What Is Elephantiasis?

  • Leona Issac Master of Public Health, University of Wolverhampton, UK

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Overview

Elephantiasis, also known as lymphatic filariasis, is a chronic disease that primarily affects the lymphatic system. The disease is characterized by the abnormal swelling and enlargement of body parts, most commonly the limbs and genitalia.1 

The term "elephantiasis" originates from the Greek word "elephant", describing the thickened and roughened skin of an elephant's hide. This condition can cause significant physical discomfort, functional limitations, and emotional distress for those affected.

Elephantiasis results from the obstruction of or damage to the lymphatic vessels, which drain excess fluids from tissues. The accumulation of fluids and immune cells leads to the characteristic swelling, hardening of the skin, and the rough texture likened to an elephant's hide.

Risk factors 

Causative agent: lymphatic filariasis parasites

Lymphatic filariasis is caused by microscopic parasitic worms known as filarial parasites. The species primarily responsible for this condition include Wuchereria bancrofti, Brugia malayi, and Brugia timori.2

These worms reside in the lymphatic system, particularly the lymph nodes and vessels, where they reproduce and release larvae known as microfilariae. These microfilariae circulate in the bloodstream and, when taken up by mosquitoes during a blood meal, mature into infective larvae, thus completing the transmission cycle.

Transmission through mosquito bites

The transmission of lymphatic filariasis occurs through infected mosquitoes, primarily those belonging to the genera Anopheles, Culex, and Aedes. When an infected mosquito bites a person, it introduces the infective larvae into the bloodstream. These larvae then migrate to the lymphatic vessels and nodes, where they develop into adult worms. The presence of these worms disrupts the normal flow of lymphatic fluids, leading to the swelling characteristic of elephantiasis.3

Commonly affected regions

Elephantiasis is most prevalent in tropical and subtropical regions of the world, where the climate and living conditions are conducive to both mosquito populations and the spread of the disease. Countries in Africa, Southeast Asia, the Indian subcontinent, the Pacific Islands, and parts of Central and South America are particularly affected. The disease tends to be more common in areas with inadequate sanitation, limited access to healthcare, and poor mosquito control measures.

Symptoms

In the early stages of lymphatic filariasis, there is often an asymptomatic period during which infected individuals do not show visible signs of disease. This phase can last for months or even years, making early detection and intervention challenging.

Swelling of limbs and other body parts: 

As the disease progresses, affected individuals begin to experience noticeable symptoms. One of the hallmark features of elephantiasis is the gradual and often asymmetric swelling of limbs and other body parts. This swelling can range from mild to severe and can impact one or multiple limbs. The limbs become visibly enlarged, and the swelling is usually accompanied by discomfort, heaviness, and tightness.1

Thickening and hardening of the skin:

In addition to swelling, the skin over the affected areas undergoes changes. It becomes thickened and tough and may take on a rough and pebbled appearance, resembling the texture of an elephant's skin. This skin transformation is a result of the underlying lymphatic disruption and the accumulation of fluids and immune cells within tissues.1

Severity and complications

Secondary bacterial infections

The altered skin texture and compromised lymphatic drainage can lead to an increased susceptibility to secondary bacterial infections. Cracks, fissures, and open sores can develop on the thickened skin, which provides entry points for bacteria. These infections can cause pain, inflammation, and further damage to the affected tissues, exacerbating the overall condition.1

Impaired limb function

As the disease advances and the swelling intensifies, it can lead to impaired limb function and mobility. The increased size and weight of the affected limbs can make movement difficult and uncomfortable. This can significantly impact an individual's ability to perform daily activities, resulting in reduced quality of life and potential social isolation.1

Diagnosis

Clinical examination

Clinical examination by trained healthcare professionals plays a crucial role in diagnosing elephantiasis. During this process, doctors assess the patient's medical history, symptoms, and physical appearance. The characteristic swelling of limbs and other affected body parts, along with changes in skin texture, may raise suspicion of lymphatic filariasis. 

However, clinical examination alone may not be sufficient for a definitive diagnosis, as other conditions could also cause similar symptoms.

Microscopic examination of blood samples

Microscopic examination of blood samples is a key diagnostic method for confirming the presence of microfilariae in the bloodstream. This involves taking a blood sample and examining it under a microscope to identify and count the microfilariae. Blood samples are typically collected during the night, as this is when microfilariae are more likely to be present in the bloodstream.4

Serological tests

Serological tests involve analyzing blood samples for the presence of specific antibodies produced by the immune system in response to the filarial parasites. These tests provide valuable information about a person's exposure to parasites, even in cases where microfilariae might not be readily detectable. Serological tests are particularly useful for assessing the overall prevalence of the disease within a community.

