Elephantiasis: symptoms, causes and treatments

There are a large number of diseases and disorders in the world, many of which are largely unknown to most countries of the world or tend to be strange given their low prevalence in our countries of origin.

However, some of them cause physiological alterations evident to the naked eye, which allows some existing cases to stand out and be recognized or remembered. This is what happens with elephantiasis, Also known as lymphatic filaria (although elephantiasis refers more to the symptom in question, they are often identified as synonyms).

    What is elephantiasis?

    By elephantisasis we mean the presence of marked and obvious swelling and thickening of tissues that appear as a result of a blockage of the lymphatic system, Which stops draining lymph. This is the third phase of lymphedema, in which the disorders become permanent. It usually appears in the chronic phase of lymphatic filariasis, to the point that it is often identified and used as a synonym for lymphatic filariasis and elephantiasis. Thickening is usually produced in the legs or arms, and is also common to affect the genitals and breasts. This can often cause pain to those who suffer from it. The kidneys and the immune system are also often damaged, as are the bones.

    The deformities caused by this disorder can have serious consequences for people who suffer from it, and the appearance of fistulas, wounds with the possibility of infection or even the appearance of tumors are not uncommon. Functionally, it can also profoundly alter a person’s life and can impair or even make impossible the ability to walk or move, which is a common cause of physical disability. If this occurs in the genitals, it also impairs sexual functionality.

    The parasitic infection that generates it is usually onset in childhood, although in most cases symptoms begin to be seen in adulthood. This infection, in fact, can remain asymptomatic despite damage to the lymphatic system.

    In addition, these alterations are often a cause of great shame and discomfort for those affected, many of whom avoid social contact and isolation. In fact, even the term elephantiasis (which compares the legs of people with the condition to those of an elephant) can already be a source of stigma for them. Social and professional life is severely impaired as an indirect effect, and the onset of discomfort, depression and anxiety is not uncommon.

    This is a tropical disease mainly found in countries of Africa, South America, Central America or Indonesia. While this may sound like a strange disease, and it’s easy to think that it can be classified as a rare and rare disease, the truth is that it is more common than it looks: around 120 million people suffer from some form of this disorder. However, it is a disease that is little considered in general, having neglected research into its treatment for years.

      Stages of appearance

      It is possible to identify three phases in which elephantiasis occurs gradually. Technically, the name elephantiasis would correspond to the third or final phase of the process, evolution of lymphedema (edema generated by the lymph) in the process to reach a chronic phase.

      1. Post-puncture edema

      The first moment to consider is the appearance of the mosquito bite which transfers the wireworm. Initially, no symptoms can appear. In cases where this occurs, palpable inflammation is usually seen in the affected area, which will gradually increase. In the morning the swelling is imperceptible, but resurfaces throughout the day. The skin is always soft.

      2. Second phase: progression of lymphedema

      In a second phase, the swelling has increased and is noticeable at all times, although it seems to decrease even in the morning (which with the total time will cease to do). The skin gradually hardens.

      3. Elephantiasis

      Third and final phase, in which the problem of swelling becomes irreversible and acquires a characteristic hardness. The level of swelling may increase and morphological changes will already be permanent.

      The causes of this disease

      Elephantiasis is a problem that can have different causes, although the most common is infection with parasitic worms known as filariasis. This parasite blocks the lymphatic system, causing edema or fluid buildup in different areas of the body. Specifically, the most common is Wucheria bancrofti, although there are other species that also cause this disease. The parasite usually comes into contact with our body through the bite of mosquitoes such as Anopheles and Culex, transmitting the infection from the blood to the lymphatic system (where the parasites feed and develop).

      However, although elephantiasis is usually caused by this reason, sometimes alterations can occur and eventually generate elephantiasis (if we understand it as a symptom and not as a disorder in itself). We would then speak of non-filarial elephantiasis, Caused by other injuries such as certain metastases from certain tumors, other diseases or the consequences of surgery that damaged the lymphatic system.

      treatments

      Fortunately, the disease that causes elephantiasis can be treated with the use of different drugs and pesticides, Especially in an acute and initial phase. Among the most used and effective are usually ivermectin or diethylcarbamazine. It may also require the use of antibiotics and pain relievers to fight infections and pain, which are common in this condition.

      It should be noted that even if the parasites are killed, the malformations present in the chronic phase (i.e. extreme swelling of the affected parts) can persist for life. There are procedures such as compression therapy and surgery that can reverse the swelling, although the use of compression mechanisms is necessary. Draining or bypassing excess lymph can also be of great help. In these cases, compressive measures, establishment of hygiene guidelines to prevent infection, and physiotherapy may be helpful.

      Always treatable, the need to set up prevention plans must be taken into account. Hygiene and mosquito avoidance the use of mosquito nets or insecticides can help prevent this disease, which has traditionally been poorly treated around the world (although the WHO has launched a global program for the elimination of lymphatic filariasis which is expected to be successful in 2020).

      Bibliographical references:

      • Lozano, I. (2009). Elephantiasis. Because of a case. Electronic Medical Journal, 31 (3). Matances, Cuba.
      • Fenwick, A. (2012). The global burden of abandoned tropical diseases. Public Health, 126 (3): 233-236.
      • Fortuny, EI; Guerrero, MF; Pereira, JM (2014). Is lymphedema reversible? Tower. Chilean Dermatol .; 30 (4).

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