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If the adult gravid female worm dies in deeper tissues before completing its life cycle, or if it is traumatized in the subcutaneous tissues before a cutaneous lesion develops, the larvae may be released into the tissues, causing a localized acute inflammatory reaction or a cellulitis and abscess lying between tissue planes. The localization is useful in differentiating this condition from tropical pyomyositis (Fig. 27.9).

When worms migrate in soft tissues, nearby joints may become involved, especially the knee and ankle joints. There is edema, plasma cell infiltrate and foreign body giant cells in the synovial membrane and, at times, larvae may be found in the synovial fluid. When an adult worm dies and calcifies in the tissues adjacent to a major joint, the synovial membrane may become fibrotic, but a fibrous ankylosis usually does not occur unless a septic arthritis develops.

Fig. 27.9 Multiple guinea worm abscesses in the left leg of a 6-year-old girl. Each swelling contained an adult female D. medinensis. (Courtesy of Drs. S. Anand and K.T. Evans and Br J Surg, 1964).

Laboratory Diagnosis

The diagnosis of dracunculiasis is usually established by observing the head of the worm in a cutaneous blister and its body as a thread-like cord in the subcutaneous tissues. The morphological features of the worm and the characteristic clinical presentation are specific and easily recognized by villagers. Calcified guinea worms may be identified radiographically (Figs. 27.11- 27.20). Specific laboratory tests are rarely available and are unnecessary. There is usually a moderate to occasionally marked eosinophilia.

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