WEBVTT - Ep 58 Guinea worm: (Almost) Ancient History 0:00:00.880 --> 0:00:03.120 When I was a young boy, I had two uncles. 0:00:03.440 --> 0:00:06.600 Both were heavily infected with guinea worms, and back then, 0:00:07.000 --> 0:00:10.039 no one here knew how guinea worm was transmitted. People 0:00:10.039 --> 0:00:13.880 would become infected and we just kept wondering why. During 0:00:13.920 --> 0:00:17.520 those years, we had some communal fighting, fighting between communities 0:00:17.600 --> 0:00:21.960 amid South Sudan struggle for independence. One day, fighting erupted 0:00:22.000 --> 0:00:24.640 in the evening, so everyone in my village ran away, 0:00:24.960 --> 0:00:27.720 but my uncles could not run, so they crawled to 0:00:27.720 --> 0:00:30.120 the garden to hide because no one could carry them. 0:00:30.400 --> 0:00:32.560 My mom could not carry them, and I had lost 0:00:32.600 --> 0:00:35.760 my dad during the struggle, so we had to leave them. 0:00:36.280 --> 0:00:40.559 There weren't any options. We just cried. So warfare comes 0:00:40.600 --> 0:00:43.159 and fighters raid our cows and kill some people and 0:00:43.200 --> 0:00:46.599 then go back where they came from. After that, when 0:00:46.640 --> 0:00:49.360 the people came back, we found that my uncles were gone. 0:00:49.920 --> 0:00:52.560 They had been killed. If it were not for guinea worm, 0:00:52.680 --> 0:00:54.639 they would have just joined us and treked away from 0:00:54.680 --> 0:00:57.440 the danger. So I say that it was guinea worm 0:00:57.480 --> 0:01:00.680 that killed them indirectly. When I was young, I could 0:01:00.720 --> 0:01:03.680 not understand how the guinea worm killed my uncles, But 0:01:03.760 --> 0:01:06.000 as time goes on, I have come to know this 0:01:06.080 --> 0:01:09.520 is our story. Later, we were living at a refugee 0:01:09.560 --> 0:01:12.479 camp and we were given pipe filters from the Carter Center. 0:01:13.080 --> 0:01:15.319 I didn't know why people were given pipe filters, so 0:01:15.400 --> 0:01:18.360 I refused to use mine. My mom is educated and 0:01:18.400 --> 0:01:20.959 she told me these were for guinea worm. And now 0:01:21.080 --> 0:01:23.520 she began to tell me this story, and I finally 0:01:23.520 --> 0:01:26.480 could see the connection between the guinea worm and the 0:01:26.520 --> 0:01:30.160 loss of my uncles. I said, okay, there are people 0:01:30.160 --> 0:01:32.560 that are working for this, and that was when I 0:01:32.600 --> 0:01:36.039 committed to working for guinea worm eradication. Because guinea worm 0:01:36.080 --> 0:01:39.240 had done something bad to me, and even if it 0:01:39.280 --> 0:01:41.720 had not been me, what of the rest of the community. 0:01:42.319 --> 0:01:44.600 That's what inspired me to work for the eradication of 0:01:44.640 --> 0:01:47.280 guinea worm. So I went away to school and when 0:01:47.280 --> 0:01:49.640 I came back, I looked for this work. When I 0:01:49.680 --> 0:01:52.200 found the man who would be my director, I told 0:01:52.280 --> 0:01:54.840 him I will never let you and my country down. 0:01:55.160 --> 0:01:57.800 I just need to relate to my community and see 0:01:57.880 --> 0:02:00.880 how this guinea worm is cruel to my community. I 0:02:00.920 --> 0:02:04.200 want my community to be free, and that's why you 0:02:04.280 --> 0:02:07.840 see I am doing this work. It is very difficult. 