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| Fig. 33.5 A, Caduceus. B, The classic matchstick recovery technique used in extracting the adult female worm. (From Zaiman H, Jong EC: Parasitic diseases of the skin and soft tissue. In Stevens DL, editor: Atlas of infectious diseases, vol. II, New York, 1995, Churchill Livingstone.) |
Dirofilaria tenuis, the raccoon heartworm, can cause subcutaneous nodules.
Dracunculus medinensis, or guinea worm, wanders through the subcutaneous tissue as part of its life cycle and eventually settles down where it may cause nodules and ulceration. Ivermectin, with or without coadministration of albendazole, has been used in many of the filarial diseases described previously. Dosages range from 200 to 400 mg/kg. The native treatment for
Dracunculus is to snare the worm (up to 120 cm long in the female worm) through the skin and roll it up on a stick (the matchstick technique). Some medical historians believe that the caduceus (Fig. 33-5A), the symbol for a physician, has its origins from the ancient method of extracting the
Dracuncula worm with a stick (Fig. 33-5B).
