"Dracunculiasis" - the name itself sounds monstrous... and indeed it is. The monster in this case is a worm that builds a home inside the human body, lives there happily until breeding time, then begins a journey to emerge from the skin and find a body of water to lay its eggs in. Although this may very well be a pleasant journey for the worm, for the human, it's an excrutiating one. And so we begin The Tale of the Guinea Worm.

Dracunculiasis is a disease caused by the parasitic worm Dracunculus medinensis or "Guinea worm". This worm is the largest of the tissue parasites affecting human. The parasite migrates through the victim's subcutaneous tissues causing severe pain especially when it occurs in the joints. The worm eventually emerges (from the feet in 90% of the cases), causing an intensely painful oedema, a blister and the an ulcer accompanied by fever, nausea and vomiting.

People get infected with Guinea worm disease by drinking water contaminated with Dracunculus larvae. In the water, the larvae are swallowed by small copepods ("water fleas"). The worms mature inside the water flea and become infective in about 10 days. Once the worms have matured inside the water flea, any person who swallows contaminated water becomes infected.

Once inside the body, the stomach acid digests the water flea, but not the Guinea worm. During the next year, the Guinea worm grows to a full-size adult. Adult worms are up to 3 feet long and are as wide as a spaghetti noodle.

After a year, the worm will migrate to the surface of the body. As the worm migrates, a blister develops on the skin where the worm will emerge. This blister will eventually rupture, causing a very painful burning sensation. For relief, persons will immerse the affected skin into water. The temperature change causes the blister to erupt, exposing the worm. When someone with a
Guinea worm ulcer enters the water, the adult female emerges from the wound and releases a milky white liquid containing millions of immature worms into the water, thus contaminating the water supply.

The guinea worm -- this one strangely knotted -- is coaxed from an ankle during a procedure performed in public. Villagers often make a party out of the worm extractions to get people to attend and learn how to protect themselves.

People, in remote, rural communities who are most commonly affected by Guinea worm disease do not have access to medical care. Therefore, ulcers may take many weeks (8 weeks average) to heal; often becoming infected with bacteria. This causes disabling complications, such as locked joints or even permanent crippling. Each time a worm emerges, persons may be unable to work or resume daily activities for an average of 3 months. This usually occurs during planting or harvesting season, resulting in heavy crop losses. Parents who have active Guinea worm disease cannot care for their children. They also cannot tend or harvest or crops, which leads to financial problems for the entire family.

Once the worm emerges from the wound, it can only be pulled out a few centimeters each day and wrapped around a small stick. Sometimes the worm can be pulled out completely within a few days, but this process usually takes weeks or months

No medication is available to end or prevent infection. However, the worm can be surgically removed before an ulcer forms. Analgesics, such as aspirin or ibuprofen, can help reduce swelling; antibiotic ointment can help prevent bacterial infections.

Lelmi Malik writhes in pain as Solomon Olukade massages a guinea worm from her ankle in the village of Dunkure, Nigeria. Malik had four more worms extracted this day.

Just think how much more interesting Thursday night television would have been if the Survivor: Africa participants had come down with a case of Dracunculiasis!