Elephantiasis, also known as Lymphatic filariasis refers to a parasitic infection that causes extreme swelling in the arms, legs or genitals.
Other terms for elephantiasis are Barbados leg, elephant leg, morbus herculeus, mal de Cayenne, and myelolymphangioma.
The disease is caused by the filarial worm, which is transmitted from human to human via the female mosquito when it takes a blood meal. The parasite grows into an adult worm that lives in the lymphatic system of humans. The swelling is caused by obstruction of the lymphatic system, which results in the accumulation of a fluid called lymph in the affected areas.
When an infected female mosquito bites a person, she may inject the worm larvae into the bloodstream. The worm larvae reproduce and spread throughout the bloodstream, where they can live for many years.
Lymphatic filariasis is caused by three types of thread-like filarial worms which includes Wuchereria bancrofti, Brugia malayi, and B. timori.
There is podoconiosis, also known as non-filarial elephantiasis. This is a disease of the lymph vessels of the lower extremities that is caused by chronic exposure to irritant soils.
Other situations that can lead to elephantiasis are:
a protozoan disease called leishmaniasis
a repeated streptococcal infection
the surgical removal of lymph nodes (usually to prevent the spread of cancer)
a hereditary birth defect
Elephantiasis is typically characterized by a thickening of the skin and subcutaneous tissue that gives rise to the grossly enlarged and swollen limbs that earn the condition its name.
The condition currently affects over 120 million people, with 40 million affected by a severe form of the disease. Elephantiasis is most common among populations from India; an Indian person is affected in one third of all cases. Another third of cases involve people from Africa and the remainder are from South Asia, the Americas and the Pacific. The infection is most well known in tropical and subtropical regions.
Elephantiasis is a neglected tropical disease. The disease appears to be spreading, in spite of decades of research in this area.
Infection is usually acquired in childhood causing hidden damage to the lymphatic system. The painful and profoundly disfiguring visible manifestations of the disease, lymph-oedema, elephantiasis and scrotal swelling occur later in life and can lead to permanent disability. These patients are not only physically disabled, but suffer mental, social and financial losses contributing to stigma and poverty.
The lymphatic system is a complicated network of very fine tubes, about the diameter of a needle, which criss-cross body tissues to collect a fluid known as lymph. Lymph is a milk-like substance (containing white blood cells, proteins, and fats) that plays an important role in absorbing fats from the intestine, in fighting infections, and in the proper functioning of the immune system. Lymph is returned to the bloodstream via many vessels known as lymphatics. At various points, the lymphatics drain into masses of tissue known as lymph nodes or glands. If a blockage occurs, fluid may collect in the tissues, causing a type of swelling known as lymph-oedema. In the lymph system draining the legs, for example, few connections exist, and the legs often are a site of swelling when lymph-oedema occurs.
Signs and Symptoms of Elephantiasis In many cases, symptoms of elephantiasis do not appear until years after infection. As the parasites accumulate in the blood vessels, they can restrict circulation and cause fluid to build up in surrounding tissues. The symptoms may include:
Blocked lymph ducts
Brawny skin colour
Enlarged groin lymph nodes
Fibrotic skin tissue
Impaired lymphatic drainage
Massive limb swelling
Pain in testicles
Pain above testicles
Pebbly skin appearance
Thickened skin tissue
Verrucous skin appearance
The standard test for detecting the infection is microscopic examination of a blood smear for presence of the microfilariae. The blood should be sampled at night because the microfilariae circulate via the blood nocturnally.
Often times, the doctor diagnoses the disorder based on the symptoms and a medical history, after ruling out other disorders with similar symptoms.
Treatment for Elephantiasis
The main medication used to treat this condition is diethylcarbamazine or DEC, which kills the microfilariae as well as some adult worms. The medication is usually well tolerated but side effects include dizziness, fever and aching muscles.
Most times medications are not very effective against adult worms, but prevent further spread of the disease until the worms die on their own.
Though, treatments for lymphatic filariasis differ depending on the geographic location of the endemic area. In sub-Saharan Africa, albendazole is being used with ivermectin to treat the disease, whereas elsewhere in the world, albendazole is used with diethylcarbamazine. Geo-targeting treatments are part of a larger strategy to eventually eliminate lymphatic filariasis.
Additionally, surgical treatment may be helpful for issues related to scrotal elephantiasis and hydrocele. However, surgery is generally ineffective at correcting elephantiasis of the limbs.
A vaccine is not yet available but in 2013 the University of Illinois was reporting 95% efficacity in testing against B. malayi in mice.
Treatment for podoconiosis consists of consistent shoe-wearing (to avoid contact with the irritant soil) and hygiene; daily soaking in water with an antiseptic added, washing the feet and legs with soap and water, application of ointment, and in some cases, wearing elastic bandages.
Antibiotics are used in cases of infection.
Other treatment is symptomatic and supportive.
Elephantiasis Home Remedies/Home Cure
Carefully wash the swollen area with soap and water every day
Disinfect wounds if any using antibacterial and antifungal creams
Elevate and exercise the swollen arm or leg to improve the lymph flow
Maintain proper hygienic conditions
Use insect repellents and mosquito nets
Complications of Elephantiasis
Elephantiasis can complicate itself to very dangerous levels if left untreated in the early stages.
The following are some of the drastic complications that can occur:-
Hydrocele is very commonly observed in men who suffer from elephantiasis. Hydrocele is the accumulation of fluids in the testicles. This is a very painful condition, which renders men impotent.
Similarly, elephantiasis of the penis and the scrotum in males is a very painful condition and can lead to impotency.
In women, the elephantiasis can spread to the vulva. This could make it impossible for the woman to enjoy penetrative sex, and also to conceive. This causes growths in form of tumour, which may make the condition quite severe.
Elephantiasis can cause damage to the lungs in the form of eosinophilia, in which there is an increase in the number of eosinophils in the blood. This condition is characterized by a wheezing cough and fevers.
Prolonged elephantiasis can cause failure of the kidneys.
With DEC treatment, the prognosis is good for early and mild cases of lymphatic filariasis. The prognosis is poor, however, for heavy parasitic infestations.
Prevention can be achieved by treating entire groups in which the disease exists, known as mass deworming. The World Health Organization recommends mass deworming. This is done every year for about six years, in an effort to rid a population of the disease entirely.
Efforts to prevent mosquito bites are also recommended, including reducing the number of mosquitoes and promoting the use of bed nets.
Avoiding mosquito bites with insecticides and insect repellents is helpful, as is wearing protective clothing.
Much effort should be made in cleaning the breeding sites (stagnant water) of mosquitoes near people's homes in areas where filariasis is found.
Before visiting countries where lymphatic filariasis is found, it would be wise to consult a travel physician to learn about current preventative measures.