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ELEPHANTIASIS

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 thescrotum,to swell to the size of abasketball.[1]

More rarely, it can cause

swelling in thevulva.[2]

It is caused byfilariasis orpodoconiosis

Elephantiasis leads to marked swelling of the lower half of the body.

Elephantiasis occurs in the presence of microscopic, thread-like parasitic worms such

asWuchereria bancrofti,Brugia malayi,andB. timori,all of which are transmitted

bymosquitoes.[4]

However, the disease itself is a result of a complex interplay between several

factors: the worm, the symbioticWolbachiabacteria within the worm, the hosts immune

response, and the numerous opportunistic infections and disorders that arise. Consequently, it is

common in tropical regions andAfrica.The adult worms only live in the humanlymphatic

system.

[5]

The parasite infects the lymph nodes and blocks the flow of lymph throughout thebody; this results in chronicedema,most often noted in the lower torso (typically in the legs and

genitals)

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

inUganda,Tanzania,Kenya,Rwanda,Burundi,Sudan,Egypt andEthiopia.[7]

The worst affected

area is Ethiopia, where up to 6% of the population is affected in endemic areas.[8][9]

Nonfilarial

elephantiasis is thought to be caused by persistent contact with irritant soils: in particular, red

clays rich in alkali metals such assodium andpotassium and associated with volcanic activity

According to medical experts the worldwide efforts to eliminate lymphatic filariasis is on track

to potentially be successful by 2020.[12]

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. In 2011, podoconiosis was added to the World Health Organization'sNeglected

Tropical Disease list,which was an important milestone in raising global awareness of the

condition.

Treatment

Treatments for lymphatic filariasis differ depending on the geographic location of the endemic

area.[13]

Insub-Saharan Africa,albendazole is being used withivermectin to treat the disease,

whereas elsewhere in the world, albendazole is used withdiethylcarbamazine.[13]

Geo-targeting

treatments is part of a largerstrategy to eventually eliminate lymphatic filariasis by 2020.[13]

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

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te-NYT-1http://en.wikipedia.org/wiki/Basketball_(ball)http://en.wikipedia.org/wiki/Scrotum

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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.[citation needed]

In addition, surgical treatment may be helpful for issues related to scrotal elephantiasis

andhydrocele.However, surgery is generally ineffective at correcting elephantiasis of the limbs.

Avaccine is not yet available but is likely to be developed in the near future.[citation needed]

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.[14]

Antibiotics are used in cases of infection.

Antibiotics

In 2003 it was suggested that the common antibioticdoxycycline might be effective in treating

lymphatic filariasis.[15]

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 theLiverpool School of Tropical Medicine in June 2005 reported that an 8

week course almost completely eliminated microfilariaemia.[16]

Epidemiology

Lymphatic filariasis affects over 120 million people, primarily in Africa and South-East Asia,

with about 40 million disfigured and incapacitated by the disease

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