Elephantiasis: Wikis

  
  

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Elephantiasis
Classification and external resources

Self Created Illustration: Drawn from the collection at the National Museum of Health and Medicine. This illustration shows the effect of "Elephantiasis" in a historic context. Anatomical items: Left Leg, Scrotum. Created by Jeff Mitchell
ICD-10 B74.0
(ILDS B74.01)
I89.
ICD-9 125.9, 457.1
DiseasesDB 4824
eMedicine derm/888
MeSH D004605

Elephantiasis (/ˌɛləfənˈtaɪəsɪs, -fæn-/ [el-uh-fuhn-tahy-uh-sis, -fan-]) is a disease that is characterized by the thickening of the skin and underlying tissues, especially in the legs, male genitals and female breasts. In some cases the disease can cause certain body parts, such as the scrotum, to swell to the size of a softball or basketball.[1] "Elephantitis" is a common mis-hearing or mis-remembering of the term, from confusing the ending -iasis (process or resulting condition) with the more commonly heard -itis (irritation or inflammation). The proper medical term is Elephantiasis,[2] and it is caused by lymphatic filariasis or podoconiosis [3].

Contents

Causes

An East African man with elephantiasis of the scrotum

Elephantiasis occurs in the presence of microscopic, thread-like parasitic worms such as Wuchereria bancrofti, Brugia malayi, and B. timori, all of which are transmitted by mosquitoes.[4] However, the disease itself is a result of a complex interplay between several factors: the worm, the symbiotic Wolbachia bacteria within the worm, the host’s immune response, and the numerous opportunistic infections and disorders that arise. Consequently, it is common in tropical regions and Africa. The adult worms only live in the human lymphatic system.[5] Obstruction of the lymphatic vessels leads to swelling in the lower torso, typically in the legs and genitals. It is not definitively known if this swelling is caused by the parasite itself, or by the immune system's response to the parasite.

Elephantiasis of the legs due to filariasis. Luzon, Philippines.

Alternatively, elephantiasis may occur in the absence of parasitic infection. This nonparasitic form of elephantiasis is known as "nonfilarial elephantiasis" or "podoconiosis", and areas of high prevalence have been documented in Uganda, Tanzania, Kenya, Rwanda, Burundi, Sudan, Egypt and Ethiopia.[6] The worst affected area is Ethiopia, where up to 6% of the population is affected in endemic areas.[7][8] Nonfilarial elephantiasis is thought to be caused by persistent contact with irritant soils: in particular, red clays rich in alkali metals such as sodium and potassium and associated with volcanic activity.[9][10]

Cultural aspects

Elephantiasis is associated in the public mind with "The Elephant Man", the carnival stage name of Joseph Merrick. The name refers to the resemblance of the sufferer's limbs to the thick, baggy skin on the limbs and trunks of elephants. However, it is now believed that Merrick's deformity was not actually caused by elephantiasis, and that it may have been proteus syndrome instead, possibly combined with neurofibromatosis type I.

Treatment

"Bellevue Venus" Oscar G. Mason's portrait of a woman with elephantiasis, published in Fox.

Treatments for lymphatic filariasis differ depending on the geographic location of the endemic area.[11] In sub-Saharan Africa, albendazole is being used with ivermectin to treat the disease, whereas elsewhere in the world, albendazole is used with diethylcarbamazine.[11] Geo-targeting treatments is part of a larger strategy to eventually eliminate lymphatic filariasis by 2020.[11]

Another form of effective treatment involves rigorous cleaning of the affected areas of the body. Several studies have shown that these daily cleaning routines can be an effective way to limit the symptoms of lymphatic filariasis. The efficacy of these treatments suggests that many of the symptoms of elephantiasis are not directly a result of the lymphatic filariasis but rather the effect of secondary skin infections.

In addition, 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 is likely to be developed in the near future.

Treatment for podoconiosis consists of consistent shoe-wearing (to avoid contact with the irritant soil) and hygiene - daily soaking in water with an antiseptic (such as bleach) 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.

Antibiotics

In 2003 it was suggested that the common antibiotic doxycycline might be effective in treating lymphatic filariasis.[12]. The parasites responsible for elephantiasis have a population of symbiotic bacteria, Wolbachia, that live inside the worm. When the symbiotic bacteria are killed by the antibiotic, the worms themselves also die.

