Elephantitis

Elephantitis is a lymphatic system disease and is also known as elephantiasis. This parasitic disease affects almost 120 million people worldwide and is prevalent in the tropic and the sub-tropic regions. Due to the obstruction of the lymphatic vessels, visible enlargement of the skin and tissues takes place. The arms, legs and groin area is mainly affected by elephantitis, but it can also be seen in the trunk, head, breast and few other body parts. Elephantitis results in the thickening of these parts almost to triple the original diameter. The deformity of body parts due to swelling causes difficulty in leading a normal life.

Elephantiasis

Signs and Symptoms

It is often misdiagnosed due to the similarity of its symptoms with few other diseases in early stages. Sometimes it takes years for the symptoms to be visible even after infection. However, these symptoms are prominent in advanced stages:

• Pain
• Headache
• Vomiting
• Severe swelling
• Fever with chills
• Thickened skin
• Hardened and baggy skin
• Ulcers on the skin
• Skin hyper-pigmentation
• Malaise or feeling of constant discomfort
• Enlarged lymph nodes
• White urinary discharge in severe cases
• Swollen spleen and liver in severe cases

Diagnosis

It can be diagnosed by the following two methods:

• Microscopic Examination: Blood sample of the suspected patient is observed under a microscope. The blood sample should be collected during the night to allow microfilariae to be present in the blood stream.
• Lymph Node Biopsy: Lymph node biopsy is done to find the infection, but is not a very successful method of diagnosis.

Types and Causes

It is extremely important to know the types of elephantitis or elephantiasis to understand their causes. The two main types and causes of elephantitis are:

• Lymphatic Filariasis: This is a common form of elephantitis disease found mainly in Africa. It is parasitic in nature and transmitted through infected female mosquitoes. Lymphatic filariasis is caused by roundworms Wuchereria bancrofti, Brugia malayi and Brugia timori which use the lymphatic system as a host. The bacterial infection from worms obstruct the lymphatic vessels which results in massive swelling of the infected body part. The skin becomes thick, hard and wrinkled, resembling that of an elephant.
• Non-Filarial Elephantitis: This type of elephantitis is non-parasitic in nature and mainly found in the tropics and Africa. This too results due to the blockage of lymphatic vessels and infection in the lymphatic system. When the bare feet come in frequent contact with irritant soil containing sodium and potassium in volcanic areas, these chemicals enter the body. It then moves towards the lymphatic vessels and causes lymph block and infection.

Treatment

There is no vaccine or effective treatment for elephantitis or elephantiasis, due to the difficulty in early diagnosis, making it one of the most dreaded diseases. These are the popular elephantiasis treatment options followed worldwide:

• Antibiotics: A single course of antibiotic is said to be effective in treating elephantitis. An 8 weeks course of antibiotic doxycycline is used for reduction of larvae and adult worms. This is not widely followed due to the need for long term treatment, as the worms activity is restrained only for 8-14 months. Long term use of this antibiotic is restricted for pregnant women and children below 8 yrs.
• Medication against Parasites: Antifilarial drug treatment is given as per the geographic location, in an aim to eliminate the disease by 2020. In African region, albendazole is used with ivermectin, but albendazole is used in all other parts of the world. These drugs are mainly active against worm larvae, but have little effect on adult worms.
• Preventive Methods: Used mainly for non-parasitic elephantitis, this is more a prevention than a treatment. This method includes wearing shoes to contact with soil, washing feet and hands with antiseptic soap and water, wearing bandages and application of ointment. For lymphatic filariasis, frequent cleaning of affected areas is recommended to reduce symptoms, as the symptoms of elephantitis is more due to skin infections.
• Surgery: Surgery is done in severe cases of elephantitis and is useful only for the limbs.

This dreaded disease is the cause of the highest disability worldwide, and prevention of elephantitis is difficult, but not impossible. Avoiding mosquito bites using bed nets, repellents, and cleaning of stagnant water are useful preventive methods. A proper diet is also extremely important, as a weak immune system due to improper diet makes the body prone to such infections.