ELEPHANTIASIS Lymphatic filariasis By Shantanu Pisharoty Shireen Gupta

ELEPHANTIASIS (Lymphatic filariasis) By Shantanu Pisharoty Shireen Gupta

Epidemiology Elephantiasis, puts at risk more than a billion people in more than 80 countries. l Over 120 million have already been affected by it, over 40 million of them are seriously incapacitated and disfigured by the disease. l One-third of the people infected with the disease live in India, one third are in Africa and most of the remainder are in South Asia, the Pacific and the Americas. l

Definition l The word elephantiasis describes: the gross (visible) enlargement of the arms, legs, or genitals to elephantoid size.

Causes It is caused by thread-like parasitic worms such as Wuchereria a bancrofti, Brugia malayi, and B. timori, all of which are transmitted by mosquitoes. l Obstruction of the lymphatic vessels leads to swelling in the lower torso, typically in the legs and genitals l

Nematodes (round worms) l There are 9 known filarial nematodes which use humans as the definitive host. l These are divided into 3 groups according to the niche within the body that they occupy: ¡ Lymphatic Filariasis, ¡ Subcutaneous Filariasis ¡ Serous Cavity Filariasis.

• liquid jigsaw - life-cycle of lymphatic filariasis animation

Signs and Symptoms many people never acquire outward clinical manifestations of their infections and there may be no clinical symptoms l However, studies have shown that victims, outwardly healthy, may have: -hidden lymphatic pathology -kidney damage -10 -50% of men suffer from genital damage including elephantiasis of penis and scrotum -10% women suffer from elephantitis of the breasts l

Diagnosis l The table below shows how the symptoms are graded by severity of the swelling – known as a lymphœdema. These swellings usually occur in the legs, breast tissue and groin.

Treatment – in endemic communities Aim to eliminate microfilariae from the blood of infected individuals so that transmission of the infection by the mosquito can be interrupted l single doses of diethylcarbamazine (DEC) optimally albendazole or ivermectin have long-term (1 -year) effect in decreasing microfilaraemia. l It is 99% effective in removing microfilariae from the blood for a full year after treatment. l In India, DEC has been used in a medicated salt to help prevent spread of the disease. l Side effects of DEC may include fever, chills, headache, dizziness, nausea and vomiting, itching, and joint pain. They usually occur within the first few days of treatment and go away as the person continues l

Treatment – for the individual anti-parasite treatment can result in improvement of patients' elephantiasis l rigorous hygiene to the affected limbs, with accompanying adjunctive measures to minimize infection and promote lymph flow which results both in a dramatic reduction in frequency of acute episodes of inflammation l Surgery can be performed to reduce elephantiasis by removing excess fatty and fibrous tissue, draining the swelled area, and removing the dead worms. With DEC treatment, the prognosis is good for early and mild cases of lymphatic filariasis. l