical Diseases predicts that total eradication will begin between 2022 and 2030.^34-42

TREATMENT:

If the marine worm comes out through a skin lesion, the patient slowly and carefully pulls it out (to minimize inflammation and pain), twisting a few centimeters of the worm over a stick every day. This painful process can last several weeks because the worm can reach a meter in length. Pain can be alleviated by applying moist compresses to the affected area and using an oral pain reliever. The risk of bacterial superinfection can be reduced by using topical antiseptics or antibiotic creams. In one study, the average duration of rabies injuries was 50% shorter in patients who received antibiotics instructions, and supplies for cleaning and debridement than in those who received no intervention. No anthelmintic drug is effective against the disease and there is no vaccine. Chippaux found that mebendazole treatment was associated with abnormal worm migration, which was more likely than usual in areas other than the lower extremities. Prevention is the only effective way to reduce the incidence of seaworm disease.

ALLOPATHIC:

No medication will cure the infection, but metronidazole and mebendazole are sometimes used to control inflammation and get rid of the worm. Wet compression relieves discomfort.Occlusive dressings improve hygiene and limit the spread of infectious larvae. Worms are removed by successively rolling them on a small stick." ROD OF ASCLIPIO".

AYURVEDIC MEDICINES AND FORMULATIONS^55-66

Neem (Azadirachta indica): Known for its powerful antimicrobial and anti-parasitic properties, neem leaves, oil, or extracts have traditionally been used in Ayurveda to fight various infections.

Turmeric (Curcuma longa): Curcumin, the active compound in turmeric, is known for its antimicrobial properties and can help control certain parasitic infections.

Garlic (Allium sativum): Garlic is believed to have natural anti-parasitic properties and has been used in traditional medicine to treat various infections.

Triphala: This traditional Ayurvedic formula of three fruits – Amalaki, biblical, and habitat – is known for its overall health benefits, including potential antimicrobial properties.

Vidanga (Embeliaribes): This herb has been used in Ayurvedic medicine for its anthelmintic (antiparasitic) properties and may be effective against some parasites.

Rasna- Rasna root is believed to have natural anti-parasitic properties and has been used in Ayurvedic medicine to treat various infections.

Bilva root- Bilva root is believed to have natural anti-parasitic properties and has been used in traditional medicine to treat various infections.

Bala root- Bala root is believed to have natural anti-parasitic properties and has been used in traditional medicine for treating various infections.

Gokshura- Gokshura is believed to have natural antiparasitic properties and has been used in traditional medicine to treat various infections.

AYURVEDIC FORMULATIONS ^43-66

Sr. No.	Internal Formulation	External Formulation	Nutraceutical
1.	Yogaraja Guggulu	Dhanvantara Taila	Raw garlic
2.	Dashamoolarishtha	Murivennum	Pumpkin seed
3.	Rasnasaptaka Kashaya	Ksheerabala Taila	Poamgranets
4.	Shallaki Plus (gufic)	Kottamchukkadi Taila	Beetroot
5.	Palsinuron (phyto pharma)	Nirgundi Taila	Carrot

CONCLUSION:

Over the past 20 years, the Global Dracunculiasis Eradication Campaign has been incredibly effective, as seen by the 95-98% reduction in the disease's worldwide burden. This has been made possible by villagers' community-based health activities, persistent financial assistance, and high-level political campaigning. The end of Sudan's protracted civil conflict and the implementation of successful preventative initiatives will be necessary to fully eradicate guinea worm disease globally. A few Ayurvedic remedies were also covered in the latest review study, and they are crucial in managing the elimination of Dracunculiasis.

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Received on 18.02.2024 Modified on 08.04.2024

Res. J. Pharmacology and Pharmacodynamics.2024;16(3):192-198.

DOI: 10.52711/2321-5836.2024.00033

¹B. Pharm Scholar, Smt. R.D. Gardi B. Pharmacy College,

Gujarat Technological University, Rajkot, Gujarat, India.

²Associate Professor, Department of Pharmacognosy,

Smt. R. D. Gardi B. Pharmacy College, Gujarat Technological University, Rajkot, Gujarat, India.

INVESTIGATION AND CASE-CONTROL:

SAFE WATER:

REFERENCES:

1B. Pharm Scholar, Smt. R.D. Gardi B. Pharmacy College,

Gujarat Technological University, Rajkot, Gujarat, India.

2Associate Professor, Department of Pharmacognosy,

Smt. R. D. Gardi B. Pharmacy College, Gujarat Technological University, Rajkot, Gujarat, India.

INVESTIGATION AND CASE-CONTROL:

SAFE WATER:

REFERENCES:

¹B. Pharm Scholar, Smt. R.D. Gardi B. Pharmacy College,

²Associate Professor, Department of Pharmacognosy,