Lymphatic Filariasis – Elephantiasis, neglected tropical crippling disease.

Elephantiasis

Lymphatic filariasis also called elephantiasis is a disease caused by filarial parasitic worms that can lead to swellings of the limbs and genitalia. This usually leads to social stigma and severe disability of the patient making them to stay at home and not doing productive work hence economic loss.

Currently the disease is affecting 120 million people with 40 million suffering the severe form of the disease around the world. The disease is endemic mainly in India, Africa and South America. In Kenya over 3 million people are at risk of the disease mostly the poor communities where sanitation is poor and mosquito breeding is rampant. There are campaigns on going to eradicate the disease by 2020. The government of Kenya set aside 1 Billion Kenya shilling for eradication of elephantiasis along the coastal region.

Elephantiasis is caused by three types of worms Wuchereria bancrofti (90% of cases), Brugia malayi and Brugia timori. These worms damage our lymphatic system leading to the presentation of the disease. Interestingly to note is that elephantiasis worms are spread by bites of infected mosquitoes. Infection usually begins in childhood and by the time it shows symptoms in adults, it’s usually too late.

Most of the infections remain asymptomatic. Symptoms results from the worms causing blockage of lymphatic flow leading to swelling of the arms, legs, scrotum in men causing hydrocele formation and the vulva in women. Thickening of the skin and subcutaneous tissue especially lower limbs sometimes can lead to pain and secondary infections.

Scrotal swelling

Elephantiasis is diagnosed by blood sample taken at night examined under a microscope for microfilariae. This is because microfilariae circulate in blood at night. Testing of the blood for antibodies against the disease can also be used for diagnosis.

Prevention of elephantiasis is by giving medication to high risk population known as Deworming. Albendazole with ivermectin or albendazole with diethylcarbamazine single dose each year for about four to six years. These medications do not kill the adult worm but prevent further spread of the disease. Use of mosquito nets is recommended to prevent mosquito bites.

In addition to the medication, treatment includes surgery for the scrotal swelling (hydrocele), surgery for correcting elephantiasis of the limbs is generally ineffective.

Clinical progression and severity of the disease can be reduced by hygiene, exercise and elevation of the limbs.

With the on-going programs, we hope the disease will be eradicated by 2020.

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