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Lymphatic Filariasis (Elephantiasis)


  • Lymphatic Filariasis, also known as Elephantiasis, is a disease which affects more than 120 million people in 80 different countries and a leading cause of permanent disability worldwide.
  • It is a parasitic disease caused by microscopic, thread-like worms.
  • Lymphatic Filariasis is prevalent in tropical and subtropical areas esp. in areas where there is rapid and unplanned growth cities that often result in the creation of numerous breeding sites for mosquitoes that transmit the disease.
Cause
  • Filariasis is caused by thread-like, parasitic filarial (slender, parasitic nematode worms) worms Wuchereria bancrofti and Brugia malayi that live almost exclusively in humans
  • Wuchereria bancrofti and Brugia malayi worms live in the human lymphatic system, live for 5-7 years and produce millions of microfilariae or minute larvae that circulate in the blood.
Transmission
  • Lymphatic Filariasis is spread from person to person by mosquito bites. When a mosquito bites a person infected with lymphatic filariasis, microfilariae in the person's blood enters the mosquito. The microscopic worms develop inside the mosquito for 7-21 days and then migrates to the mosquito's mouth parts. When the infected mosquito bites a person, the microscopic worms enters the person's punctured skin where they travel to the lymph vessels where they grow as adults and live for more than 5 years, mate, and release millions of microscopic worms that circulate in the person's blood.
Signs and Symptoms
  • enlargement of the entire leg and/or the entire arms
  • hydrocoele (fluid-filled balloon-like enlargement of the sacs around the testes) and enlargement of the scrotum and penis in men
  • enlargement of the vulva and breasts in women
  • acute bacterial infections in the skin
  • pulmonary symptoms: cough, wheezing, shortness of breath
  • high levels of IgE (Immunoglobulin E) and antifilarial antibodies in the blood
Diagnosis
  • The new development of a very sensitive, very specific simple "card test" to detect circulating parasite antigens without the need for laboratory facilities and using only finger-prick blood droplets taken anytime of the day has completely transformed the approach to diagnosis.
  • The standard method for diagnosing active infection is the identification of microfilariae by microscopic examination. This is difficult as microfilariae are nocturnally periodic, which means that they only circulate in the blood at night. Thus, the blood collection has to be done at night to coincide with the appearance of the microfilariae.
Prevention
  • Mosquito bites should be avoided, especially between dusk and dawn. It is best to sleep under a mosquito net, wear long sleeves and trousers, and use mosquito repellent on exposed skin.
  • Communities may be given medicines that kills microscopic worms through an annual mass treatment program. This reduces the level of microfilariae in the blood and thus, diminishes transmission of infection.
Treatment
  • Diethylcarbamazine (DEC) is the drug of choice for persons currently infected with the parasite-->kills microfilariae and some adult worms in the blood-->prevents transmission of the disease from one person to another
  • For patients with lymphedema, the following is recommended by a lymphedema therapist:
  1. Carefully wash the swollen area with soap and water every day.
  2. Elevate and exercise the swollen arm or leg to move the fluid and improve the lymph flow.
  3. Disinfect any wounds. Use antibacterial or antifungal cream if necessary.
  • The treatment for hydrocoele is surgery.
Related Link:
DOH: National Filariasis Elimination Program

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