Clinical trials by the Liverpool School of Tropical Medicine in June 2005 reported that an 8 week course almost completely eliminated microfilariaemia.[13][14]

Genome for lymphatic filariasis deciphered

On September 20, 2007, scientists mapped the genome or genetic content of Brugia malayi - the roundworm which causes elephantiasis (lymphatic filariasis). Figuring out the content of the genes might lead to development of new drugs and vaccines.[15]

Possible elimination

A banner which directs the people to take the Albendazole tablets as a preventive measure against Elephantiasis; A scene from the Indian state of Kerala

According to medical experts the worldwide efforts to eliminate lymphatic filariasis is on track to potentially be successful by 2020.[16] An estimated 6.6 million children have been prevented from being infected, with another estimated 9.5 million in whom the progress of the disease has been stopped.

For podoconiosis, international awareness of the disease will have to rise before elimination is possible. Podoconiosis does not yet appear on the Neglected Tropical Disease lists [17], and is not part of the work of organizations such as the World Health Organization.

Impact on endemic communities

Elephantiasis caused by lymphatic filariasis is one of the most common causes of disability in the world.[11] In endemic communities, approximately 10 percent of women can be affected with swollen limbs and 50 percent of men can suffer from mutilating genital disease.[11]

In areas endemic for podoconiosis, prevalence can be 5% or higher.

See also

References

  1. ^ McNeil, Donald (2006-04-09). ""Beyond Swollen Limbs, a Disease's Hidden Agony"". New York Times. http://www.nytimes.com/2006/04/09/world/americas/09lymph.html. Retrieved 2008-07-17. 
  2. ^ http://www.who.int/mediacentre/factsheets/fs102/en/ Retrieved on May 17, 2009
  3. ^ http://ejhd.uib.no/ejhd-v22-n1/1%20Podoconiosis%20let%20Ethiopia%20lead%20the%20way.pdf Retrieved on January 26, 2010
  4. ^ CDC. (2008). "Lymphatic Filariasis". Centers for Disease Control and Prevention.: http://www.cdc.gov/ncidod/dpd/parasites/lymphaticfilariasis/index.htm. 
  5. ^ Niwa, Seiji. "Prevalence of Vizcarrondo worms in early onset lymphatic filariasis: A case study in testicular elephantiasis". Univ Puerto Rico Med J 22: 187–193. 
  6. ^ Davey G, Tekola F, Newport MJ (2007). "Podoconiosis: non-infectious geochemical elephantiasis". Trans R Soc Trop Med Hyg 101 (12): 1175–80. doi:10.1016/j.trstmh.2007.08.013. PMID 17976670. 
  7. ^ Birrie H, Balcha F, Jemaneh L. "Elephantiasis in Pawe settlement area: podoconiosis or bancroftian filariasis?". Ethiop Med J 35: 245–250. 
  8. ^ Desta K, Ashine M, Davey G (2003). "Prevalence of podoconiosis (endemic non-filarial elephantiasis) in Wolaitta, Southern Ethiopia". Trop Doct 32: 217–220. 
  9. ^ Price EW (1974). "The relationship bewteen endemic elephantiasis of the lower legs and the local soils and climate. A study in Wollamo District, Southern Ethiopia". Trop Geogr Med 26: 226–230. 
  10. ^ Price EW (1976). "The Association of endemic elephantiasis of the lower legs in East Africa with soil derived from volcanic rocks". Trans R Soc Trop Med Hyg 70: 288–295. doi:10.1016/0035-9203(76)90078-X. 
  11. ^ a b c d e The Carter Center. ""Lymphatic Filariasis Elimination Program"". http://www.cartercenter.org/health/lf/index.html. 
  12. ^ Hoerauf A, Mand S, Fischer K, Kruppa T, Marfo-Debrekyei Y, Debrah AY, Pfarr KM, Adjei O, Buttner DW (2003). "Doxycycline as a novel strategy against bancroftian filariasis-depletion of Wolbachia endosymbionts from Wuchereria bancrofti and stop of microfilaria production". Med Microbiol Immunol (Berl) 192 (4): 211–6. doi:10.1007/s00430-002-0174-6. PMID 12684759. 
  13. ^ Taylor MJ, Makunde WH, McGarry HF, Turner JD, Mand S, Hoerauf A (2005). "Macrofilaricidal activity after doxycycline treatment of Wuchereria bancrofti: a double-blind, randomised placebo-controlled trial". Lancet 365 (9477): 2116–21. doi:10.1016/S0140-6736(05)66591-9. PMID 15964448. 
  14. ^ Outland, Katrina (2005 Volume 13). "New Treatment for Elephantitis: Antibiotics". The Journal of Young Investigators. http://www.jyi.org/news/nb.php?id=361. 
  15. ^ Ghedin E, Wang S, Spiro D, et al. (2007). "Draft genome of the filarial nematode parasite Brugia malayi". Science 317 (5845): 1756–60. doi:10.1126/science.1145406. PMID 17885136. 
  16. ^ http://news.bbc.co.uk/2/hi/health/7659222.stm
  17. ^ http://gnntdc.sabin.org/about-ntds Retrieved January 26, 2010