0:02:08.080 --> 0:02:09.840 If you want to work for guinea worm, you need 0:02:09.880 --> 0:02:11.960 to leave the good things in your life behind and 0:02:12.000 --> 0:02:15.040 become part of the community. That way, you come to 0:02:15.120 --> 0:02:18.080 understand the dynamic of how to help the community to 0:02:18.160 --> 0:02:22.480 eliminate the guinea worm. And that's been very effective. I've 0:02:22.480 --> 0:02:25.120 been there and I've worked, and I've seen how the 0:02:25.120 --> 0:02:27.880 guinea worm can go to nothing, and I have hope 0:02:27.919 --> 0:02:30.600 that one day we will be free and able to 0:02:30.639 --> 0:02:33.640 say that guinea worm is gone. It will be a 0:02:33.760 --> 0:02:36.760 very great achievement. I thank the Carter Center for helping 0:02:36.840 --> 0:03:20.560 us achieve it. 0:03:21.160 --> 0:03:26.000 Wow. That was that was Wow? That was an amazing story. Yeah. 0:03:26.080 --> 0:03:30.919 Yeah, so that was from Daniel deng Uh and he 0:03:31.000 --> 0:03:33.920 wrote that story called guinea Worm Killed My Uncle's which 0:03:33.919 --> 0:03:37.200 we found on the Carter Center blog. So that's who 0:03:37.240 --> 0:03:41.640 that was from. Yeah. Hi, I'm Aaron Welsh and I'm 0:03:41.760 --> 0:03:43.200 Erin Allman Updyke. 0:03:43.080 --> 0:03:45.120 And this is this podcast will Kill. 0:03:45.000 --> 0:03:49.360 You And if you haven't guessed, today we're talking about guinea. 0:03:49.000 --> 0:03:54.320 Worm, guinea worm tricculasis. I am really excited for this episode, 0:03:54.360 --> 0:03:56.520 which I know we say that every episode. 0:03:56.080 --> 0:03:59.240 Episode, but we're always excited, So it's always always excited. 0:03:59.720 --> 0:04:01.360 If you like, it's been a while since we've done 0:04:01.400 --> 0:04:06.000 a parasitic disease, so that's always interesting, you know. And 0:04:06.800 --> 0:04:09.480 the other reason that I'm super excited for this episode 0:04:09.640 --> 0:04:11.680 is that we have an incredible guest. 0:04:12.240 --> 0:04:13.840 Yes, we were. 0:04:13.920 --> 0:04:18.120 Fortunate enough to interview Sarah Urian, who is the senior 0:04:18.160 --> 0:04:21.680 Associate director of the guinea worm eradication program at the 0:04:21.800 --> 0:04:22.480 Carter Center. 0:04:23.040 --> 0:04:24.760 How amazing, I know. 0:04:24.880 --> 0:04:26.000 So we got to talk. 0:04:25.800 --> 0:04:28.440 With her a bit about her experiences on the ground 0:04:28.800 --> 0:04:30.720 as well as some of the more like, you know, 0:04:31.040 --> 0:04:35.400 the logistical finer points of how eradication is actually achieved. 0:04:35.520 --> 0:04:38.599 So keep an ear out for that later in the episode. 0:04:38.920 --> 0:04:42.040 Yeah, we're really excited about it. But first, oh, what 0:04:42.720 --> 0:04:43.560 what time is it? 0:04:43.680 --> 0:04:45.800 I think it's I think it. 0:04:45.800 --> 0:04:50.000 It must be quarantininey time. If I'm not mistaken, you're right. 0:04:50.080 --> 0:04:52.960 I just it's quarantine time. I checked my watch and everything. 0:04:56.880 --> 0:04:59.159 Well, Aaron, what are we drinking this week? 0:04:59.360 --> 0:05:01.880 We're drinking the Littlest Dragon. 0:05:03.040 --> 0:05:06.520 I love this name, so but it does require maybe 0:05:06.520 --> 0:05:10.719 a bit of explanation. Just so, the species name for 0:05:10.920 --> 0:05:16.679 guinea worm is Dracunculus medinensis, and dracunculus means little dragon, 0:05:16.920 --> 0:05:20.120 and so it's like the littlest dragons. 0:05:20.240 --> 0:05:22.000 The Tiniest Little Dragon. 0:05:22.520 --> 0:05:25.840 A cute name for a not so cute worm. I 0:05:25.920 --> 0:05:27.919 have to admit it's not the cutest of worms. 0:05:28.080 --> 0:05:30.760 You know. Are there cute worms out there? 0:05:30.800 --> 0:05:31.560 Absolutely? 0:05:32.040 --> 0:05:32.120 Oh? 0:05:32.120 --> 0:05:35.080 Okay, yeah, I don't know anybody, but I'm sure I'm 0:05:35.080 --> 0:05:35.880 sure that there are. 0:05:36.520 --> 0:05:39.720 Like oceanic worms. Actually, there's some cute ones in the ocean. 