Elephantitis

Elephantitis is caused by microscopic parasitic worms such as Brugai timori, Brugai malayi and Wuchereria bancrofti that live in the lymphatic systems of humans. the vectors are mosquitoes of different genus like Culex, Anopheles, Ansonia, Aedes and Coquillettidia depending on the geographical location. When these infected mosquitoes bite the humans in a blood meal, the larvae at the third stage of their life cycle is introduced through the skin of the host. Once inside, these larvae would develop into adults and would normally stay in the lymphatic system of the host. the adults would produce sheathed microfilaria that have night-time rhythm. These microfilaria are then ingested by the vectors when they bite the host for a blood meal. These larvae then would grow until they are passed again to the human host during their third larval stage.

When the parasitic worms migrate into the lymphatics, they would cause inflammation of the vessels causing swelling of the affected area (commonly the legs and scrotum). this is termed as elephantiasis disease and would occur more frequently in tropical regions, particularly in most parts in Africa.

Lymphatic Filariasis

Elephantiasis is also commonly called as lymphatic filariasis. the infection is generally acquired during childhood however the painful and extremely disfiguring manifestations would appear later. Acute bouts of the disease would result to temporary disability but lymphatic filariasis would cause permanent ones.

At present, over 1.3 billion people are at risk in 81 different countries and around 61% infected individuals are in the Southeast Asia, 30% are in the African regions and the rest are in the other tropical regions. More than a hundred twenty million individuals are presently infected and roughly forty million of them are incapacitated and disfigured. Lymphatic filariasis or elephantiasis disease cause genital problems in more than 25 million men and lymphedema in more than 15 million individuals. this disease is often linked with poverty thus eliminating this contributing factor would help in controlling or eradicating the disease.

Lymphedema is a chronic debilitating condition due to the obstruction of the lymph vessels causing excess fluid to collect in tissues resulting to edema. the lymphatics are the one responsible for draining the excess water and protein that constantly break out in slight amounts from the blood.

However a blocked lymphatic system would still continue to receive excess protein causing a build-up in the tissues. the accretion of protein in the tissues would attract the excess fluid thus the tissues will become distended. Distention would cause poor circulation, especially of oxygen, which would interfere with the normal operation causing gradual healing of the tissues. the chronic inflammation would also result in more formation and dilation of capillaries thus the affected area would feel warm.

Lymphedema is manifested by symptoms such as a feeling of heaviness and tightness in affected limb, bursting or shooting pains, tingling sensation of affected limb, tenderness and warmth of affected area.

The symptoms of elephantiasis are so general that diagnosing the disease in its early stages is quite difficult and moreover, the symptoms are not visible. As the disease advances, the symptoms would become more prominent.

Inflammation

The elephantiasis disease is characterized by considerable enlargement of the affected limb or area due to the accumulation of fluid in the tissues. the worst condition a person with this disease can manifest is the enlargement of the testicles or the “elephantitis of the balls”.

Enlarged Lymph nodes

The swollen lymph nodes are due to the obstruction of the lymph vessels by the parasitic worms. Some of the inflammation is also caused by the body’s immune response to the presence of the parasites.

Sweating

The back pressure that is placed on the lymphatic vessels would cause dilation of superficial vessels that would cause swelling and sweating. too much sweating causes discomfort.

Pain

Pain is felt due to the inflammation process that occurs in the disease process. the lymphedema that occurs will cause also the distention of the tissues and lymph vessels contributing to the pain.

Headache

The body’s reaction to the presence of the parasites and the dilation of superficial vessels would contribute to the head ache suffered by individuals with this disease.

Fever

Acute local inflammation and the immune response of the body to the presence of the parasitic worm cause fever. the underlying bacterial infection of the skin due to lymphatic damage is also a contributing factor to the disease.

Chills

The fever and inflammation would cause the patient to shake and have chills.

Vomiting

The allergic reaction and the increasing amounts of toxins in the body may cause the patient to vomit.

Skin Ulcers, rashes and abscesses

The ulcers are due to the chronic inflammation of the skin due to edema. the skin becomes sensitive thus can easily be damaged. the overburdened immune system cannot cope with the stress thus bacterial infection can easily infiltrate.

