As the first part of the worm emerges, it is typically wrapped around a piece of gauze or a stick to maintain steady tension on the worm, encouraging its exit. Each day, several centimeters of the worm emerge from the blister, and the stick is wound to maintain tension. This is repeated daily until the full worm emerges, typically within a month. If too much pressure is applied at any point, the worm can break and die, leading to severe swelling and pain at the site of the ulcer.Treatment for dracunculiasis also tends to include regular wound care to avoid infection of the open ulcer while the worm is leaving. The U.S. Centers for Disease Control and Prevention (CDC) recommends cleaning the wound before the worm emerges. Once the worm begins to exit the body, the CDC recommends daily wound care: cleaning the wound, applying antibiotic ointment, and replacing the bandage with fresh gauze. Painkillers like aspirin or ibuprofen can help ease the pain of the worms exit. Outcomes
Dracunculiasis is a debilitating disease, causing substantial disability in around half of those infected. People with worms emerging can be disabled for the three to ten weeks it takes the worms to fully emerge. When worms emerge near joints, the inflammation around a dead worm, or infection of the open wound can result in permanent stiffness, pain, or destruction of the joint. Some people with dracunculiasis have continuing pain for 12 to 18 months after the worm has emerged.
Biologics that reduce the signalling of the major inflammatory cytokines TNF-α (Simponi, Humira) and IL-1β (anakinra) are promising treatments. Consultation with a rheumatologist can help to determine appropriate medications. After knee replacement
Arthrofibrosis can occur after total knee replacement or partial knee replacement, when excessive scar tissue (collagen fibril) deposition occurs in and around the knee. This can be accompanied by shortening of the patellar tendon (patella baja/infera) which can also contribute to limited flexion. The rates of AF after TKA vary widely in the literature as there is no standard definition. One studys definition is a total range of motion (ROM) <90 degrees constitutes AF, another definition is flexion contracture >10 degrees, or inability to flex the knee >100 degrees. AF is a diagnosis of exclusion; before making a final diagnosis of arthrofibrosis, other causes of stiffness following knee replacement should be excluded (ex: infection, malposition of the implants, or mechanical block to motion). In the case of AF after total knee arthroplasty (TKA) management traditionally consisted of aggressive physical therapy, and in the case that failed, manipulation under anesthesia (MUA). As discussed above, aggressive exercise is now avoided. The rates of MUA after TKA vary widely. There are several reasons for this: there is no definite consensus to when a MUA is required (different surgeons follow different indications), there is no standardized definition of arthrofibrosis (see above), and MUA is not always a reliable treatment.