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Calcified guinea worms in anterior chest wall: An incidental finding
Rajendra Prasad Takhar1, Motilal Bunkar2, Savita Arya3, Sheema Maqsood4
1Assistant Professor, Dept of Respiratory Medicine, Govt Medical College, Kota, Rajasthan.
2Senior Resident, Dept of Respiratory Medicine, Govt Medical College, Kota, Rajasthan.
3PG Resident, Govt Medical College, Kota, Rajasthan.
4PG Resident, Department of Pulmonary Medicine Peoples Medical College, Bhopal, MP.

Article ID: 100007Z09RT2015
doi:10.5348/Z09-2015-7-CR-7

Address correspondence to:
Rajendra Prasad Takhar
Type First Quarter No.4, Medical College Campus
Rangbari Road
Kota (Rajasthan)
India 324010
Phone: +919784006021

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How to cite this article
Takhar RP, Bunkar M, Arya S, Maqsood S. Calcified guinea worms in anterior chest wall: An incidental finding. Case Rep Images Med 2015;1:25–28.



Case Report

A 60-year-old female from rural area came to pulmonary out patient department with a history of cough and breathlessness since five months. She denied for fever, chest pain and hemoptysis. Her routine blood investigations were normal except total eosinophil count of 850/mm3. Her chest X-ray showed increased bronchovascular marking with curvilinear, coiled and serpentine calcification in the left upper zone suspecting calcified guinea worms (Figure 1). On examination a hard, crackling feeling present over left supra and infraclavicular region. Overlying skin was normal in color and texture. Past history suggestive of guinea worm infection with multiple times thread like worms had been taken out from her lower limbs. She was consuming unsafe drinking water from an open pond. Pulmonary function test revealed mild obstructive pattern. She advised for excisional biopsy of calcified guinea worm but did not give consent, later managed with bronchodilator and symptomatic treatment.

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Figure 1: Chest X-ray zoomed at left upper zone showing multiple curvilinear, coiled and serpentine densely calcified shadows just above the clavicle (arrow) suggestive of calcified guinea worms.


Discussion

The dracunculiasis has been eradicated from many countries of the world. The last reported case from India was in July 1996 and on completion of three years of zero incidences, declared free from Guinea worm disease [1]. Most probably, our case got infestation before the eradication.

Guinea worm disease (Dracunculiasis) is a parasitic infestation caused by a tissue nematode, Dracunculus medinensis (also known as serpent worm, dragon worm, and Medina worm) transmitted to humans through ingestion of contaminated water from ponds and shallow, open wells which contain immature forms of the parasite in the gut of tiny crustaceans (copepods- Cyclops) [2]. In the due course, these parasites are released following digestion of the Cyclopes by gastric juice in the stomach [3]. The worm penetrates the gut mucosa and migrates into subcutaneous tissues. Some worm (usually gravid female) emerges through a skin lesion while few of them lodged in subcutaneous tissue, die, get encapsulated and calcified. The mature female worm may cause a skin blister, a sterile abscess, an acute aseptic arthritis or an asymptomatic calcification [4]. A painful blister forms at site of emergence which rupture into contact with water to continue the life cycle. An allergic reaction occurs just prior to rupture in 30–80% of patients manifesting as rash, fever, urticaria and bronchial asthma. The radiological differential diagnosis includes hydatid disease, filarial infestation, cysticercosis and porocephalus [4]. There is no effective vaccine or medicine is available till date to treat or prevent guinea worm disease, although various benzimidazoles/nitroimidazole may have an anti-inflammatory action, aiding elimination. Since antiquity, winding worms out on a stick, a few centimeters a day, has been practiced and is still useful, along with antibiotic dressing to prevent secondary bacterial infection. The calcified worms represent dead parasite and asymptomatic in the majority of cases requiring no treatment like in our case [2].


Conclusion

Calcified guinea worms in chest wall are important for chest physicians because few patients may present with this type of X-ray picture and respiratory pathology is not always present in such cases.

Keywords: Calcified, Chest wall, Dracunculiasis, Guinea worm, Medina worm


Acknowledgements

All the staff members who were involved in the care of the patient.


References
  1. Mathur S, Gahlot RS. Calcified guinea worms in breast. J Assoc Physicians India 2006 Mar;54:201.   [Pubmed]    Back to citation no. 1
  2. Hakim FA, Khan NN. Dracunculiasis. An incidental diagnosis in a Saudi female. Saudi Med J 2007 Sep;28(9):1438–40.   [Pubmed]    Back to citation no. 2
  3. Hopkins DR, Ruiz-Tiben E, Ruebush TK, Diallo N, Agle A, Withers PC Jr. Dracunculiasis eradication: delayed, not denied. Am J Trop Med Hyg 2000 Feb;62(2):163–8.   [CrossRef]   [Pubmed]    Back to citation no. 3
  4. Stelling CB. Dracunculiasis presenting as sterile abscess. AJR Am J Roentgenol 1982 Jun;138(6):1159–61.   [CrossRef]   [Pubmed]    Back to citation no. 4
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Author Contributions
Rajendra Prasad Takhar – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Motilal Bunkar – Substantial contributions to conception and design, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published
Savita Arya – Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Sheema Maqsood – Conception and design, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Rajendra Prasad Takhar et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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