External links


1911 encyclopedia

Up to date as of January 14, 2010

From LoveToKnow 1911

Medical warning!
This article is from the 1911 Encyclopaedia Britannica. Medical science has made many leaps forward since it has been written. This is not a site for medical advice, when you need information on a medical condition, consult a professional instead.

ELEPHANTIASIS (Barbadoes leg; Boucnemia), is a disease dependent on chronic lymphatic obstruction, and characterized by hypertrophy of the skin and subcutaneous tissue. Two distinct forms are known, (r) elephantiasis arabum, due to the development of living parasites, filaria sanguinis hominis (or filaria Bancrofti), and (2) the non-filarial form due to lymphatic obstruction from any other cause whatsoever, as erysipelas, the deposit of tuberculous or cancerous material in the lymphatic glands, phlegmasia dolens (white leg), long-continued eczema, &c. The enlargement is limited to a particular part of the body, generally one, or in rare cases both of the lower limbs, occasionally the scrotum, one of the labiae or the mammary gland; far more rarely the face. An attack is usually ushered in by febrile disturbance (elephantoid fever), the part attacked becoming rapidly swollen, and the skin tense and red as in erysipelas. The subcutaneous tissues become firm, infiltrated and hard, pitting only on considerable pressure. The skin becomes roughened with a network of dilated lymphatics, and vesicles and bullae may form, discharging a chyle-like fluid when broken (lymphorrhoea). In a later stage still the skin may be coarse and wart-like, and there is a great tendency for varicose ulcers to form. At the end of a variable time enlargement ceases to take place, and the disease enters a quiescent state: but recrudescences occur at irregular intervals, always ushered in by elephantoid fever. At the end of some years the attacks of fever cease, and the affected part remains permanently swollen. The only difference in the history of the two forms of the disease lies in the fact that the non-filarial form progresses steadily, until either the underlying condition is cured, or in the case of cancer, &c., brings about a fatal issue. The elephantiasis due to filaria is spread by the agency of mosquitoes, in whose bodies the intermediate stage is passed. The dead mosquito falls upon the water, which thus becomes infected, and hence the ova reach the human stomach. The young worm develops, bores through the gastric mucous membrane and finally becomes lodged in the lymphatics, usually of one or other of the extremities. A large number of embryonic filariae are produced. Some remain in the lymphatic spaces and cause lymphatic obstruction, while others enter the blood stream by night (filaria nocturna), or by day (filaria diurna). It is supposed that a mosquito, biting an infected person, itself becomes infected with the blood it abstracts, and that so a new generation is developed.

Treatment for this condition is unsatisfactory. Occasionally the dilated lymph trunks can be found, and an operation performed to implant them in some vein (lymphangeioplasty). And in some few other cases artificial lymphatics have been made by introducing sterilized silk thread in the subcutaneous tissues of the affected part, and prolonging it into the normal tissues. This operation has been most successful when performed on elephantoid arms dependent on a late stage of cancerous breast. Elevation of the limb and elastic pressure should always be tried, but often amputation has to be resorted to in the end. The disease is totally different from the so-called elephantiasis graecorum or true leprosy, for which see Leprosy.


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