All about elephantiasis

Lymphatic filariasis, additionally referred to as elephantiasis, is a human disease due to parasitic worms called filarial worms.[2][3] most cases of the disease have no symptoms.[2] a few humans, but, develop a syndrome referred to as elephantiasis, that is marked via excessive swelling inside the arms, legs, breasts, or genitals.[2][6] The pores and skin may additionally end up thicker as nicely, and the situation can also turn out to be painful.[2] The modifications to the frame have the capability to harm the person's social and economic situation.[2]

Lymphatic filariasis
other names
Elephantiasis tropica,[1] elephantiasis arabum[1]
Elephanti.jpg
Bellevue Venus; Oscar G. Mason's portrait of a female with elephantiasis.
uniqueness
Infectious disease Edit this on
symptoms
None, excessive swelling of the palms, legs, or genitals[2]
causes
Filarial worms unfold through mosquitos[3]
Diagnostic technique
Microscopic examination of blood[4]
Prevention
bed nets, mass deworming[2]
remedy
Albendazole with ivermectin or diethylcarbamazine[2]
Frequency
38.five million (2015)[5]
The worms are spread by the bites of inflamed mosquitoes.[2] 3 forms of worms are recognised to purpose the sickness: Wuchereria bancrofti, Brugia malayi, and Brugia timori, with Wuchereria bancrofti being the maximum common.[2] those worms harm the lymphatic device.[2] The disease is diagnosed by using microscopic exam of blood amassed for the duration of the night time.[4] The blood is normally examined as a smear after being stained with Giemsa stain.[4] testing the blood for antibodies against the sickness may additionally permit prognosis.[4] other roundworms from the equal own family are accountable for river blindness.[7]

Prevention may be done via treating whole corporations wherein the sickness exists, called mass deworming.[2] this is finished each yr for approximately six years, to be able to rid a population of the sickness totally.[2] medicinal drugs used encompass antiparasitics along with albendazole with ivermectin, or albendazole with diethylcarbamazine.[2] The medications do not kill the grownup worms however save you further spread of the sickness until the worms die on their own.[2] Efforts to prevent mosquito bites also are encouraged, along with reducing the wide variety of mosquitoes and promoting the use of bed nets.[2]

In 2015 approximately 38.5 million human beings have been inflamed.[5] about 950 million humans are liable to the disease in fifty four international locations.[2] it's far maximum common in tropical Africa and Asia.[2] Lymphatic filariasis is classified as a unnoticed tropical diseases and one of the four principal malicious program infections.[7] The ailment effects in monetary losses of many billions of dollars a yr.[2]

symptoms and symptoms
Edit
The maximum magnificent symptom of lymphatic filariasis is elephantiasis, a stage three lymphedema with thickening of the pores and skin and underlying tissues. This turned into the primary mosquito-borne disorder to be discovered.[8] Elephantiasis results while the parasites hotel within the lymphatic system and reason blockages to the flow of lymph. Infections usually start in formative years.[2]

The pores and skin situation the sickness reasons is called "elephantiasis tropica" (additionally known as "elephantiasis arabum").[9]:438

Elephantiasis in particular affects the decrease extremities; the ears, mucous membranes, and amputation stumps are affected much less regularly. but, numerous species of filarial worms have a tendency to affect distinctive parts of the frame: Wuchereria bancrofti can affect the arms, breasts, legs, scrotum, and vulva (inflicting hydrocele formation), while Brugia timori rarely impacts the genitals.[10]:665 those who develop the persistent levels of elephantiasis are usually amicrofilaraemic and often have destructive immunological reactions to the microfilariae in addition to the adult worms.[10]

The subcutaneous worms present with skin rashes, urticarial papules, and arthritis, as well as hyper- and hypopigmentation macules. Onchocerca volvulus manifests itself within the eyes, inflicting "river blindness" (onchocerciasis), one of the leading reasons of blindness inside the international.[11][12]

Serous hollow space filariasis offers with signs and symptoms much like subcutaneous filariasis; it may also be related to ascites following the extreme inflammatory response inside the lymphatics.[13]:818

Elephantiasis leads to marked swelling of the decrease 1/2 of the body and thickening of the skin, making it seem like that of an elephant, a term known as "pachyderm".


Drawn from the collection at the national Museum of health and remedy and indicates the impact of elephantiasis in an ancient context. Anatomical gadgets: Left Leg, Scrotum.