0:05:40.400 --> 0:05:42.560 Yeah, yeah, okay. 0:05:42.720 --> 0:05:48.040 Anyway, the Littlest Dragon. The Littlest Dragon is actually quite 0:05:48.080 --> 0:05:52.880 a delicious cocktail. So it has blue currosow, it has 0:05:52.960 --> 0:05:58.359 a rum pineapple juice cream of coconut, and the most 0:05:58.440 --> 0:06:02.640 crucial part is that you garnish it with a toothpick 0:06:03.040 --> 0:06:06.760 with a sour gummy worm wrapped around the toothpick for 0:06:06.839 --> 0:06:09.720 reasons that will become clearer later in the episode. 0:06:10.000 --> 0:06:13.240 Yes, and we'll post the full recipe for that quarantini 0:06:13.320 --> 0:06:16.040 as well as our non alcoholic plusy Brita on our 0:06:16.080 --> 0:06:18.159 website This podcast will Kill You dot com and all 0:06:18.200 --> 0:06:19.880 of our social media channels as well. 0:06:20.680 --> 0:06:23.479 Yes, so, I think we have a couple other pieces 0:06:23.520 --> 0:06:25.280 of business to take care of. 0:06:25.720 --> 0:06:26.640 We do so. 0:06:26.960 --> 0:06:30.000 First of all, I finally checked our po box after 0:06:30.160 --> 0:06:32.680 months of not going to the post office because of 0:06:32.720 --> 0:06:37.000 Corona and I'm thrilled for we got a couple of 0:06:37.560 --> 0:06:40.240 really really kind presents that we wanted to say thank 0:06:40.279 --> 0:06:43.320 you for. So First, I want to say thank you 0:06:43.720 --> 0:06:47.200 so much to Kira, who sent us not only the 0:06:47.240 --> 0:06:51.200 most adorable sweet just the sweetest letter, but also a 0:06:51.279 --> 0:06:55.800 handmade like Matt coaster for our quarantinies that looks like 0:06:55.839 --> 0:06:56.919 the coronavirus. 0:06:56.960 --> 0:07:00.560 Oh my gosh, it is incredible. Kira, Thank you so much. 0:07:00.600 --> 0:07:03.400 It's so sweet of you. And yeah, that letter made 0:07:03.480 --> 0:07:05.680 us like, oh, it's just like we're like, we. 0:07:05.640 --> 0:07:07.600 Don't deserve this. 0:07:07.600 --> 0:07:09.600 This is too nice. 0:07:09.640 --> 0:07:12.080 And also, thank you so much to Melanie who made 0:07:12.120 --> 0:07:15.720 us handmade masks with little germs on them. 0:07:15.880 --> 0:07:19.200 Oh my gosh, they're so cool. Thank you so much 0:07:19.320 --> 0:07:22.880 Kira and Melanie. We appreciate It's so very much, so. 0:07:22.960 --> 0:07:25.320 Much, really amazing. 0:07:26.440 --> 0:07:29.679 Well, I think the only other business is that we've got, 0:07:29.800 --> 0:07:32.600 you know, merch as per usual. Good to this podcast 0:07:32.640 --> 0:07:35.040 We'll kill you dot com and click on the merch tab. 0:07:35.320 --> 0:07:38.040 Shout out to Abigail Irvin Penner, who designed all of 0:07:38.040 --> 0:07:39.840 our new merch. We love it so much. 0:07:40.040 --> 0:07:45.760 Oh my gosh, I'm I mean, I'm obsessed seriously, and 0:07:46.320 --> 0:07:50.000 we also have a Bookshop affiliate account, so you can 0:07:50.080 --> 0:07:52.040 find all of the books that we talk about on 0:07:52.160 --> 0:07:56.960 our podcast there and also good Reads list, so check 0:07:57.000 --> 0:07:57.360 those out. 0:07:57.400 --> 0:07:59.760 You can find all of those things on our website. 0:08:00.120 --> 0:08:03.960 Awesome, is that all? I think that's all excellent. Shall 0:08:03.960 --> 0:08:06.640 we dive right into the biology of this little worm? 0:08:07.080 --> 0:08:43.040 Let's do it right after this break. Guinea worm or 0:08:43.679 --> 0:08:48.160 as you mentioned aaron, Dracunculus medinensis, right. 0:08:48.600 --> 0:08:49.959 I think that's how you say it. 0:08:50.120 --> 0:08:53.120 I even googled how to make sure I pronounced dracunculus 0:08:53.200 --> 0:08:56.280 properly because I've never been able to pronounce it. But 0:08:56.640 --> 0:08:59.360 everyone knows I have issues with pronunciation. 0:09:00.800 --> 0:09:01.960 What do you mean? Cough cough. 0:09:05.520 --> 0:09:11.960 Anyways, Dracunculus medinensis is a nematode or a roundworm. So 0:09:12.120 --> 0:09:16.199 this is the same phylum as hookworm. This is our 0:09:16.280 --> 0:09:24.280 second nematoad. Gotta love them, Gotta love them, that's their tagline. 