Patient Education

What is Elephantiasis? How does it occur?

Elephantiasis (el-e-fan-TY-a-sis) is a condition characterized by swelling of the affected part of the body, mostly limbs. It may be the result of an infection called Filariasis (fil-a-ry-a-sis). It is caused by a worm called Wucheria Bancrofti or Brugia Malayi which is transmitted by mosquito bites. This worm finds its way to the lymphatic system of the body (lymphatic system acts as a filter and drainage system for blood and has various functions including maintaining immunity) causing blockage and hence swelling of the affected part. The affected part can swell to gigantic proportions, hence the name - elephant-like.

Other types of elephantiasis are genital elephantiasis caused by a sexually transmitted organism of the Chlamydia group. The disease is called Lymphogranuloma Venereum. Another form of elephantiasis is a Non-Filarial form which is an immune reaction in genetically predisposed individuals to certain types of soil.

Other causes are Tuberculosis, Leishmaniasis, Leprosy, and Idiopathic (implying that no cause could be found). Lymphatic Filariasis is the True Elephantiasis.

Is the disease common? I recently visited a tropical country, does it mean I can get it?

Elephantiasis is fairly common in tropical countries. Approximately 25 million men have the genital disease and 15 million have lymphoedema (swelling of the affected part), according to the latest WHO report. The chances of infection increases if you are living in an area endemic for filariasis. Only after repeated exposures to the mosquito bite, the worms can multiply and cause the disease. A short trip is not a risk factor for filariasis.

About 1.4 billion people in 73 countries are prone to filariasis. However, there are various programs in place which aim at the prevention of this disease by providing medicines as mass prophylaxis. One can check about the prevalence of the disease in their area/city by contacting the appropriate authorities.

How does the worm gain access to our lymphatic system?

The mosquito transmits the disease from an infected host to another person. When the person is bitten by an affected female mosquito, several larvae are injected into the bloodstream. These larvae also called microfilaria, multiply and grow to form adult filariae. This adult filariae then mate and produce larvae. Thus, the cycle continues. These adult worms can migrate to the lymphatic channels (think of a drainage pipe) and accumulate to cause a block. The obstruction to the lymphatic drainage then causes the swelling.

What are its signs and symptoms?

The disease presents broadly in 3 forms

  • Asymptomatic - the infection does not produce any signs or symptoms but can still cause damage to the lymphatic system and the kidneys.
  • Acute Elephantiasis - acute onset of fever with lymph node enlargement in armpits or groins along with pain followed by swelling of the limb.
  • Chronic Elephantiasis - after the acute phase resolves, the episode can re-occur several times after which the swelling remains to cause skin changes and disfigured limbs.

Edema of the limbs is graded on the severity of the edema

  • Grade I - Pitting (after pressing the edematous limb with the fingertip for 30 seconds, the fluid gets displaced into the surrounding tissue and leaves a ‘depression’ in the skin) edema which is reversible after elevating the limb
  • Grade II - non-pitting edema not reversible with elevation of the limb
  • Grade III - severe swelling associated with skin changes and thickening of the skin

How is it diagnosed?

High index of suspicion along with a history of residing in an endemic area prompt towards a diagnosis. Routine tests such as a complete blood count reveal the only elevation of eosinophils which is a marker of parasitic infection.

Microscopy of blood specimen obtained strategically - either by finger prick or a venous blood sample was taken between 10 pm to 2 am, when the microfilaria are maximum in circulation, have been effective. The microfilaria of different species can be identified under the microscope.

Eye examination using the Slit-lamp technique and skin examination using a special type of skin scraping may also yield results.

Other tests such as serum IgE levels, filarial antigen, and antibody testing are also available. Detection of Filarial Antigen using the ELISA technique is diagnostic of filariasis.

Ultrasonography of the affected limb or scrotum to diagnose edema and detect filarial has been used as a prognostic marker for the effectiveness of the treatment.

Special tests such as lymphoscintigraphy and biopsy of the affected tissue can also be done to establish a diagnosis.

What is the treatment?

The treatment is aimed at three objectives:

  • Prevention

  • Symptom management

  • Specific Treatment

Patients presenting in the acute phase require specific anti-parasitic drugs along with steroids to control the edema and pain. Antibiotics such as doxycycline may also be needed during the acute phase.

For chronic elephantiasis, bed rest, limb elevation, and compression bandages are helpful.

Surgical excision of affected tissue may also be needed.

Medications for affected individuals have not proved to be effective. The microfilaria continues to grow and reproduce even after months of therapy.

How can the disease be prevented?

Certain countries have programs that give medicines to all individuals living in the area. These programs are based on WHO guidelines. It provides 2 medications to be taken at once every year. Drugs included are Albendazole along with Ivermectin or Diethylcarbamazine Citrate (DEC).

Other measures to prevent the breeding of mosquitoes and the use of mosquito nets to safeguard oneself from being bitten need to be implemented. Use of Mosquito nets, ensuring proper drainage of water, covering overhead tanks, implementing appropriate hygiene practices and use of mosquito sprays act as preventive measures.

Elephantiasis Elephantiasis https://www.pediatriconcall.com/show_article/default.aspx?main_cat=general-pediatrics&sub_cat=elephantiasis&url=elephantiasis-patient-education 2015-08-01
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