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14-September-2008 12:50:31 - Elephantiasis Elephantiasis Classification and external resources Elephantiasis of leg due to filariasis. Luzon, Philippines. ICD-10 B74.0 ILDS B74.01 I89. ICD-9 125.9, 457.1 DiseasesDB 4824 eMedicine derm/888 MeSH D004605 Elephantiasis /ˌɛlÉ™fÉ™nˈtaɪəsɪs, -fæn-/ el-uh-fuhn-tahy-uh-sis, -fan- is a disease that is characterized by the thickening of the skin and underlying tissues, especially in the legs and genitals. In some cases, the disease can cause certain body parts, such as the scrotum, to swell to the size of a softball or basketball.1 Elephantitis is a common mis-hearing or mis-remembering of the term, from confusing the ending -iasis -- process or resulting condition -- with the more commonly heard -itis -- irritation or inflammation. Its proper medical name is neurofibrome. Contents 1 Causes 2 Cultural aspects 3 Treatment 3.1 Antibiotics as a possible treatment 3.2 Genome deciphered 4 Impact on endemic communities 5 References 6 External links Causes Elephantiasis is often caused by parasitic worms such as Wuchereria bancrofti, Brugia malayi, and B. timori, all of which are transmitted by mosquitoes. Consequently, it is common in tropical regions and Africa. Obstruction of the lymphatic vessels leads to swelling in the lower torso, typically in the legs and genitals. It is not definitively known if this swelling is caused by the parasite itself, or by the immune system's response to the parasite. Alternatively, elephantiasis may occur in the absence of parasitic infection. This nonparasitic form of elephantiasis, known as nonfilarial elephantiasis or podoconiosis, and areas of high prevalence have been documented in Uganda, Tanzania, Kenya, Rwanda, Burundi, Sudan and Ethiopia.2 The worst affected area is Ethiopia, where up to 6% of the population is affected in endemic areas.34 Nonfilarial elephantiasis is thought to be caused by persistent contact with irritant soils: in particular, red clays rich in alkali metals such as sodium and potassium and associated with volcanic activity.56 Elephantiasis is also commonly known as lymphatic filariasis which is caused by infection with microscopic, thread like worms.7 The adult worms only live in the human lymph system.8 Cultural aspects Elephantiasis is associated in the public mind with The Elephant Man, the carnival stage name of Joseph Merrick. The name refers to the resemblance of the sufferer's limbs to the thick, baggy skin on the limbs and trunks of elephants. However, it is now believed that Merrick's deformity was not actually caused by elephantiasis, but by a completely different medical problem called Proteus Syndrome. Treatment Bellevue Venus Oscar G. Mason's portrait of a woman with elephantiasis, published in Fox. Bellevue Venus Oscar G. Mason's portrait of a woman with elephantiasis, published in Fox. Treatments for lymphatic filariasis differ depending on the geographic location of the endemic area.9 In sub-Saharan Africa, albendazole donated by GlaxoSmithKline is being used with ivermectin donated by Merck Co. to treat the disease, whereas elsewhere in the world, albendazole is used with diethylcarbamazine.9 Geo-targeting treatments is part of a larger strategy to eventually eliminate lymphatic filariasis.9 Another form of effective treatment involves rigorous cleaning of the affected areas of the body. Several studies have shown that these daily cleaning routines can be an effective way to limit the symptoms of lymphatic filariasis. The efficacy of these treatments suggests that many of the symptoms of elephantiasis are not directly a result of the lymphatic filariasis but rather the effect of secondary skin infections. Also, surgical treatment may be helpful for issues related to scrotal elephantiasis and hydrocele. However, surgery is generally ineffective at correcting elephantiasis of the limbs. A vaccine is not yet available but is likely to be developed in the