Summary about Disease
Elephantiasis, also known as lymphatic filariasis, is a parasitic disease caused by thread-like filarial worms Wuchereria bancrofti, Brugia malayi, and Brugia timori. These worms are transmitted to humans through mosquito bites. The infection damages the lymphatic system, leading to abnormal swelling, most commonly in the legs, but also in the arms, genitalia, and breasts. Chronic cases can result in severe disfigurement and disability.
Symptoms
Many people with lymphatic filariasis have no symptoms. When symptoms do occur, they can include:
Lymphedema: Swelling of the limbs (legs, arms), genitalia (hydrocele), and breasts. This swelling can be temporary in early stages but becomes permanent and progressively worse over time.
Skin thickening: The skin becomes thick, hard, and rough, resembling elephant skin (hence the name).
Fever: Periodic episodes of fever.
Chills: Shaking chills.
Skin Ulcers: Open sores on affected skin.
Pain: Discomfort in the affected areas.
Hydrocele: Swelling of the scrotum (in men).
Causes
Lymphatic filariasis is caused by parasitic worms (filariae) transmitted to humans through mosquito bites. The worms reside in the lymphatic system, interfering with the flow of lymph fluid.
Parasitic Worms: Wuchereria bancrofti, *Brugia malayi*, and *Brugia timori* are the primary causative agents.
Mosquito Vectors: Different species of mosquitoes (e.g., Culex, *Anopheles*, *Aedes*, and *Mansonia*) transmit the infective larvae from person to person.
Medicine Used
The primary medications used to treat lymphatic filariasis target the microfilariae (larval stage of the worms) in the bloodstream. These medications are typically administered as part of mass drug administration (MDA) programs in endemic areas.
Diethylcarbamazine (DEC): Kills microfilariae and some adult worms. Often used in combination with other drugs.
Ivermectin: Kills microfilariae.
Albendazole: Used in combination with DEC or Ivermectin. It primarily targets adult worms. Important Note: Treatment primarily aims to reduce the microfilariae load, thus preventing further transmission of the disease. It can also help to alleviate some symptoms, but often does not reverse existing lymphedema. Careful skin hygiene, wound care, and exercises can help manage the swelling. Surgery may be considered in some cases.
Is Communicable
Lymphatic filariasis is not directly communicable from person to person. It is transmitted by mosquitoes that have fed on an infected person and then bite another person. The mosquito acts as a vector, carrying the infective larvae.
Precautions
Mosquito bite prevention:
Use insect repellent containing DEET, picaridin, or oil of lemon eucalyptus.
Wear long-sleeved shirts and pants, especially during dawn and dusk when mosquitoes are most active.
Use mosquito nets (preferably insecticide-treated nets) while sleeping.
Eliminate mosquito breeding sites around the home (e.g., standing water in containers, old tires).
Mass drug administration (MDA): Participate in MDA programs if living in an endemic area.
Skin Hygiene: Maintain good skin hygiene to prevent secondary bacterial infections in affected areas.
Wound care: Properly clean and care for any wounds or skin breaks to prevent infection.
How long does an outbreak last?
Lymphatic filariasis is not characterized by acute outbreaks in the same way as some other infectious diseases. It is a chronic, slowly progressing disease. A single mosquito bite with infected larvae does not immediately lead to elephantiasis. It takes years of repeated exposure to the parasite, for the worms to grow, reproduce, and cause lymphatic damage that leads to the visible symptoms of elephantiasis. Mass Drug Administration (MDA) programs typically run for 4-6 years to try to break the cycle of transmission.
How is it diagnosed?
Microscopic examination: Blood samples are examined under a microscope to identify microfilariae. Because microfilariae circulate mainly at night in most areas, blood samples are usually collected at night.
Antigen detection: Immunochromatographic card tests (ICT) and ELISA tests can detect filarial antigens in the blood, indicating the presence of the parasite.
Antibody detection: Tests can detect antibodies against filarial worms in the blood.
Ultrasound: Can be used to visualize adult worms in the lymphatic vessels.
Lymphoscintigraphy: A nuclear medicine imaging technique that can assess lymphatic function.
Timeline of Symptoms
The development of lymphatic filariasis symptoms is gradual and can take many years.
Initial Infection: Often asymptomatic.
Subclinical Stage: Damage to the lymphatic system begins, but there are no visible signs. This can last for years.
Acute Adenolymphangitis (ADL) Attacks: Episodes of fever, chills, and inflammation of the lymph nodes and vessels. These attacks can occur periodically.
Chronic Stage: Lymphedema begins to develop, initially reversible but eventually becoming permanent. Skin thickening and other complications develop over time. This can take 10-15 years or more to fully manifest.
Important Considerations
Global Elimination Program: The World Health Organization (WHO) has a program to eliminate lymphatic filariasis as a public health problem.
Secondary Infections: Lymphedema makes affected individuals more susceptible to secondary bacterial and fungal infections, which can worsen the condition.
Psychosocial Impact: Elephantiasis can cause significant social stigma, discrimination, and psychological distress.
Management of Lymphedema: Proper skin care, hygiene, exercise, and elevation of the affected limb are essential for managing lymphedema and preventing secondary infections. Compression bandages can also be helpful.
Prevention is Key: Preventing mosquito bites and participating in MDA programs are the most effective ways to prevent lymphatic filariasis.