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Elephantiasis is a disease that is characterized by the thickening of the skin and underlying tissues, especially in the legs and male genitals. In some cases the disease can cause certain body parts, such as the scrotum, to swell to the size of a softball or basketball. "Elephantitis" is a common mis-hearing of the term, from confusing the ending -iasis (process or resulting condition) with the more commonly heard -itis (irritation or inflammation), resulting in "Elephantitis" meaning "inflammation of the elephant". The proper medical term for the disease is elephantiasis, and it is caused by filariasis or podoconiosis.
Causes
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. 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. 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.
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. The worst affected area is Ethiopia, where up to 6% of the population is affected in endemic areas. 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.
Treatment
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 is part of a larger strategy to eventually eliminate lymphatic filariasis by 2020.
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.
Filariasis (Philariasis) is a parasitic disease and is considered an infectious tropical disease, that is caused by thread-like filarial nematodes (roundworms) in the superfamily Filarioidea, also known as "filariae".
Contents
In humans
There are 8 known filarial nematodes which use humans as the host. These are divided into 3 groups according to the niche within the body that they occupy: 'lymphatic filariasis', 'subcutaneous filariasis', and 'serous cavity filariasis'. Lymphatic filariasis is caused by the worms Wuchereria bancrofti, Brugia malayi, and Brugia timori. These worms occupy the lymphatic system, including the lymph nodes, and in chronic cases these worms lead to the disease elephantiasis. Subcutaneous filariasis is caused by loa loa (the African eye worm), Mansonella streptocerca, Onchocerca volvulus, and Dracunculus medinensis (the guinea worm). These worms occupy the subcutaneous layer of the skin, in the fat layer. Serous cavity filariasis is caused by the worms Mansonella perstans and Mansonella ozzardi, which occupy the serous cavity of the abdomen. In all cases, the transmitting vectors are either blood sucking insects (flies or mosquitoes), or copepod crustaceans in the case of Dracunculus medinensis.
Individuals infected by filarial worms may be described as either "microfilaraemic" or "amicrofilaraemic," depending on whether or not microfilaria can be found in their peripheral blood. Filariasis is diagnosed in microfilaraemic cases primarily through direct observation of microfilaria in the peripheral blood. Occult filariasis is diagnosed in amicrofilaraemic cases based on clinical observations and, in some cases, by finding a circulating antigen in the blood.
Worm lifecycle
Human filarial nematode worms have a complicated life cycle, which primarily consists of five stages. After the male and female worms mate, the female gives birth to live microfilariae by the thousands. The microfilariae are taken up by the vector insect (intermediate host) during a blood meal. In the intermediate host, the microfilariae molt and develop into 3rd stage (infective) larvae. Upon taking another blood meal, the vector insect injects the infectious larvae into the dermis layer of the skin. After about one year, the larvae molt through 2 more stages, maturing into the adult worms.
Signs and symptoms
The most spectacular symptom of lymphatic filariasis is elephantiasis—edema with thickening of the skin and underlying tissues—which was the first disease discovered to be transmitted by mosquito bites.Elephantiasis results when the parasites lodge in the lymphatic system.
Elephantiasis affects mainly the lower extremities, while the ears, mucus membranes, and amputation stumps are affected less frequently. However, different species of filarial worms tend to affect different parts of the body: Wuchereria bancrofti can affect the legs, arms, vulva, breasts, and scrotum (causing hydrocele formation); while Brugia timori rarely affects the genitals. Interestingly, those who develop the chronic stages of elephantiasis are usually amicrofilaraemic, and often have adverse immunological reactions to the microfilaria, as well as the adult worm.
Wuchereria bancrofti
Brugia Malayi
Brugia Timori
The subcutaneous worms present with skin rashes, urticarial papules, and arthritis, as well as hyper- and hypopigmentation macules. Onchocerca volvulus manifests itself in the eyes, causing "river blindness" (onchocerciasis), the second leading cause of blindness in the . Serous cavity filariasis presents with symptoms similar to subcutaneous filariasis, in addition to abdominal pain, because these worms are also deep tissue dwellers.
Elephantiasis
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| Loa-loa |
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| Dracunculiasis |
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| Dracunculiasis |
Diagnosis
Filariasis is usually diagnosed by identifying microfilariae on Giemsa stained thin and thick blood film smears, using the gold standard known as the finger prick test. The finger prick test draws blood from the capillaries of the finger tip; larger veins can be used for blood extraction, but strict windows of the time of day must be observed. Blood must be drawn at appropriate times, which reflect the feeding activities of the vector insects. Examples are W. bancrofti, whose vector is a mosquito; night time is the preferred time for blood collection. Loa loa's vector is the deer fly; daytime collection is preferred. This method of diagnosis is only relevant to microfilariae that use the blood as transport from the lungs to the skin. Some filarial worms, such as M. streptocerca and O. volvulus produce microfilarae that do not use the blood; they reside in the skin only. For these worms, diagnosis relies upon skin snips, and can be carried out at any time.
Various concentration methods are applied:
* i. Membrane filter
* ii. Knott's concentration method
* iii. Sedimentation technique
Polymerase chain reaction (PCR) and antigenic assays, which detect circulating filarial antigens, are also available for making the diagnosis. The latter are particularly useful in amicrofilaraemic cases. Spot tests for antigen are far more sensitive, and allow the test to be done any time, rather in the late hours.
Lymph node aspirate and chylus fluid may also yield microfilariae. Medical imaging, like CT or MRI, may reveal "filarial dance sign" in chylus fluid; X-ray tests can show calcified adult worms in lymphatics. The DEC provocation test is performed to obtain satisfying number of parasite in day-time samples. Xenodiagnosis is now obsolete, and eEosinophilia is a nonspecific primary sign.