Elephantiasis of the legs because of filariasis. Luzon, Philippines.


guy with big scrotal elephantiasis, Tanzania, early twentieth century

causes
Edit

lifestyles cycle of Wuchereria bancrofti, a parasite that causes lymphatic filariasis
Elephantiasis happens in the presence of microscopic, thread-like parasitic worms together with Wuchereria bancrofti (the maximum commonplace[2]), Brugia malayi, and Brugia timori (also called B. timori), all of that are transmitted by using bites from infected mosquitoes.[14] it is a form of helminth contamination. three sorts of worm cause the disease and damage the lymphatic machine:

The ailment itself is a end result of a complex interplay among several elements: the trojan horse, the endosymbiotic Wolbachia micro organism within the bug, the host’s immune reaction, and the severa opportunistic infections and problems that rise up. The grownup worms best live inside the human lymphatic device.[15] The parasite infects the lymph nodes and blocks the float of lymph for the duration of the frame; this results in continual lymphedema, most usually stated within the lower torso (usually in the legs and genitals).[16]

analysis
Edit
the same old method for diagnosing active infection is with the aid of finding the microfilariae through microscopic exam.[17] this will be hard, as in maximum elements of the world, microfilariae most effective circulate in the blood at night.[4][17] because of this, the blood must be collected nocturnally.[17] The blood pattern is usually in the shape of a thick smear and stained with Giemsa stain. testing the blood serum for antibodies in opposition to the ailment can also be used.[4]

Prevention
Edit
the arena fitness enterprise recommends mass deworming—treating entire companies of folks that are at threat with a single annual dose of two medicines, specifically albendazole in aggregate with either ivermectin or diethylcarbamazine citrate.[18] With consistent treatment, for the reason that disorder desires a human host, the discount of microfilariae approach the ailment will no longer be transmitted, the grownup worms will die out, and the cycle will be damaged.[19] In sub-Saharan Africa, albendazole (donated with the aid of GlaxoSmithKline) is getting used with ivermectin (donated by means of Merck & Co.) to deal with the ailment, whereas some place else in the international, albendazole is used with diethylcarbamazine.[20] Transmission of the contamination may be damaged when a unmarried dose of these mixed oral drugs is continually maintained yearly for a length of four to 6 years.[18] the usage of a combination of remedies higher reduces the number of microfilariae in blood. keeping off mosquito bites, which include by means of the use of insecticide-handled mosquito mattress nets, also reduces the transmission of lymphatic filariasis.[19][21]

The Carter center's worldwide undertaking pressure for sickness Eradication declared lymphatic filariasis one in all six probably eradicable illnesses.[19] in step with medical examiners, the global effort to cast off lymphatic filariasis is on course to doubtlessly succeed via 2020.[22]

For comparable-searching but causally unrelated podoconiosis, global attention of the sickness will need to growth before removal is viable. In 2011, podoconiosis changed into added to the world health enterprise's ignored Tropical sicknesses listing, which turned into an crucial milestone in elevating global cognizance of the situation.[23] The efforts of the worldwide Programme to remove LF are envisioned to have avoided 6.6 million new filariasis cases from developing in youngsters among 2000 and 2007, and to have stopped the development of the disease in some other nine.5 million individuals who had already shriveled it.[24] Dr. Mwele Malecela, who chairs the programme, said: "we are on track to perform our purpose of elimination by using 2020."[22] In 2010, the WHO published an in depth progress record at the elimination marketing campaign wherein they assert that of the eighty one countries with endemic LF, fifty three have applied mass drug management, and 37 have completed five or greater rounds in a few areas, though city areas remain tricky.[25]

treatment
Edit
Anthelmintic
Edit
remedies for lymphatic filariasis range depending on the geographic region of the area of the arena in which the disorder changed into received.[20] In sub-Saharan Africa, albendazole is getting used with ivermectin to deal with the disease, whereas somewhere else within the world, albendazole is used with diethylcarbamazine.[20] Geo-focused on treatments is part of a larger method to ultimately eliminate lymphatic filariasis through 2020.[20]

Antibiotics
Edit
The antibiotic doxycycline is likewise powerful in treating lymphatic filariasis.[26] Its drawbacks over anthelmintic pills are that it requires 4 to 6 weeks of treatment, must now not be utilized in younger kids and pregnant women, and is photosensitizing, which limits its use for mass prevention.[26] The parasites accountable for elephantiasis have a population of endosymbiotic bacteria, Wolbachia, that live within the malicious program. when the symbiotic micro organism of the grownup worms are killed with the aid of the antibiotic, they now not offer chemical compounds which the nematode larvae need to broaden, which either kills the larvae or prevents their ordinary improvement. This permanently sterilizes the grownup worms, which additionally die within 1 to two years rather than their ordinary 10 to 14 12 months lifespan.[27]

Vaccine development
Edit
A vaccine isn't always yet available, but in 2013 the college of Illinois university of medication become reporting 95% efficacy in trying out towards B. malayi in mice.[28]

Supportive remedies
Edit
moreover, surgical remedy can be useful for issues related to scrotal elephantiasis and hydrocele. however, surgery is typically ineffective at correcting elephantiasis of the limbs.[29][30]

Epidemiology
Edit

disability-adjusted existence year for lymphatic filariasis according to 100,000 population
  no statistics
  less than 10
  10-50
  50-70
  70-80
  80-ninety
  ninety-a hundred
  100-150
  one hundred fifty-200
  200-three hundred
  300-400
  four hundred-500
  more than 500
Elephantiasis due to lymphatic filariasis is one of the maximum common reasons of disability in the international.[20] A 2012 file stated that lymphatic filariasis affected a hundred and twenty million human beings[31] and one thousand million human beings at hazard for infection.[32] about 40 million humans were disfigured or incapacitated by way of the ailment in 2015.[33] it's far considered endemic in tropical and subtropical areas of Africa, Asia, significant and South the united states, and Pacific Island international locations.