near future. Antibiotics as a possible treatment In 2003 it was suggested that the common antibiotic doxycycline might be effective in treating elephantiasis10. The parasites responsible for elephantiasis have a population of symbiotic bacteria, Wolbachia, that live inside the worm. When the symbiotic bacteria are killed by the antibiotic, the worms themselves also die. Clinical trials in June 2005 by the Liverpool School of Tropical Medicine reported that an 8 week course almost completely eliminated microfilariaemia.1112 Genome deciphered On September 20, 2007, scientists mapped the genome or genetic content of Brugia malayi - the worm which cause elephantiasis lymphatic filariasis. Figuring out the content of the genes might lead to development of new drugs and vaccines.13 Impact on endemic communities Elephantiasis caused by lymphatic filariasis is one of the most common causes of disability in the world.9 In endemic communities, approximately 10 percent of women can be affected with swollen limbs and 50 percent of men can suffer from mutilating genital disease.9 References ^ McNeil, Donald 2006-04-09, Beyond Swollen Limbs, a Disease's Hidden Agony, New York Times, http://www.nytimes.com/2006/04/09/world/americas/09lymph.html. Retrieved on 17 July 2008 ^ Davey G, Tekola F, Newport MJ 2007. Podoconiosis. Trans R Soc Trop Med Hyg 101: 1175-80. doi:10.1016/j.trstmh.2007.08.013. ^ Birrie H, Balcha F, Jemaneh L. Elephantiasis in Pawe settlement area: podoconiosis or bancroftian filariasis?. Ethiop Med J 35: 245-250. ^ Desta K, Ashine M, Davey G 2003. Prevalence of podoconiosis endemic non-filarial elephantiasis in Wolaitta, Southern Ethiopia. Trop Doct 32: 217-220. ^ Price EW 1974. The relationship bewteen endemic elephantiasis of the lower legs and the local soils and climate. A study in Wollamo District, Southern Ethiopia. Trop Geogr Med 26: 226-230. ^ Price EW 1976. The Association of endemic elephantiasis of the lower legs in East Africa with soil derived from volcanic rocks. Trans R Soc Trop Med Hyg 70: 288-295. doi:10.1016/0035-92037690078-X. ^ CDC. 2008. Lymphatic Filariasis. Centers for Disease Control and Prevention.: http://www.cdc.gov/ncidod/dpd/parasites/lymphaticfilariasis/index.htm. ^ Niwa, Seiji. Prevalence of Vizcarrondo worms in early onset lymphatic filariasis: A case study in testicular elephantiasis. Univ Puerto Rico Med J 22: 187-193. ^ a b c d e The Carter Center, Lymphatic Filariasis Elimination Program, http://www.cartercenter.org/health/lf/index.html ^ Hoerauf A, Mand S, Fischer K, Kruppa T, Marfo-Debrekyei Y, Debrah AY, Pfarr KM, Adjei O, Buttner DW 2003. Doxycycline as a novel strategy against bancroftian filariasis-depletion of Wolbachia endosymbionts from Wuchereria bancrofti and stop of microfilaria production. Med Microbiol Immunol Berl 192 4: 211-6. doi:10.1007/s00430-002-0174-6. PMID 12684759. ^ Taylor MJ, Makunde WH, McGarry HF, Turner JD, Mand S, Hoerauf A 2005. Macrofilaricidal activity after doxycycline treatment of Wuchereria bancrofti: a double-blind, randomised placebo-controlled trial. Lancet 365 9477: 2116-21. doi:10.1016/S0140-67360566591-9. PMID 15964448. ^ Outland, Katrina 2005 Volume 13. New Treatment for Elephantitis: Antibiotics, The Journal of Young Investigators. ^ Ghedin E, Wang S, Spiro D, et al. 2007. Draft genome of the filarial nematode parasite Brugia malayi. Science 317: 1756-60. doi:10.1126/science.1145406. PMID 17885136. External links Antibiotics help combat Elephantiasis Elephantiasis photographic documention The Carter Center Lymphatic Filariasis Elimination Program Retrieved from http://en..org/wiki/Elephantiasis Categories: Neglected diseases | Parasitic diseases Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages ÄŒesky Dansk Deutsch Ελληνικά Español Français Italiano Lietuvių Nederlands 日本語 Polski Română РуÑ?Ñ?кий Suomi Svenska Türkçe ä¸æ–‡ This page was last modified on 3 September 2008, at 00:21
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