Gunjan Agarwal
Elephantiasis - 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 maybe the result of an infection called as Filariasis (fil-a-ry-a-sis). It is caused by a worm called as 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 Chlamydia group. The disease is called as 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 25million men have 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 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 as microfilaria, multiply and grow to form adult filarie. These adult filarie 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 causing 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 finger tip 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 history of residing in an endemic area prompt towards a diagnosis. Routine tests such as a complete blood count reveal only elevation of eosinophils which is a marker of parasitic infection.
Microscopy of blood specimen obtained strategetically – either by finger prick or a venous blood sample taken between 10pm to 2am, when the microfilaria are maximum in circulation, have been effective. The microfilaria of different species can be identified under the microscope.
Eye examination using 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 ELISA technique is diagnostic of filariasis.
Ultrasonography of the affected limb or scrotum to diagnose oedema and detect filarial have been used as a prognostic marker for 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 –
1. Prevention
2. Symptom management
3. 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 has not proved to be effective. The microfilaria continue 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 breeding of mosquitoes and 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 08/01/2015
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