In areas endemic for podoconiosis, prevalence can be 5% or better.[34] In groups where lymphatic filariasis is endemic, as many as 10% of women may be troubled with swollen limbs, and 50% of fellows can be afflicted by mutilating genital symptoms.[20]

Filariasis is considered endemic in 73 nations; 37 of those are in Africa.

in the Americas, it's miles found in Brazil, Costa Rica, the Dominican Republic, Guyana, Haiti, Suriname, and Trinidad and Tobago.
In Asia, it's miles present in Bangladesh, Cambodia, India, Indonesia, Laos, Malaysia, Maldives, the Philippines, Sri Lanka, Thailand, Timor-Leste, and Vietnam.
within the center East, it is present most effective in Yemen.
within the Pacific area, it's far endemic in American Samoa, the cook Islands, Fiji, French Polynesia, Micronesia, Niue, Papua New Guinea, Samoa, Tonga, Tuvalu, and Vanuatu.
In many of these nations, giant development has been made towards elimination of filariasis. In July 2017, the sector health agency (WHO) announced that the ailment were removed in Tonga.[35] removal of the sickness has also passed off in Cambodia, China, the cook dinner Islands, Niue, the Marshall Islands, South Korea, and Vanuatu, according to the WHO.[35]

records
Edit

a man in Japan is helped to hold his enlarged scrotum
Lymphatic filariasis is idea to have affected people for approximately 4000 years.[36] Artifacts from historical Egypt (2000 BC) and the Nok civilization in West Africa (500 BC) show viable elephantiasis symptoms. the first clear reference to the sickness happens in ancient Greek literature, wherein students differentiated the frequently similar signs and symptoms of lymphatic filariasis from the ones of leprosy, describing leprosy as elephantiasis graecorum and lymphatic filariasis as elephantiasis arabum.[36]

the first documentation of signs passed off in the sixteenth century, whilst Jan Huyghen van Linschoten wrote about the disease throughout the exploration of Goa. similar signs and symptoms have been said by means of subsequent explorers in regions of Asia and Africa, although an know-how of the disease did now not begin to expand until centuries later.

In 1866, Timothy Lewis, constructing on the work of Jean Nicolas Demarquay [de] and Otto Henry Wucherer, made the connection among microfilariae and elephantiasis, setting up the path of studies that could in the long run provide an explanation for the ailment. In 1876, Joseph Bancroft found the grownup shape of the trojan horse.[37] In 1877, the lifecycle related to an arthropod vector changed into theorized by using Patrick Manson, who proceeded to demonstrate the presence of the worms in mosquitoes. Manson incorrectly hypothesized that the sickness turned into transmitted through skin touch with water in which the mosquitoes had laid eggs.[38] In 1900, George Carmichael Low decided the actual transmission method via discovering the presence of the malicious program in the proboscis of the mosquito vector.[36]

Many human beings in Malabar, Nayars as well as Brahmans and their other halves — in truth about 1 / 4 or a 5th of the whole populace, inclusive of the human beings of the lowest castes — have very large legs, swollen to a notable size; and they die of this, and it is an ugly thing to peer. they are saying that that is because of the water through which they move, because the us of a is marshy. that is known as pericaes inside the native language, and all of the swelling is the same from the knees downward, and they have no pain, nor do they take any word of this infirmity.
— Portuguese diplomat Tomé Pires, Suma Oriental, 1512–1515.[39]
research guidelines
Edit
Researchers on the college of Illinois at Chicago (UIC) have advanced a unique vaccine for the prevention of lymphatic filariasis. This vaccine has been proven to elicit strong, shielding immune responses in mouse models of lymphatic filariasis contamination. The immune reaction elicited by using this vaccine has been confirmed to be protecting towards both W. bancrofti and B. malayi infection inside the mouse model and may prove useful within the human.[40]

On September 20, 2007, geneticists published the first draft of the whole genome (genetic content material) of Brugia malayi, one of the roundworms which causes lymphatic filariasis.[41] This challenge were began in 1994 and by using 2000, eighty% of the genome were determined. determining the content of the genes would possibly lead to the improvement of new drugs and vaccines

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