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. 2017 May;22(5):558-566.
doi: 10.1111/tmi.12855. Epub 2017 Apr 5.

Guinea worm infection in northern Nigeria: reflections on a disease approaching eradication

Brian Greenwood  1   2 , Alice Greenwood  2 , Andrew Bradley  2
Affiliations

Guinea worm infection in northern Nigeria: reflections on a disease approaching eradication

Brian Greenwood et al. Trop Med Int Health. 2017 May.

Abstract
in English, French, Spanish

Global eradication of the guinea worm (Dracunculus medinensis) is near, although perhaps delayed a little by the discovery of a transmission cycle in dogs. It is therefore an appropriate time to reflect on the severe impact of this infection on the life of the communities where it was endemic prior to the start of the global eradication programme in 1981. From 1971 to 1974, we conducted a series of unpublished studies on guinea worm in a group of villages in Katsina State, northern Nigeria, where the infection was highly endemic. These studies demonstrated the high rate of infection in affected communities, the frequent recurrence of the infection in some subjects and the long-standing disability that remained in some infected individuals. Immunological studies showed a high level of immediate hypersensitivity to adult worm and larval antigens but a downregulation of Th1-type T-cell responses to worm antigens. Freeing communities such as those described in this article from the scourge of guinea worm infection for good will be an important public health triumph.

L’éradication mondiale du ver de Guinée (Dracunculus medinensis) est proche, quoique peut‐être un peu retardée par la découverte d'un cycle de transmission chez les chiens. Il est donc opportun de réfléchir à l'impact sévère de cette infection sur la vie des communautés où elle était endémique avant le début du programme mondial d’éradication en 1981. De 1971 à 1974, nous avions mené une série d’études non publiées sur le ver de Guinée dans un groupe de villages dans l'Etat de Katsina, dans le nord du Nigeria, où l'infection était fortement endémique. Ces études ont démontré le taux élevé d'infection dans les communautés affectées, la récurrence fréquente de l'infection chez certains sujets et le handicap de longue durée qui restait chez certaines personnes infectées. Des études immunologiques ont montré un niveau élevé d'hypersensibilité immédiate aux vers adultes et aux antigènes larvaires mais une régulation négative des réponses des lymphocytes T de type TH1 aux antigènes du ver. Libérer pour de bon les communautés telles que celles décrites dans ce document du fléau de l'infection par le ver de Guinée sera un triomphe important de la santé publique.

La erradicación global del gusano de Guinea (Dracunculus medinensis) está cerca, aunque tal vez se ha retrasado un poco por el descubrimiento de un ciclo de transmisión en perros. Por lo tanto, es el momento apropiado de reflexionar sobre el impacto severo que esta infección tiene sobre la vida de las comunidades en donde era endémica antes del inicio del programa global de erradicación en 1981. Entre 1971‐74 realizamos una serie de estudios no publicados sobre el gusano de Guinea en un grupo de poblados del Estado de Katsina, al norte de Nigeria, en donde la infección era altamente endémica. Estos estudios demostraron la alta tasa de infección en las comunidades afectadas, la frecuente recurrencia de la infección en algunos sujetos y la discapacidad prolongada en algunos de los individuos infectados. Los estudios inmunológicos mostraban un alto nivel de hipersensibilidad a los antígenos del gusano adulto y de las larvas pero una regulación decreciente de la respuesta de inmunidad celular TH1 frente a los antígenos del gusano. Liberar definitivamente a comunidades como las descritas en este artículo del flagelo del gusano de Guinea, será un importante triunfo para la salud pública.

Keywords: eradication; erradicación; guinea worm; gusano de Guinea; immunologie; immunology; inmunología; morbidity; morbidité; morbilidad; vers de Guinée; éradication.

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Figures

Figure 1
Figure 1
Map of Nigeria showing the site of the study in Katsina State, Nigeria, and a more detailed map of the study area indicating the area covered by the Malumfashi Endemic Diseases Research Project. Villages circled in red had more than 10 cases.
Figure 2
Figure 2
(a) Typical pool used for washing and as a source of drinking water during the farming season, (b) local extraction of a guinea worm using a twig, (c) arthritis of the knee in a patient with a guinea worm emerging above the medial malleolus, (d) synovial needle biopsy from the patient shown in panel c showing infiltration of the synovium with mononuclear cells, (e) long‐standing damage to the knee and permanent disability following guinea worm arthritis of the knee.
Figure 3
Figure 3
Age and sex distribution of 563 Nigerian cases of guinea worm infection.
See this image and copyright information in PMC

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