Clinical Manifestations and Pathology

Usually the first clinical sign of infection is a blister, which the adult worm produces, accompanied by severe burning of the skin, at the site where the worm is about to start emerging. This begins about 1 year after the contaminated water has been drunk. The blister ruptures when the affected part of the body is immersed in water, leaving a small ulcer, at the center of which is the worm. Most worms emerge on the foot, ankle, or lower leg, but they can emerge through the skin on any part of the body. Sometimes the worm first appears as a curvy line beneath the skin, or at the center of a painful abscess or nodule.

Worms that do not emerge from the body die and are then absorbed, or calcify, in which case they appear as characteristic curled lines on X-ray. The worms may invade a major joint, the brain or spinal cord, or other vital area, producing more serious manifestations, although this is rare. Much more common are secondary infections of the local wound that give rise to abscesses, local arthritis, and sometimes tetanus. In most patients, only one worm emerges at a time, though as many as two dozen or more may present themselves simultaneously in one person.

Affected persons may be crippled for several weeks or even months, by the pain associated with the worm's slow emergence and secondary infections. Because the infection appears at such a critical time of year for food production and cripples large numbers of persons simultaneously, it has an enormous economic impact. Moreover, people who are infected develop no immunity, so they may be and often are infected year after year.

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