0:09:25.200 --> 0:09:30.720 So okay, because this is a complex parasite, we obviously 0:09:30.800 --> 0:09:33.120 have to start with the life cycle. 0:09:33.240 --> 0:09:34.480 Okay, excellent. 0:09:34.720 --> 0:09:39.160 We're gonna start with the first stage, larva, so that 0:09:39.280 --> 0:09:42.600 when we end this cycle will end with the human 0:09:42.720 --> 0:09:46.240 part of the life cycle. Okay, Okay, So the first 0:09:46.280 --> 0:09:50.040 stage larva, if dracunculus are tiny dragons. These are the 0:09:50.160 --> 0:09:55.560 tiniest dragons, the babies. They're found in water sources, fresh 0:09:55.600 --> 0:10:00.559 water or brackish water sources. They swim and they thrash 0:10:00.600 --> 0:10:03.200 about in this water the way that worms like to do. 0:10:03.840 --> 0:10:08.679 And then they find tiny little copa pods. Okay. A 0:10:08.720 --> 0:10:12.839 copa pod is a little crustacean think plankton from SpongeBob. 0:10:13.320 --> 0:10:15.959 They're really cute, really cute. 0:10:16.160 --> 0:10:21.680 Yeah, they're very adorable. These copa pods swallow this first 0:10:21.679 --> 0:10:26.160 stage larva of the guinea worm, and then within the 0:10:26.200 --> 0:10:29.199 body of the copa pod, the larva kind of burst 0:10:29.280 --> 0:10:32.840 out of their stomach and begin to develop and grow. 0:10:33.440 --> 0:10:33.840 Question. 0:10:34.320 --> 0:10:40.760 Yes, I know, it's starting early. Okay, So the first 0:10:40.760 --> 0:10:45.040 stage larva it is ingested by the copapod. Does it 0:10:45.240 --> 0:10:49.199 have any movement towards the copa pod, like you know 0:10:49.240 --> 0:10:51.040 what I mean? Does it have any directional movement? 0:10:51.640 --> 0:10:54.400 They have certainly movement. I don't know if they have 0:10:54.520 --> 0:10:58.120 directional movement towards copapods. I didn't see anything about that 0:10:58.200 --> 0:10:59.960 in the literature that I read. But that's a really 0:11:00.040 --> 0:11:05.240 interesting question. Okay, gotcha Okay, so now they've molted, they've 0:11:05.320 --> 0:11:08.960 grown inside of this copa pod, and then a human 0:11:09.360 --> 0:11:13.280 comes along and fills up their water container from the 0:11:13.320 --> 0:11:17.040 well or the pond or whatever that this copa pod 0:11:17.040 --> 0:11:19.920 has been living in, and they've been walking for a while. 0:11:20.000 --> 0:11:22.839 So they take a big old swig of that water 0:11:23.200 --> 0:11:28.920 and they swallow these tiny little plankton copa pods, and 0:11:28.960 --> 0:11:33.560 then inside our stomach, the human stomach, the copopods die 0:11:33.720 --> 0:11:37.400 because of all of the acid, and they're obliterated, and 0:11:37.480 --> 0:11:44.600 the larva come forth, burst free, survive somehow in our stomach, 0:11:45.120 --> 0:11:49.240 travel down into our small intestine, and then burrow their 0:11:49.280 --> 0:11:52.400 way out of the small intestine and into the wall 0:11:52.840 --> 0:11:53.840 of our abdomen. 0:11:54.360 --> 0:12:00.840 What it's terrifying. It is truly like the movie Ali, Yes, 0:12:01.000 --> 0:12:03.400 but just a little much smaller scale. 0:12:03.200 --> 0:12:04.920 The tiniest dragon of scale. 0:12:05.120 --> 0:12:07.640 Which is actually really funny because there's a documentary I 0:12:07.720 --> 0:12:11.600 watched which is narrated by a Sigourney Weaver about guinea worm. 0:12:11.760 --> 0:12:17.440 Yeah, oh my gosh, that's phenomenal. Okay, so now these 0:12:17.520 --> 0:12:22.400 tiny larval worms are in basically like the connective tissue 0:12:22.480 --> 0:12:26.440 layers of your abdominal wall, your belly wall, and there 0:12:26.600 --> 0:12:30.440 is where they will begin to mature into fully adult worms. 