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 rare given their low prevalence in our home countries.
However, some of them cause physiological alterations that are evident to the naked eye, something that makes them stand out and makes some existing cases stand out or be remembered. This is what happens with elephantiasis , also known as lymphatic filiarisis (although elephantiasis would make more reference to the symptom in question, they are often identified as synonyms).
What is Elephantiasis?
We understand elephantisis to be 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 the lymph. This is the third phase of a lymphodema, in which the alterations become permanent. It usually appears in the chronic phase of lymphatic filariasis, to the extent that it is often identified and used as synonyms for 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 usually affected, as well as the bones.
The deformities caused by this disorder can have serious consequences for the people who suffer from it, not being strange the appearance of fistulas, wounds with possibility of infection or even the appearance of tumors. On a functional level, it can also profoundly alter a person’s life, altering or even making it impossible to walk or move, and is 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 beginning, although in most cases the symptoms begin to be observed in the adult age. Such infection, in fact, may remain asymptomatic despite the fact that damage is being done to the lymphatic system.
In addition, these alterations are often a cause of great shame and discomfort for those affected, many of them avoiding 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 working life are deeply affected as an indirect effect, and the occurrence of discomfort, depression and anxiety is not uncommon.
It is a tropical disease mainly present in countries in Africa, South America, Central America or Indonesia . Although it may seem a strange disease and it is easy to think that it can be classified among rare diseases, the truth is that it is more common than it seems: around 120 million people suffer from some form of this disorder. However, it is a disease that is little considered at a general level, and research on its treatment has been neglected for years.
Stages of appearance
It is possible to identify three phases in which elephantiasis gradually occurs. Technically, the name elephantiasis would correspond to the third or last phase of the process, with lymphedema (lymph generated edema) evolving in the process until reaching a chronic phase.
1. Post-puncture edema
The first moment to take into account is the appearance of the bite of the mosquito that transfers the filaria. Initially, no symptoms may appear. In those cases where it does occur, a palpable swelling is usually observed in the affected area, which will gradually increase. In the mornings the swelling is imperceptible, but it reappears throughout the day . The skin is still soft.
2. Phase two: progression of lymphedema
In a second phase, the swelling has been increasing and is noticeable at all times, although it seems to decrease even in the mornings (something that will eventually stop). The skin starts to harden little by little .
Third and last phase, in which the problem of swelling becomes irreversible and acquires a characteristic hardness. The level of swelling may increase, and the morphological changes will become permanent .
Causes of this disease
Elephantiasis is a problem that can have different causes, although the most common is infection by parasitic worms known as filarias . This parasite blocks the lymphatic system, something that generates oedemas or accumulation of liquids in different areas of the body. Specifically, the most common is Wucheria bancrofti , although there are other species that also generate 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, despite the fact that elephantiasis is usually produced for this reason, sometimes alterations can also occur 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 elephantiasis , caused by other lesions such as some of the metastasis of some tumours, other diseases or the consequences of surgery that damages the lymphatic system.
The disease that causes elephantiasis can fortunately be treated by the use of different drugs and antiparasitics , especially in an acute and initial phase. Among the most used and effective are usually ivermectin or diethylcarbamazine. The use of 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) can 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. The drainage or derivation of the excess lymph can also be of great help . In these cases, compressive measures, establishing hygienic guidelines to avoid infections and physiotherapy may be useful.
Although treatable, it is necessary to take into account the need to establish prevention plans. Hygiene and mosquito avoidance using mosquito nets or insecticides can help prevent this traditionally under-served disease at the global level (although WHO has launched a global programme for the elimination of lymphatic filariasis that is expected to be successful by about 2020).
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- Fortuny, E.I.; Guerreiro, M.F.; Pereira, J.M. (2014). Is lymphedema reversible? Rev. Chilena Dermatol; 30 (4) .