Vanquishing the Little Dragon from Medina

I’m not trying to scare you off, dear reader, because the information I am about to impart is rather fascinating in my opinion. But if you are easily grossed out, or if your tolerance for disgust is anything less than moderate and you’re about to sit down to breakfast, you may not want to read beyond this point. You have been warned.

I learned something new today. There has been a pitched battle going on since 1980, and most Americans and Europeans have had the luxury of not even knowing about it. And yet winning this battle, as we may do soon, would potentially prevent 3,500,000 people per year from experiencing a painful, debilitating, and disgusting disease.

Dracunculiasis is poised to be the second human disease to be completely eradicated in all of human history. (Smallpox was the first. Three cheers for vaccinations!) And oddly enough, we have Jimmy and Rosalynn Carter to thank for this upcoming victory.

Dracunculiasis has been around for about 3000 years, but it disproportionately impacts the more poverty-stricken amongst us. It’s typically contracted by drinking contaminated water, and it is usually only found in subtropical and tropical regions of the planet, because the strange and twisted process that results in this disease requires temperatures between 77 and 86°F, so, historically speaking, we’re talking about Africa and South Asia.

A few things must happen before a human has the misfortune of coming down with this nauseating malady, and yet more revolting things must occur before that human can help pass the disease along to others. I’m about to describe the entire disease cycle. Brace yourself.

We shall enter the cycle by meeting an interesting little creature called a copepod. (We could enter at any point in the cycle, really, as cycles are, by their very definition, circular, but these guys are kind of cute, so they make as good a starting point as any. Give me a bit of credit. I’m trying to ease you into this as gently as possible. given the circumstances.)

Copepods are tiny little crustaceans, typically 1 – 2mm long, that live in both fresh and salt water. There are at about 13,000 species of copepods that we know of. Each has its own unique and quirky anatomy. They are really important to have around, because they feed fish, and taken all together, they are most likely the largest biomass on earth. Only krill can really compete with copepods in the biomass contest.

Copepods are vital to the planet, in that they get rid of a sizable chunk of the human carbon emissions that we so selfishly produce. Also, no saltwater aquarium could thrive without copepods. They’ve been around for at least 500 million years, since the early Paleozoic Era.

If you have eaten any type of seafood whatsoever, especially if it’s under-cooked, or eaten any creature that eats seafood, or if you have swallowed any unfiltered water, accidentally or on purpose, or drank water directly from the water supply systems in New York City, Boston, or San Francisco, you have consumed copepods. Quite likely you do so on a daily basis. This is often nothing to worry about, but as I said, there are many different types of copepods.

Some copepods have been linked to cholera. It’s a rare American who comes down with cholera these days. (But think twice before time traveling to the 1800’s.)

And then there’s the copepod that dracunculiasis cannot exist without. This little guy is called, interestingly enough, the Cyclops.

Yes, they have a single, large eye. Hence the name. They are also called water fleas, and they can jump out of water much like a dolphin can. I don’t find these guys to be as cute as some of their cousins, but I might be biased now that I know their role in this story, which is about to get much more gross.

It’s only fair to mention that it’s really not the cyclop’s fault. It is just swimming around, minding its own business, not plotting to become a disease vector for a scourge that most white folks have never heard of. No. The little cyclops is a victim, too.

The real villain of this story is dracunculus medinensis, a parasite whose name translates as “The Little Dragon from Medina” because it was particularly common in the city of Medina in what is now Saudi Arabia.

It is more commonly known as the Guinea worm, because it was also very common along the Guinea coast of West Africa. Fortunately for the locals in both areas, Guinea Worms are no longer endemic in either place.

So the Cyclops is swimming along, looking for sustenance, and he comes upon the larvae of our evil little dragon. He chows down, not realizing that the larvae will remain alive inside him, and will in fact hang out there long enough to transform themselves into much larger larvae. If the parasite gets very lucky, the copepod in which it resides will then be swallowed by some clueless, thirsty human.

Once swallowed, the copepods die in our digestive tracts, and that releases the larvae, which then make their escape by penetrating the person’s stomach or intestine. They then take refuge in the abdominal area for the next two or three months. During that time, they develop into adult worms. If they’re male, they’re only about an inch and a half long, but the females… oh, the females! They get up to 39 inches long. (Are you feeling queasy yet? Because it gets worse.)