0:12:30.640 --> 0:12:34.240 And these worms have male worms and female worms, and 0:12:34.400 --> 0:12:38.640 they will mate and then the females will grow and 0:12:38.760 --> 0:12:43.840 grow and grow and become all full of millions of eggs. 0:12:44.440 --> 0:12:47.720 And this is a process that takes many, many months. 0:12:48.559 --> 0:12:50.719 And then over the course of these months, as her 0:12:50.760 --> 0:12:56.000 eggs mature into embryos, she will then travel down through 0:12:56.160 --> 0:13:01.800 our connective tissue, down and down and down to the 0:13:01.920 --> 0:13:06.000 lower limbs like your leg, usually your ankle or your foot, 0:13:06.280 --> 0:13:09.240 although she could travel anywhere because she's basically just under 0:13:09.320 --> 0:13:12.400 your skin, just like in the fatty tissue underneath your skin. 0:13:13.360 --> 0:13:16.800 And these little worms are migrating through down into your 0:13:16.840 --> 0:13:22.440 lower extremities. And then ten to fourteen months after somebody 0:13:22.559 --> 0:13:28.400 drinks these copapods, this fully engorged female worm, which is 0:13:28.480 --> 0:13:33.800 now seventy to one hundred centimeters long, that's up to 0:13:33.960 --> 0:13:35.880 a meter long. 0:13:36.160 --> 0:13:36.840 Very long. 0:13:37.040 --> 0:13:38.520 It's just very long. 0:13:38.800 --> 0:13:42.880 It started in like microscopic and now it's a meter long. Okay. 0:13:43.440 --> 0:13:45.920 Then they come all the way forth to the surface 0:13:46.080 --> 0:13:49.680 of your skin, and in doing so it produces a blister. 0:13:50.920 --> 0:13:57.880 And this blister is incredibly incredibly itchy, like unbearably itchy, 0:13:57.960 --> 0:14:01.400 and it's burning, and it's really uncomfortable, so much so 0:14:01.800 --> 0:14:03.439 that the only thing you want to do to try 0:14:03.480 --> 0:14:07.040 and stop the itch is submerge your foot in cool, 0:14:07.160 --> 0:14:09.840 cool water. So you find a pond and you do that, 0:14:09.920 --> 0:14:12.600 and as soon as your foot enters the pond, that 0:14:12.760 --> 0:14:17.720 worm contracts and she pushes up, and she bursts forth 0:14:17.760 --> 0:14:22.760 and literally pushes open part of her gravit uterus out 0:14:22.840 --> 0:14:27.040 of the blister, bursts open and expels upwards of five 0:14:27.120 --> 0:14:31.920 hundred thousand larval worms into the water, thus completing her 0:14:31.960 --> 0:14:32.600 life cycle. 0:14:33.160 --> 0:14:40.960 It's incredible, It is incredible. So seems like otherworldly. Absolutely 0:14:41.480 --> 0:14:45.280 seems like this is everything about it. 0:14:45.080 --> 0:14:49.080 Is mind blowing. It's it really is. Nematodes in general, 0:14:49.200 --> 0:14:51.520 I think are absolutely mind blowing creatures. 0:14:51.840 --> 0:14:54.160 Like I genuinely am fascinated by them. 0:14:54.480 --> 0:14:58.320 Same So I said that she bursts forth and releases 0:14:58.360 --> 0:15:01.680 all these larval worms, that's not the end of her story. 0:15:02.200 --> 0:15:04.480 That's just what happens the very first time that she 0:15:04.600 --> 0:15:08.440 comes into contact with water. But now she is partially 0:15:08.520 --> 0:15:11.720 freed from your skin. Literally part of this female worm 0:15:11.800 --> 0:15:14.760 is sticking out of you. And then every time that 0:15:14.840 --> 0:15:18.360 she's submerged in water, she'll release more larva, and the 0:15:18.400 --> 0:15:21.000 part that's outside of your body will kind of just 0:15:21.040 --> 0:15:23.040 shrivel up and die, and then a little bit more 0:15:23.080 --> 0:15:27.200 of her will emerge every day, every day, every day, 0:15:27.280 --> 0:15:31.880 until finally she is completely gone and has released I 0:15:31.880 --> 0:15:35.800 don't know, more than like three million larval worms into 0:15:35.840 --> 0:15:36.520 the environment. 0:15:38.280 --> 0:15:39.360 Whoa mm hm. 0:15:39.840 --> 0:15:40.480 It's a journey. 