Joint Pain

This is caused by the edema of the surrounding limbs.

Other symptoms suffered by people with this disease include: thickened skin, hydrocele, hyperpigmentation of the skin, body malaise and in severe cases swollen spleen and liver with white discharges in the urinary tract.

Picture 1 : Picture of  Elephantitis of legs

Image source : freeyellow

Picture 2 : Picture of Elephantiasis

Image source : freeyellow

Picture 3 :  Elephantitis

Image source : photobucket

This is the inflammation of the testicles, the extremely feared warning sign of elephantiasis. the social stigma the patient suffers is so great since the affected person cannot cover his scrotum because of the enlargement of the testicles –sometimes as large as a basketball or watermelon.

According to studies, around fifty percent of the males with elephantiasis also suffer from testicular elephantiasis. the elephantiasis of the balls may include the outer penile skin, scrotum, testes or sometimes all three structures.

Picture – Elephantitis (Elephantiasis) BallsImage source Source – headbonesgallery

The main cause of elephantitis is the parasitic nematodes Brugai timori, Brugai malayi and Wuchereria bancrofti. of the three parasites, infection caused by Wuchereria bancrofti is the most widespread and severe. this disease condition is also caused by recurring streptococcal infection, surgical excision of the lymph nodes or it can be hereditary.

There are latest studies that show the red soil in Africa may cause elephantiasis. When individuals walk barefoot, minute chemical particles may penetrate the skin and lodge in the tissues of the lymphatic system. they could cause irritation of the tissues which becomes vulnerable to infection especially caused by streptococcus.

The definitive diagnosis for elephantiasis is the actual identification of the nematodes within the body fluids and tissues from infected individuals. this is quite difficult to do since the lymph nodes where the nematodes usually reside are not easily accessed.

At times, blood samples are taken and examined for the presence of microfilariae. Since these microorganisms only come out at night, the blood must be drawn at night to increase the chance of getting a blood sample that contains the parasites. during the day, these microfilariae would move to blood vessels that are located deeper in the circulation most especially those inside the lungs. if there is a need to perform a blood exam during daytime, there may a need to take drugs that would trigger the parasites to come out. After an hour, blood samples may be collected for examination.

In some cases where the blood samples come out negative but other symptoms are present, there is a need to examine the hydrocele fluid or urine.

Diethylcarbamazine (DEC or Hetrazan in the US) is the medicine of choice to treat lymphatic filariasis. the tablet (2mg/kg/day) is taken thrice a day for 3 weeks. the drug would kill the microfilariae swiftly while adult worms are killed slowly. Care must be taken to kill all the adult worms for the surviving female and male worms would pair and continue to reproduce thus the need for the prolonged intake of the drug. aside from this, DEC has shown its capacity to shrink the distended lymph nodes and reduce elephantiasis (if taken for a longer period).

There are also some Indian herbs that would help treat elephantiasis and some of these herbs have been used for centuries. Included in the list are Indian gooseberry (anti-helminthic properties), winter cherry, country mallow, Indian pennywort and cowhage plant.

Other ways of dealing with the disease is using pressure bandages to swathe the inflamed limb or elastic stockings to help lessen the pressure. Make sure to exercise and elevate the bandaged limb in order to facilitate drainage of fluids. for more severe cases, surgery is usually performed to remove the excess fibrous and fatty tissues, drain off the fluid and take out the dead nematodes.

To prevent the spread of disease, DEC should be taken as a preventive medication and the reduction of the vector numbers (mosquitoes) in a specific area. the use of insecticides and repellents, use of mosquito nets while sleeping and sporting of protective garments may also help prevent the spread of the disease condition. Cleaning the surrounding areas especially possible breeding grounds of mosquitoes would also be beneficial.

For non-filarial elephantiasis, the best way to prevent this is to wear shoes all the time in identified places where this kind of condition has been known to exist. Proper hand washing can also help decrease the possibility of contamination.

References:

who.int/mediacentre/factsheets/fs102/en/

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by dr.rajesh moganti on 17. Apr, 2011 in Diseases and Conditions