Elephantiasis: symptoms, causes and treatments

This disease is usually caused by parasites that arrive through mosquito bites.

There are a large number of diseases and disorders in the world, many of which are largely unknown to most 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, something that makes them stand out and some existing cases are recognized or remembered. This is the case with elephantiasisalso known as lymphatic filiarisis (although elephantiasis would refer more to the symptom in question, they are often identified as synonyms).

What is Elephantiasis?

We understand by elephantiasis the presence of a marked and evident swelling and thickening of the tissues that appears as a consequence of a blockage of the lymphatic system, which stops draining lymph.which stops draining the lymph. This is the third phase of lymphoedema, in which the alterations become permanent. It usually appears in the chronic phase of lymphatic filariasis, to the point that it is often identified and used synonymously with lymphatic filariasis and elephantiasis. Generally the thickening is produced in legs or arms, being also frequent the affectation of genitals and breasts. In many occasions it can generate pain in those who suffer it. The renal and immune systems are also often affected, as well as the bones.

The deformities caused by this disorder can have serious consequences for sufferers. for the people who suffer from it, being not strange the appearance of fistulas, wounds with possibility of infection or even the appearance of tumors. At a functional level, it can also profoundly alter the life of the person, and may alter or even make it impossible to walk or move, being a frequent cause of physical disability. If it occurs in the genitals, it also alters sexual functionality.

The parasitic infection that generates it is usually of infantile onset, although in most cases the symptoms begin to be observed in adulthood. Such infection may in fact remain asymptomatic Despite damage to the lymphatic system, the infection may in fact remain asymptomatic.

Furthermore, these alterations are often a source of great embarrassment and discomfort for those affected, with many of them shying away from social contact and isolating themselves. In fact, even the term elephantiasis (which compares the legs of those affected with those of an elephant) can already be a source of stigma for them. Social and work life are profoundly impaired as an indirect effect, and the appearance of malaise, depression and anxiety is not uncommon.

It is a tropical a tropical disease mainly found in countries in Africa, South America, Central America and Indonesia.. Although it may seem a strange disease and it is easy to think that it can be classified among rare and infrequent diseases, the truth is that it is more common than it appears: about 120 million people suffer from some form of this disorder. However, it is a disease that is little taken into account at a general level, and research into its treatment has been neglected for years.

Stages of onset

It is possible to identify three stages in which elephantiasis gradually occurs. Technically, the name elephantiasis would correspond to the third or last phase of the process, evolving lymphedema (edema generated by lymph) in the process until reaching a chronic phase.

1. Post-stroke edema

The first moment to be taken into account is the appearance of the bite of the mosquito that transfers the filaria. Initially, no symptoms may appear. In cases where symptoms do occur, there is usually a palpable swelling in the affected area, which will gradually increase. In the morning the swelling is imperceptible, but resurfaces throughout the day.. The skin remains soft.

2. Second phase: progression of lymphedema

In the second phase, the swelling has been increasing and is noticeable at all times, although it seems to reduce even in the mornings (which it will eventually stop doing). The skin gradually hardens..

3. Elephantiasis

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

Causes of this disease

Elephantiasis is a problem that can have different causes, although the most the most common is infection by parasitic worms known as filarial worms.. This parasite blocks the lymphatic system, which generates edema or fluid accumulation in different areas of the body. Specifically, the most common is the Wucheria bancroftialthough 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, passing the infection from the blood to the lymphatic system (where the parasites feed and grow).

However, although elephantiasis is generally produced for this reason, sometimes there may also be alterations that end up generating elephantiasis (if we understand it as a symptom and not as a disorder in itself). We would then be talking about non-filarial elephantiasiscaused by other lesions such as metastasis of some tumors, other diseases or the consequences of surgery that damaged the lymphatic system.

Treatments

The disease that causes elephantiasis fortunately can be treated by means of the use of different drugs and antiparasitic agentsespecially in an acute and initial phase. Among the most commonly used and effective are ivermectin or diethylcarbamazine. Antibiotics and analgesics may also be required to combat infections and pain, which are frequent in this disease.

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) may remain for life. There are procedures such as compressive therapies and surgery that can reverse the swelling, although the use of compression mechanisms will be necessary. Drainage or diversion of excess lymph may also be helpful.. Compressive measures, establishment of hygienic guidelines to avoid infection and physiotherapy may be helpful in these cases.

Although treatable, it is necessary to take into account the need to establish prevention plans. Hygiene and avoidance of mosquitoes The use of mosquito nets or insecticides can help prevent this traditionally underserved disease worldwide (although WHO has launched a global program for the elimination of lymphatic filariasis that is expected to achieve success around 2020).

Bibliographic references:

• Lozano, Y. (2009). Elephantiasis. A case report. Electronic Medical Journal, 31 (3). Matanzas, Cuba.
• Fenwick, A. (2012). The global burden of neglected tropical diseases. Public health, 126 (3): 233-236.
• Fortuny, E.I.; Guerreiro, M.F.; Pereira, J.M.. (2014). is lymphedema reversible. Rev. Chilena Dermatol; 30 (4) .