0:15:40.600 --> 0:15:42.040 Yeah, it's a real journey. 0:15:42.640 --> 0:15:43.080 Okay. 0:15:43.240 --> 0:15:48.120 So number one, what happens to the male? Ooh, great question, 0:15:49.080 --> 0:15:51.680 because he's just floating around in there somewhere. 0:15:51.320 --> 0:15:53.920 Pretty much just floating around. Yeah, you can sometimes get 0:15:53.960 --> 0:15:57.280 like a small inflammatory response from wherever he ends up, 0:15:57.320 --> 0:16:00.200 but usually he just sort of your body will just 0:16:00.240 --> 0:16:02.760 sort of calcify him, and then you'll just have a 0:16:02.760 --> 0:16:06.880 little like boop of calcium some deposit somewhere in your body. 0:16:07.080 --> 0:16:11.440 Nothing much does the where he ends up dying? Can 0:16:11.480 --> 0:16:13.520 that be problematic in terms of like if he ends 0:16:13.560 --> 0:16:14.240 up in a joint? 0:16:14.600 --> 0:16:18.400 Oh, Aaron, you are getting so far ahead. Okay, we'll 0:16:18.480 --> 0:16:21.400 just put a pin in it all right. 0:16:23.440 --> 0:16:30.400 My next question is how does the female know where 0:16:30.440 --> 0:16:30.840 to go? 0:16:31.480 --> 0:16:36.720 No? Idea, great question, I don't. It is the weirdest 0:16:37.080 --> 0:16:40.760 it is the weirdest thing, and all of the things 0:16:40.800 --> 0:16:42.480 that I read were She's just like, yeah, most of 0:16:42.520 --> 0:16:46.680 the time it's from the lower limbs, but it could 0:16:46.760 --> 0:16:49.280 be anywhere. I think that there's some thought that they 0:16:49.320 --> 0:16:53.560 travel in part along like lymphatic routes. So if they 0:16:53.640 --> 0:16:56.560 just get on the right lymphatic tract in your abdomen, 0:16:56.800 --> 0:16:59.600 a lot of your lymphatics are going to be draining 0:16:59.640 --> 0:17:02.200 down to your legs, or like your lymphacts from your 0:17:02.240 --> 0:17:04.160 legs are going to be draining up towards your abdomen. 0:17:04.320 --> 0:17:06.720 So it kind of makes sense they're if they're in 0:17:06.760 --> 0:17:09.000 your lower abdomen already that they just sort of end 0:17:09.080 --> 0:17:11.520 up going down to your legs. Gotcha, gotcha? 0:17:12.440 --> 0:17:17.679 Okay, And my other question pertains to the longevity of 0:17:17.720 --> 0:17:21.440 these worms. So good ten to twelve months, and that's 0:17:21.520 --> 0:17:25.240 typically just in correspondence with like a rainy, dry season 0:17:25.480 --> 0:17:27.720 in the places where these are most abundant. 0:17:27.760 --> 0:17:33.199 Probably good question, very good question. Yeah, So there is 0:17:33.359 --> 0:17:38.639 definitely seasonal dynamics in terms of transmission, but whether people 0:17:38.680 --> 0:17:41.439 are more likely to get infected in the wet or 0:17:41.480 --> 0:17:45.720 the dry season depends on where they live and what region. 0:17:46.200 --> 0:17:49.760 So in some parts of the world, transmission is highest 0:17:49.920 --> 0:17:54.040 during the rainy season if it's areas where people are 0:17:54.080 --> 0:17:57.680 primarily using ponds as their water sources that are otherwise 0:17:57.840 --> 0:18:01.720 dry during the dry season, right okay, But in other 0:18:01.800 --> 0:18:05.239 places that are maybe more wet in general, where you 0:18:05.320 --> 0:18:09.320 have step wells or other types of cisterns, then transmission 0:18:09.359 --> 0:18:12.040 tends to be highest in the dry season or right 0:18:12.119 --> 0:18:14.639 before the rainy season starts, at the very end of 0:18:14.680 --> 0:18:17.879 the dry season, because at that time the water quality 0:18:17.960 --> 0:18:21.960 supports higher numbers of copapods. The water is less turbid, 0:18:22.320 --> 0:18:26.560 and there's not as many streams washing things away, so 0:18:26.680 --> 0:18:29.080 the copapods aren't as dilute as they would be during 0:18:29.080 --> 0:18:31.760 the rainy season when water levels are high. 0:18:32.040 --> 0:18:33.800 That makes sense, isn't that ecology? 