Endemic areas:
(1) sub-Saharan Africa
(2) India
(3) Pakistan
(4) southern Iran
(5) southwestern portion of the Arabian peninsula
The person becomes infected by drinking environmental water containing copepods (water fleas) infected with larvae. The larvae are released after digestion of the fleas in the stomach.
Clinical findings:
(1) The patient develops a skin blister or papule that is pruritic, tender and "burning".
(2) The blister will rupture and part of the adult female worm will protrude from the opening. She will release larvae if submerged in water.
(3) An adult female worm may also be seen migrating in the dermis.
The blister is most common on the foot or ankle. However, it may also develop at:
(1) the groin
(2) around the umbilicus
(3) at the wrist
(4) back
(5) breast
(6) head
(7) scrotum
Complications:
(1) severe allergic reactions with eosinophilia
(2) cellulitis, cutaneous ulceration and abscesses
(3) arthritis with reduced joint mobility
(4) mild to severe disability
(5) tetanus
