Guinea worm infections

Metronidazole is the drug of choice in Europe for anaerobic bacterial infections concern about possible carcinogenicity has led to some caution in its use in the United States. Recently it has been found to be effective in treating D. medinensis (Guinea worm) infections and Helicobacter pylori... 

The guinea worm infection is a very old parasitic disease caused by Dracuncu-lus medinensis which are enlongated thread-like filarial worms living in the deep connective and subcutaneous tissues of man. The infection has been reported from different parts of Africa, South America and Asia however, it is endemic in Cameroon, Lake Chad, Sudan, Uganda and India. 

Guinea worm infection Dracunculus tnedinensis Thiabendazole, niridazole, metronidazole... 

N early 60% of illness around the world is due to contaminated water and lack of sewer treatment. According to the World Health Organisation (WHO), about 2.4 billion people do not have access to basic sanitation facifities, and more than one billion people do not have access to safe drinking water. Unclean water causes diarrhoea, cholera, dysentery, guinea worm infection, typhoid, intestinal worm infection and trachoma [3]. According to the WHO, four bilfion people get diarrhoea every year that kills nearly 1.8 million people of which 90% are children under the age of five. 

Several papers have "been published dealing with the anthelmintic activity of the di-isothi yanate (XXI). The compound appears to he effective against hookworm 5o-1d3 and ineffective against ascarids. 59>loO Niridazole (XIV) in 25-30 mg. daily doses for ten days was effective in the treatment of guinea-worm infections (Dracontiasis).l° A 5 Animal studies with thiazolinitim (XXII) ° and benzothiazolinium salts (XXIIl) ° indicate antinematode activity. 

Niridazole is used in the treatment of schistosomiasis and of guinea-worm Dracunculus medinensis) infections it is given in divided daily doses of 25 mg/kg for 5-10 days, depending on the infecting species. Niridazole is well tolerated in Schistosoma hematobium infections. It is metabolized in the liver, and its metabolites color the urine dark brown. In the treatment of schistosomiasis it has been largely superseded by newer drugs. 

Humans become infected with guinea worms by drinking water contaminated by infected Cyclops. On reaching the intestine, the Ci/clops get digested by gastric juice liberating free larvae which pierce the intestinal mucosa and reach the connective tissues where they live and attain sexual maturity in about a year. 

Some 5-nitro-l,2-disubstituted-imidazoles of the type 11 and 12 have been shown to have appreciable in vitro and in vivo antischistosomal activities, but none find use in clinical practice [21]. However, metronidazole (13) has been used widely to treat guinea worm (Dracunculus medineusis) infection in human [22]. 

Murrell, K.D., Dean, D.A. and Stafford, E.E. (1975) Resistance to infection with Schistosoma mansoni after immunization with worm extracts or live cercariae role of cytotoxic antibody in mice and guinea pigs. The American journal of Tropical Medicine and Hygiene 24, 955-962. 

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