0:18:33.880 --> 0:18:34.040 There? 0:18:34.080 --> 0:18:37.840 You go? So cool, it's very interesting. 0:18:37.880 --> 0:18:41.320 Okay, but that didn't answer your question. So the worms 0:18:41.359 --> 0:18:42.120 live a long time? 0:18:42.320 --> 0:18:47.240 Yeah, yeah, I guess I'm thinking like other species of nematodes, 0:18:47.400 --> 0:18:50.119 they mature a lot more quickly, right, yeah, than that, 0:18:50.440 --> 0:18:53.520 And so I wonder whether it does seem to be 0:18:53.560 --> 0:18:56.760 more in correspondence with like the timing of the dry 0:18:56.800 --> 0:18:57.960 and the rainy season. 0:18:58.160 --> 0:19:00.879 Yeah, yeah, that makes sense because pretty much across the board, 0:19:00.960 --> 0:19:03.159 even though in some places it's the wet season and 0:19:03.200 --> 0:19:05.840 in some places it's the dry season. Either way, we 0:19:05.920 --> 0:19:11.720 definitely see seasonal trends, so that does make sense. Yeah, cool, yeah, 0:19:11.840 --> 0:19:17.480 all right, okay, so that was that was just the worm, right, right, 0:19:17.520 --> 0:19:20.240 that was just the life cycle of the worm. We're 0:19:20.240 --> 0:19:24.239 missing like the human part of it, right, These are 0:19:24.320 --> 0:19:27.240 humans that are being infected, So what the heck is 0:19:27.320 --> 0:19:32.600 going on in you? Let's find out tell me, okay. 0:19:32.680 --> 0:19:36.200 So for some people, the first sign of infection might 0:19:36.280 --> 0:19:40.840 be noticing the worm itself, right, just kind of beneath 0:19:40.880 --> 0:19:43.640 the skin, a few days before it emerges, kind of 0:19:43.680 --> 0:19:48.720 as it's traveling down. For others, and very commonly, it's 0:19:48.840 --> 0:19:53.359 kind of a more generalized kind of allergic type symptoms, 0:19:53.600 --> 0:19:57.199 so maybe hives, maybe a bit of a fever, some 0:19:57.320 --> 0:20:00.560 swelling under your eyes, kind of like you might think 0:20:00.680 --> 0:20:02.280 I have an allergy to something. 0:20:02.680 --> 0:20:05.000 But all of this would be still around the time 0:20:05.040 --> 0:20:06.440 of its emergence. 0:20:06.119 --> 0:20:08.879 Of its emergence, right, not of when you get infected. 0:20:09.560 --> 0:20:13.160 Pretty much, there's basically no symptoms when you first get infected. 0:20:13.640 --> 0:20:17.280 So this is a year after you drink the larvae. Okay, 0:20:18.400 --> 0:20:22.560 But for most people, the very first indication of infection 0:20:22.920 --> 0:20:27.399 is the blister. And like we said, already, eighty to 0:20:27.480 --> 0:20:30.159 ninety percent of the time, it's on the legs or 0:20:30.200 --> 0:20:33.919 the feet, and it usually starts pretty small, but it 0:20:34.040 --> 0:20:37.479 grows fairly rapidly. It can grow over a number of 0:20:37.520 --> 0:20:41.560 hours or over a couple of days. And the blister 0:20:41.800 --> 0:20:45.919 before it opens is sterile, So it's not filled with 0:20:45.960 --> 0:20:50.600 like puss and bacteria like a pimple kind of blister. 0:20:50.840 --> 0:20:51.720 Right, it's just clear. 0:20:52.280 --> 0:20:58.680 It's clear liquid, it's inflammatory fluid, and it's filled filled 0:20:59.119 --> 0:21:03.879 with larva worm. So the female starts to release larval 0:21:04.000 --> 0:21:07.399 worms underneath your skin as part of the formation of 0:21:07.440 --> 0:21:07.919 the blister. 0:21:08.400 --> 0:21:10.240 So we're not quite sterile, is it. 0:21:11.440 --> 0:21:14.600 Well, yeah, it doesn't grow bacteria, is what we mean 0:21:14.640 --> 0:21:20.720 by sterile. And what's so interesting is that it's not 0:21:21.000 --> 0:21:25.880 entirely clear, like pathologically what causes the formation of the blister, 0:21:26.040 --> 0:21:30.720 like whether it's the adult worm releasing enzymes that cause 0:21:30.840 --> 0:21:35.119 tissue death, or whether it's the embryos the larva themselves 0:21:35.160 --> 0:21:38.800 that are causing the tissue damage, which I think is 0:21:38.840 --> 0:21:41.600 really interesting that we still just don't quite understand. 