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Elephantiasis and Its Treatment 1
Elephantiasis and Its Treatment
Elephantiasis, or lymphatic filariasis, is a rare disorder of the lymphatic system
caused by parasitic worms that are transmitted by mosquitoes. Elephantiasis leads to a
generalized enlargement of the lymphatic vessels, termed lymphoedema. Inflammation
of the lymphatic vessels causes the infected area to enlarge, most commonly limbs or
parts of the head and torso. While anyone can contract the parasitic worms, elephantiasis
is most common in tropical regions. It occurs frequently in Africa when an infected
female mosquito injects microfilariae, the parasite, into the blood. The microfilaria
reproduces and spreads throughout the bloodstream, where they can live for many years
(Weil, Lammie, & Weiss, 1997). This devastating parasite cripples the individual over
time and intervenes with their daily life.
Elephantiasis is a vivid and accurate term for the condition that produces swelling
in the extremities. It is a rare disorder of the lymphatic system caused by parasitic worms
such as Wuchereria bancrofti, Brugia malayi, and B. timori (Vhi Healthcare, 2002-2003).
These worms are transported to their host by mosquitoes found mostly in tropical and
subtropical places. They are particularly dangerous to humans because they obstruct the
lymphatic system. The lymph nodes in the lymphatic system help sustain fluid balance in
the body and immunity. Any blockage to these vessels causes tissue destruction, or
swelling called lymphoedema, which can cause crippling effects over time.
Furthermore, different species of mosquitoes transmit different round worms that
cause elephantiasis. Research conducted by microbiologists reveals that “Culex, Aedes,
and Anopheles mosquitoes are the carriers of W.bancrofti. Anopheles and Mansonia
mosquitoes are the carriers of B. malayi, and Anopheles mosquitoes are the carriers of B.
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timori” (Vhi Healthcare, 2000-2003, p. 3). Moreover, when a person is bitten, the larvae
in the mosquito travel through the blood stream of the host. These parasites are destined
to the lymph nodes of the lymphatic system. Eventually, it blocks the lymph node
vessels, causing swelling and disfiguration of the limbs because lymph fluid cannot be
drained from the tissues. Elephantiasis continues to spread as the infected individual is
bitten by mosquitoes not carrying the parasite. When the mosquito bites an uninfected
person, the cycle repeats inside the new host.
Individuals with lymphatic filariasis show no symptoms of carrying this rare
disease (Weil, Lammie, & Weiss, 1997). Once infected, the parasite can reside
unnoticed. Most will miss any sign of infection until the adult worm dies about seven
years after infection. The worm hosts in the lymph vessels; once it dies, the lymph
system’s function decomposes. This causes fluid to collect in the lymph system,
resulting in severe swelling to arms, legs, breasts, and genitals. The function of the
corrupted lymph system also causes hardening to the skin, due to the decreased
performance of the immune system. Long term effects caused by lymphatic filariasis are
permanent damage to lymph system, kidneys and disability. Persons carrying this rare
disease are often shunned from their community. This prevents the infected individual
from supporting their family (“CDC,” 2003).
Lymphatic filariasis creates a global burden. According to the Global Programme
to Eliminate Lymphatic Filariasis Annual Report, 120 million people are infected with
elephantiasis and more than a billion people are at risk. The disease is an endemic in
more than 80 countries and territories. Most of these cases occur in third-world countries
because the population is generally poor and lacks access to adequate health care.
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Contaminated regions have steadily increased because of the expansion of slums and
poverty, especially in Africa and the Indian subcontinent. About 90% of the lymphatic
filariasis infections occur in South East Asia, Western pacific regions of East Africa,
Eastern Mediterranean Region and Region of Americas. The remaining 10% of the
infections occur in Asia and various Pacific Islands. Lymphatic filariasis is thought to be
the second leading cause of permanent and long-term disability (Dreyer, 2002).