Once they’re adults, they mate, and the male dies. (He probably wouldn’t want to stick around to see this next bit, anyway.) The female, all 39 inches of her, migrates to the human connective tissue or nestles itself along bones, and it continues to develop the larvae within her. About a year after the human has first taken that fateful drink of unfiltered water, the female worm decides that it’s time to go.

It doesn’t leave quietly. It migrates to the skin, usually on a lower body part such as a foot or leg, and an ulcer forms. Once the ulcer bursts, the worm, all 39 inches of her, emerges, still alive. It can take 3 to 10 weeks to do so. I’ll spare you the images, but if you are truly curious, you can find hundreds on line.

Whenever the emerging worm comes in contact with fresh water during this seemingly endless process of traumatizing its host, the worm releases hundreds of thousands of larvae into that water in a milky cloud. That larvae is then eaten by a Cyclops, which is then consumed by a human (or, unfortunately, a dog or a cat), and so on and so forth.

So what, besides trauma and humiliation, is going on in the human during this time? Well, as the worm emerges, it is wrapped around a stick to maintain equal tension. Believe me, you don’t want to rip the worm in half, leaving much of it in your body to calcify, causing severe pain and swelling. A calcified worm can also cause arthritis or paraplegia, especially if it has wound its way into the central nervous tissue. Also, if the worm ruptures inside you, it will cause intense inflammation.

It’s bad enough that the worm is taking its sweet time, but it’s also releasing a toxin as it exits, and that toxin can result in nausea, rash, diarrhea, dizziness, swelling, blisters and itching. Aspirin or Ibuprofen can help a little. But you can expect to be in pain for a further 12 to 18 months after the worm hath turned, so to speak.

But meanwhile, inch by inch, day by day, the worm gets wrapped around the stick. Patience is a virtue. The site of the ulcer must be kept clean during the entire process.

After the worm is gone, it’s prudent to use antibiotic on the wound. One percent of all victims die from secondary infections. In centuries past, entire villages would come down with dracunculiasis all at once. Some scholars believe that the “fiery serpent” mentioned in the bible was actually an epic infestation of Guinea worms.

In addition, since the year 1674, it has been proposed that the Rod of Asclepius, which has since morphed into the symbol for the medical profession, actually represents a Guinea worm being wrapped around a stick. Blech. I’ll never be able to look at that symbol in the same way again.

If you’ve made it this far, you deserve a cookie. I will give it to you in the form of reassurance that we are making quite a bit of progress in eradicating the Guinea worm for good. That’s fortunate, because there is no vaccine, and once it’s in you, there’s no cure except to let it run its course.

Remember Roslyn and Jimmy Carter? They established the Carter Center to promote and expand human rights. Jimmy got a Nobel Peace Prize for co-founding it.

When Guinea worm disease came to the Carter Center’s attention in 1980, there were an estimated 3,500,000 cases reported each year, across 21 countries. Through the Carter Center’s efforts of educating people about the importance of filtering their water, providing those filters, and isolating and supporting infected people, the disease has nearly been eradicated.

This article about the Carter Center’s eradication efforts is what sent me down this wormy path. I’ve always been drawn to the macabre. It would take someone like Jimmy Carter to take on such an unsexy albeit necessary project.

In 2022, there were only 13 reported cases of the disease worldwide, and those occurred in Chad, Ethiopia, Mali, and South Sudan. Each of these countries are in the midst of civil unrest, causing health educators and medical supplies to be put at risk, and making it all but impossible to reach the people. This last stretch of the eradication marathon is perhaps the hardest. If we don’t stop the Guinea worm cycle in humans, cats and dogs, the parasite could get a foothold once again.

Still, we’ve made astounding progress toward worldwide eradication. Now is not the time to give up. For this, Jimmy Carter deserves our gratitude. (But if you plan to thank him, you may want to hurry. At the time of this writing, he is 98 years old.)

I don’t know about you, but I wouldn’t wish Guinea worm disease on my worst enemy. I’m probably going to have nightmares about it, even as I sleep in my nice home with its excellent sanitation and clean, treated water. The Guinea worm seems to have paused in its journey long enough to remind me that I have done absolutely nothing to earn such good fortune, and I should never take it for granted.

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