0:21:41.920 --> 0:21:44.879 Well. I also think you know to jumping ahead a 0:21:44.880 --> 0:21:47.520 little bit, but that there's probably a lot that we 0:21:47.640 --> 0:21:50.080 don't know about the biology or the ecology of this 0:21:50.200 --> 0:21:55.400 simply because it's not directly relevant to the control right 0:21:55.480 --> 0:21:57.720 of the parasite exactly. 0:21:57.960 --> 0:22:00.280 I think there is so much of this that we 0:22:00.520 --> 0:22:03.560 just don't know because it hasn't been studied because we 0:22:03.600 --> 0:22:10.480 didn't technically need to quote unquote to get it under control. Right, Yeah, okay, 0:22:10.560 --> 0:22:14.439 So now you have this blister, and then it'll start 0:22:14.480 --> 0:22:18.600 to open. So very often it opens at first in 0:22:18.680 --> 0:22:22.320 contact with water, because that does produce in the female 0:22:22.320 --> 0:22:27.879 worm this intense contraction where she pushes herself forth. But 0:22:28.080 --> 0:22:30.920 it is possible to have the blister break open even 0:22:31.000 --> 0:22:34.479 if you don't put your feet in water. So now 0:22:34.600 --> 0:22:39.080 you have this female worm half sticking out of a 0:22:39.200 --> 0:22:44.280 wound in your foot, and basically the only way to 0:22:44.400 --> 0:22:48.159 get her out is to slowly pull her out in 0:22:48.200 --> 0:22:51.240 a process that can take usually at least a month, 0:22:51.840 --> 0:22:59.240 where you slowly twist the worm around a small stick 0:23:00.280 --> 0:23:05.120 yep And that's why we have a gummy worm in 0:23:05.160 --> 0:23:06.280 our quarantini. 0:23:06.880 --> 0:23:12.120 It is indeed, if anyone still even wants to make 0:23:12.160 --> 0:23:14.600 it after that, after the script. 0:23:15.440 --> 0:23:17.720 Of a worm coming out of your foot that you're 0:23:17.760 --> 0:23:21.960 wrapping around a stick slowly over the course of a month, Okay, 0:23:23.160 --> 0:23:28.280 And that is the best case scenario, right, That's not 0:23:28.680 --> 0:23:33.760 what always happens. More than fifty percent of the time, 0:23:34.880 --> 0:23:39.600 the wound itself is complicated by a secondary bacterial infection. 0:23:40.680 --> 0:23:43.160 And there's a whole bunch of different ways that this 0:23:43.240 --> 0:23:47.879 can happen. Okay. So when the worm is happily living 0:23:48.000 --> 0:23:51.280 under the surface of your skin, in your subcutaneous tissue, 0:23:51.520 --> 0:23:55.160 it's in this little worm house, Okay. So it forms 0:23:55.200 --> 0:23:58.960 like this little fibrous worm sheath around itself, and that's 0:23:58.960 --> 0:24:02.160 how it can move without getting stuck to your tissues, 0:24:02.280 --> 0:24:06.880 like because of our inflammatory response. Okay, whoa, Yeah, it's 0:24:06.960 --> 0:24:11.080 that really cool, which I think is probably part of 0:24:11.119 --> 0:24:14.240 why it takes so long to travel down, right, It's 0:24:14.240 --> 0:24:17.800 not just like swimming through. It's like slowly moving its 0:24:17.840 --> 0:24:19.560 little sheath within its sheath. 0:24:19.600 --> 0:24:20.560 Oh my god. 0:24:21.160 --> 0:24:25.600 Okay wow. Yeah, But once it starts to emerge and 0:24:25.640 --> 0:24:29.720 it breaks through our skin, then our inflammatory response can 0:24:29.800 --> 0:24:32.879 really start to kick in and it can form adhesions 0:24:32.960 --> 0:24:36.760 to the worm itself rather than the sheath, which can 0:24:36.800 --> 0:24:39.359 complicate the removal and make it harder because it's stuck 0:24:39.400 --> 0:24:43.840