Elephantiasis

What is Elephantiasis?
Elephantiasis is a condition characterized by gross enlargement of an area of the body, most especially the limbs. Other areas are commonly affected include the external genitals. Elephantiasis is caused by the obstruction of the lymphatic system, which results the accumulation of a fluid called lymph in the affected areas. 

Causes

In areas where filariasis is endemic, the cause of elephantiasis mostly is a parasitic disease known as lymphatic filariasis and, in the literature medical, the terms lymphatic

filariasis and elephantiasis may be used interchangeably. Elephantiasis is due to lymphatic filariasis may also be referred to as "true" elephantiasis. In the most areas, the lymphatic damage associated with elephantiasis has other causes including certain sexually transmitted diseases (e.g., lymphogranuloma venereum); tuberculosis; an infectious disease called leishmaniasis; repeated streptococcal infections; leprosy; and environmental factors such as exposure to certain minerals (e.g., silica). In some cases, no cause can be identified (idiopathic).

Treatment

The drug of choice in treating lymphatic filariasis is diethylcarbamazine (DEC). The trade name in the United States is Hetrazan.

The treatment schedule is typically 2 mg/kg per day, thrice a day, for three weeks. The drug is taken in a tablet form.

DEC kills the microfilariae quickly and injures or slowly kills the adult worms, if at all. If all the adult worms are not killed, the remaining paired males and females may continue to produce more larvae. Therefore, many courses of DEC treatment over a long time period may be necessary to rid the individual of the parasites.

DEC has been shown to reduce the size of enlarging lymph nodes and, when taken in long-term, to reduce elephantiasis. In India, this DEC has been given in the form of a medicated salt, which will help prevents the spread of disease.

The side effects of DEC almost all are due to the body's natural allergic reactions to the dying parasites rather than to the DEC itself. And for this reason, DEC must be given carefully to reduce the danger to the individual. Side effects includes headache, fever, chills, dizziness, nausea and vomiting, joint pain, and itching. These side effects usually occur within the first few days of treatment. The side effects usually subside as the individual continues taking the drug.

There is an alternate treatment plan for the use of DEC. This plan designs to kill the parasites slowly (to reduce allergic reactions to the dead microfilariae and dying adult worms inside the body). Lower doses of DEC are taken for the first few days, then followed by the higher dose of 2 mg/kg per day for the remaining three weeks. In addition, steroids can be prescribed to prevent the individual's body from reacting severely to the dead worms.

Another drug used is Ivermectin. Early research studies show that Ivermectin is excellent in killing microfilariae, but the effects of this drug on adult worms are still being investigated. It's probable that patients will need to continue using DEC to kill adult worms. Mild side effects of Ivermectin includes headache, fever, and myalgia.

Other means of managing lymphatic filariasis are pressure bandages to wrap the swollen limb and elastic stockings to help reduce the pressure.  Elevating and exercising a bandaged limb can also help reduce its size.

A surgery can be done to reduce elephantiasis by removing excess fatty and fibrous tissue, draining the swelled area, and removing the dead worms.