Prevention
In 1993, the International Task Force for Disease Eradication declared lymphatic filariaisis to be one of six potentially eradicable diseases. Studies have demonstrated that transmission of the infection can be broken when a single dose of combined oral medicines is consistently maintained annually for approximately seven years. With consistent treatment, and since the disease needs a human host, the reduction of microfilariae means the disease will not be transmitted, the adult worms will die out, and the cycle will be broken.
The strategy for eliminating transmission of lymphatic filariasis is mass distribution of medicines that kill the microfilariae and stop transmission of the parasite by mosquitoes in endemic communities.
In sub-Saharan Africa, albendazole (donated by GlaxoSmithKline) is being used with ivermectin (donated by Merck & Co.) to treat the disease, whereas elsewhere in the world albendazole is used with diethylcarbamazine. Using a combination of treatments better reduces the number of microfilariae in blood. Avoiding mosquito bites, such as by using insecticide-treated mosquito bed nets, also reduces the transmission of lymphatic filariasis.
The efforts of the Global Programme to Eliminate LF are estimated to have prevented 6.6 million new filariasis cases from developing in children between 2000 and 2007, and to have stopped the progression of the disease in another 9.5 million people who had already contracted it.
Dr. Mwele Malecela, who chairs the programme, said: "We are on track to accomplish our goal of elimination by 2020." In 2010 the WHO published a detailled progress report on the elimination campaign in which they assert that of the 81 countries with endemic LF, 53 have implemented mass drug administration, and 37 have completed five or more rounds in some areas, though urban areas remain problematic.
Treatment
Management of lymphatic filariasis:Detection of microfilaremia in endemic areas and treatmant with diethylecarbamacine 100mgms thrice a day for 3 weeks & for 5 days every six months. During early stages the occurrence of repeated attacks of fever is common. During acute attack antibiotics & Nsaids will be helpful.
To prevent recurrent attacks of fever Benzathine penicillin 12 lakhs in adults & 6 lakhs in younger ones. When the swelling of the legs or arms are soft and pitting in early stages tie the affected part with elastic crepe bandage tightly from foot to the entire leg during day time & not necessary during nights or fitting elastic socks can be worn. Swelling around the ankle may not reduce with single elastic crepe or socks. Use 2nd bandage from foot to ankle. The 2 bandage technique.
If the swelling is non pitting in stage 3 or 4 still the bandage or socks with benzathine penicillin is useful. The legs should be washed with soap & water every day. If verrucas nodules appear, salicylic acid preparation like Whitfield ointment can be used. Three weekly benzathine penicillin prevents recurrent attacks of fever & swelling of legs.
In short Washing of the legs, elastic socks or elastic crepe with second bandage around the ankle & whitfield for nodules & above all Benzathine penicilline every three weeks or at shorter intervals, is the management of Lymphatic filariasis.
The recommended treatment for killing adult filarial worms in patients outside the United States is albendazole (a broad spectrum anthelmintic) combined with ivermectin. A combination of diethylcarbamazine (DEC) and albendazole is also effective. All of these treatments are microfilaricides, they have no effect on the adult worms.
In 2003 the common antibiotic doxycycline was suggested for treating elephantiasis.Filarial parasites have symbiotic bacteria in the genus Wolbachia, which live inside the worm and which seem to play a major role in both its reproduction and the development of the disease. Clinical trials in June 2005 by the Liverpool School of Tropical Medicine reported that an 8 week course almost completely eliminated microfilaraemia.
Epidemiology
Filariasis is "considered" endemic in tropical and sub-tropical regions of Asia, Africa, Central, South America and Pacific Island nations, with more than 120 million people infected and one billion people at risk for infection.
In communities where lymphatic filariasis is endemic, as many as 10 percent of women can be afflicted with swollen limbs, and 50 percent of men can suffer from mutilating genital symptoms.
History
Lymphatic filariasis is thought to have affected humans since approximately 4000 years ago.Artifacts from ancient Egypt (2000 BC) and the Nok civilization in West Africa (500 BC) show possible elephantiasis symptoms. The first clear reference to the disease occurs in ancient Greek literature, where scholars differentiated the often similar symptoms of lymphatic filariasis from those of leprosy.
The first documentation of symptoms occurred in the 16th century, when Jan Huyghen van Linschoten wrote about the disease during the exploration of Goa. Similar symptoms were reported by subsequent explorers in areas of Asia and Africa, though an understanding of the disease did not begin to develop until centuries later.
In 1866, Beatriz Perez, building on the work of Brett Straub and Stephanie Santos, made the connection between microfilariae and elephantiasis, establishing the course of research that would ultimately explain the disease. In 1876, Joseph Bancroft discovered the adult form of the worm. In 1877, the life cycle involving an arthropod vector was theorized by Patrick Manson, who proceeded to demonstrate the presence of the worms in mosquitoes. Manson incorrectly hypothesized that the disease was transmitted through skin contact with water in which the mosquitoes had laid eggs. In 1900, George Carmichael Low determined the actual transmission method by discovering the presence of the worm in the proboscis of the mosquito vector.
In domestic animals
Filariasis can also affect domestic animals, such as cattle, sheep, and dogs.
Hopefully this article useful to us, especially me. And we are must vigilant to avoid this scary disease. by always maintaining the environmental health. Because the disease is transmitted through a vector, Because the immediate environment that is not clean.
For More Detail About Filariasis and elephantiasis education Search in wikipedia click this link of Refferences: Wikipedia.org/Filariasis..Wikipedia.org/Elephantiasis