Prevention and control

Mosquito control measures

Controlling mosquito populations is a fundamental component of preventing the transmission of lymphatic filariasis. Mosquitoes are responsible for transmitting the disease by transferring infective larvae from infected to healthy individuals. Mosquito control strategies include:

Insecticide-Treated Nets: Distributing bed nets treated with insecticides helps reduce mosquito bites during sleep, thereby decreasing the risk of infection.

Indoor Residual Spraying: Spraying insecticides on the walls and surfaces of homes helps kill mosquitoes that come into contact with the treated surfaces.

Environmental Management: Eliminating or managing mosquito breeding sites, such as stagnant water sources, can significantly reduce mosquito populations.

Mass drug administration

Mass drug administration involves providing antiparasitic medications to entire communities, regardless of infection status, to reduce the overall burden of the disease. 

Health education and awareness

Raising awareness about lymphatic filariasis is essential for fostering community participation and support in prevention and control efforts. 

Treatment

Antiparasitic medications

Antiparasitic medications are a cornerstone of treating lymphatic filariasis. These medications target both adult worms and microfilaria to reduce the parasitic load in the body. Commonly used drugs include ivermectin, diethylcarbamazine, and albendazole. These medications are often distributed during mass drug administration campaigns to entire communities, especially in areas where the disease is endemic. Treating infected individuals and preventing new infections contribute to the control and elimination of the disease.5

Management of symptoms

While antiparasitic medications address the underlying cause of the disease, managing the symptoms and complications of lymphatic filariasis is also crucial. Symptomatic treatment focuses on alleviating discomfort, reducing swelling, and preventing secondary bacterial infections. Compression garments, limb elevation, and skincare routines are commonly recommended to manage symptoms and improve overall quality of life.

Surgical interventions 

In severe cases where elephantiasis has led to severe deformities and functional impairment, surgical interventions may be considered. Surgical procedures aim to remove excess tissue, improve limb mobility, and enhance the appearance of the affected body parts. These interventions require careful planning and post-operative rehabilitation to ensure successful outcomes.

Summary

Elephantiasis, or lymphatic filariasis, leads to severe swelling due to parasitic infection. Parasites spread through mosquitoes in tropical areas, causing swelling, skin changes, and potential complications. 

Swift action is vital. Detecting and treating the disease early prevents worsening symptoms and complications. The medication targets parasites, while symptom management improves lives. Raising awareness combats myths, reduces stigma, and promotes prevention. Collaboration between governments, healthcare, and research sectors is crucial for advancing treatments and diagnostics, ultimately eliminating the disease.

References 

  1. Newman TE, Juergens AL. Filariasis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Aug 25]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK556012/ 
  2. Zerbo A, Castro Delgado R, Arcos González P. Exploring the dynamic complexity of risk factors for vector-borne infections in sub-Saharan Africa: Case of urban lymphatic filariasis. Journal of Biosafety and Biosecurity [Internet]. 2021 Jun 1 [cited 2023 Aug 26];3(1):17–21. Available from: https://www.sciencedirect.com/science/article/pii/S2588933821000054 
  3. Michael E, Gambhir M. Vector transmission heterogeneity and the population dynamics and control of lymphatic filariasis. In: Michael E, Spear RC, editors. Modelling Parasite Transmission and Control [Internet]. New York, NY: Springer New York; 2010 [cited 2024 Mar 14]. p. 13–31. Available from: http://link.springer.com/10.1007/978-1-4419-6064-1_2
  4. Enbiale W, Böer-Auer A, Amare B, Verdonck K, Davey G, Van Griensven J, et al. Podoconiosis: Clinical spectrum and microscopic presentations. Fuller C, editor. PLoS Negl Trop Dis [Internet]. 2022 May 23 [cited 2024 Mar 14];16(5):e0010057. Available from: https://dx.plos.org/10.1371/journal.pntd.0010057
  5. Campbell S, Soman-Faulkner K. Antiparasitic drugs. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Mar 14]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK544251/

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Leona Issac

Bachelor of Dental Surgery, Rajiv Gandhi University of Health Sciences

Master of Public Health, University of Wolverhampton

Dr Leona Issac is a dynamic professional with a diverse background in dentistry and public health. With extensive experience as a dentist, she offers valuable insights into oral health, complemented by her Master’s degree in Public Health, which provides her with a comprehensive understanding of healthcare systems and their integration with dentistry. Her dedication to public health has led her to actively engage in health promotion, disease prevention and healthcare policy advocacy. Dr Leona continues to make a significant impact on the health and wellbeing of communities through her exceptional work and dedication to her field.

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