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Testicular involvement in dracunculosis is extremely rare, although intrascrotal abscesses do occur in this infestation. Two cases of testicular abscess are reported. In both cases the guinea worm had penetrated the tunica albuginea to be lodged in the testicular as well as the paratesticular tissue. Dracunculosis should be included in the differential diagnosis of testicular swellings in areas where it is endemic.
Onchocerciasis is a disease of Africa and Central and South America. It produces severe skin disease and is a leading cause of blindness worldwide. Dracunculosis infection, caused by the guinea worm Dracunculosis medinensis, occurs in tropical Africa. Included in this article are discussions of the vector and transmission, pathology, immunology, diagnosis, and treatment of these two diseases.
We studied 18 cases of dracunculosis treated in our department of Internal Medicine in Paris. The mean duration of the hospital stay is 38 days (15 to 90). The cost of this stay, calculated on the basis of the daily charge, accounts for 93.3 % of the total cost. The longest stays are due to serious subcutaneous infections at the site of the worm and to multiple or complex associated diseases. Average charge for laboratory test, roentgenograms or other investigations amounts to 4.4 % of the cost of the hospital stay. A significant part of these investigations is warranted by cellulitis and the diagnosis of associated conditions. Antibodies prescribed for subcutaneous infections account for almost all of the drug expense (2.3 % of the total cost). Thus, investigations and treatment together amount to only 6.7 % of the daily charge. Traditional treatment of dracunculosis is based on manual extraction of the worm. Thiabendazole was added in 12 of the 18 patients. The average duration of hospitalization (34 days) and average charge for investigations and drug treatment (FF 611) were less in these 12 patients than in the 6 others (47 days, FF 1286). However, this result is to be considered with caution as the number of patients in each group is small, treatments were assigned without any statistical rule, subcutaneous infections were more or less serious and associated diseases may have had a bearing on results.
This report describes the case of a 29-year-old Nigerian woman with dracunculosis presenting as an adnexal mass. The patient had a history of two second-trimester spontaneous abortions for which she was being evaluated. During the evaluation, she was found to have multiple uterine leiomyomas and a calcified left adnexal mass by pelvic ultrasound and radiography. At laparotomy, the calcified mass was excised from the left broad ligament, and a myomectomy was performed. Histologic examination revealed a calcified, coiled guinea worm embedded in the fibrous tissue of the broad ligament. Only one other case of calcified guinea worm in the broad ligament has been reported in the literature.
A clinical and epidemiological longitudinal survey was made from 1985 to 1989 in four villages of a dracunculiasis hyper endemic region of Benin to identify indices usable in evaluation of prevalence or incidence of dracunculiasis. 720 patients were examined. 93.5% presented a typical eruption of one or more worms. Inflammatory, infectious or mechanical complications were observed in 57.5% of cases and induced disabilities in 44.7% of patients. Although retrospective surveys are easier, authors do not recommend such studies. Cross-sectional surveys would be performed at the peak of transmission. The index would be the number of disabled seen in the village at the moment of investigators' passage. This index represents about 20% of annual dracunculosis cases. Longitudinal surveys would be made by village health workers. The best index is the number of worm eruptions corrected by a reducing factor: from 0.4 to 0.67 according to transmission pattern of the region and knowledge of the local transmission model.
A young boy of 15 is examined because a swelling of the right lumbar fossa, of which etiology was not established. As a matter of fact, this swelling was the abscess wrapping up the anterior tip of a Medina filaria, which was rooted out by the patient himself in one step and without complication. Delay in diagnosis is explained by the lack of dracunculosis in the area, and by the migratory habits of this young patient who did consider his filariosis as a benign occurrence.
It is reported Dracunculus sp. in a dog from Fontana city, department of Patiño, in the Formosa Province, Argentina. This is the fourth report of Dracunculosis occurred in animals all from the same geographic area of Formosa.
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