An individual with elephantiasis will first notice abnormal growths that may
superficially appear as a typical insect bite. Most patients will first seek advice from their
family physician concerning the abnormal growth. However, if the patient’s condition
progresses before seeking help, the site of infection can enlarge and produce a grid or
brick like pattern on the skin. The skin is often accompanied by foul smelling bacteria
and fungi and becomes extremely engorged. These conditions are clear indicators to the
physician that treatment for lymphoedema must begin before permanent damage occurs
to lymphatic vessels, muscle, and nervous tissue. However, the family physician will
need further tests to determine that microscopic parasites are responsible for the patient’s
lymphoedema. Commonly, a nurse will take blood samples and a lab technician will
separate the lymph using a centrifuge. The presence of filarial worms is easily detected
with a microscopic analysis and elephantiasis is confirmed with relative certainty.
(Erikson, Kobayashi, & Vogel, 2003).
Resolving elephantiasis first begins with eliminating the parasitic worms. If the
worms are in the larva stage, the physician will prescribe Ivermectin. Ivermectin is not
approved by the Food and Drug Administration, but is available in the United States
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under agreement with the Center for Disease Control. Adult worms are eliminated with
the FDA approved drug Hetrazan (Farley, 1997).
With the parasites removed from the lymph system, the family physician will
focus on restoring function to affected limbs. Antibiotics are used to treat bacterial and
fungal infections. Skin lesions are treated with topical keratolytic and oral retinoids, but
the patient may have to use these drugs indefinitely in order to maintain the positive
results (Erikson, Kobayashi, & Vogel, 2003). Urologists and cosmetic surgeons work
together to correct possible swelling in the genitals. The generalized swelling of limbs
from elephantiasis is reversed with restrictive stockings that compress previously fluidfilled tissue. If affected limbs cannot be improved with standard compression stockings,
the physician may recommend pneumatic stockings that maintain an even greater
pressure over the affected limb. However, the most severely affected patients may have
their extremities amputated if treatments fail to reduce swelling. Physical therapy is
coupled with medication to restore the patient’s mobility. Ironically, the areas of the
world that are most plagued by elephantiasis do not have access to these resources.
As technology advances, it should be the goal of scientists worldwide to conduct
more laboratory tests and improve treatment of elephantiasis. Like other diseases,
treatment is most effective when coupled with early detection. However, this disease is
difficult to detect during its early stages. Therefore, to prevent this disease from
spreading even further, it is imperative that more research is performed regarding its
prevention, treatment, and rehabilitation. Someone with elephantiasis has to live
everyday with feelings of shame and embarrassment about their physical condition.
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Continued advances in elephantiasis will diminish this problem that plagues third world
countries.
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An individual with elephantiasis. The large masses on the legs are caused by lymph fluid
buildup in the limbs.
Brugia malayi, one of worms that cause elephantiasis.
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Work Cited
Center for Disease Control. (2003). Division of Parasitic Diseases – Lymphatic
filariasis. Retrieved March 10, 2004 from
http://www.cdc.gov/ncidod/dpd/parasites/lymphaticfilariasis/factsht_lymphatic_fi
lar.htm
Dreyer, H. (2002). Basic Lymphoedema Management: Treatment and Prevent of
Problems Associated with Lymphatic Filariasis. Hollis NH. Hollis
Publishing Company.
Erickson, Q., Kobayashi, T., & Vogel, P. (2003). Diagnosis of skin diseases. American
Family Physician, 76, 583-585.
Farley, D. (1997). Treating tropical diseases. FDA Consumer, 31, 26-31.
Vhi Healthcare. (2003). Elephantitis: Causes, Symptoms and Definition. Retrieved
March 18, 2004 from http://www.raintree-health.co.uk/cgibin/getpage.pl?/data/elephantitis.html
Weil, G., Lammie, P., & Weiss, N. (1997). The ICT Filariasis Test. A Rapid-format
Antigen Test for Diagnosis of Bancroftiam Filariasis, 13, 401-404.
World Health Organization. (2002). Global Programme to Eliminate Lymphatic
Filariasis Annual Report. Geneva: Author.