Elephant foot disease: Causes, symptoms and treatment

Elephantiasis, also known as elephantiasis, is a complication of lymphatic filariasis. The disease is endemic mainly in hot and humid countries and occurs when mosquitoes transmit filariasis larvae to humans.

What you need to know about elephantiasis

Worms only parasitize in the lymphatic system from which damage to the lymphatic vessels causes fluid retention in the extremities, so it is called elephantiasis.

Treatment of elephantiasis depends on the stages of the disease, mainly treatment has a good effect in the early stages. However, at this early stage, the disease is often overlooked due to its silent manifestations. With the late stage, especially when there are vascular complications, the treatment results are often limited, depending on the case, surgery can be performed.

The cause of elephantiasis is filariasis.

Causes of elephant foot disease

The cause of elephantiasis is filariasis. In the world, 3 species of filariasis causing human disease have been detected: Wuchereria bancrofti (W. bancrofti), Brugia malayi (B. malayi) and Brugia timori (B.timori). In our country, only 2 species are detected, W. bancrofti and B. malayi (B.malayi).

Characteristics

W. bancrofti species is usually localized in the inguinal or axillary lymphatic system. The adult W. bancrofti thread-like, milky white worm is 25 - 40 mm long, about 0.1 mm wide. The female W. bancrofti worm is about 60 - 100 mm in length.

B. malayi larvae have affinity for genital ganglia and renal region. Morphologically, B. malayi is similar to W. bancrofti. Male worms are about 22.8 x 0.08 mm, female worms are about 55 x 0.16 mm.

The male and female worms often coil together thereby obstructing the lymphatic vessels.

Ability to survive in the environment:

Both filariasis and adult filariasis do not exist in the natural environment, only in the human body and in the body of the mosquito that transmits the disease.

Symptoms of elephant foot disease

Elephantiasis is the most obvious manifestation in the complicated stage of filariasis. Symptoms of elephantiasis depend on the stage as follows:

1. Incubation period: is the time from when worm larvae are introduced into the body until they develop into adult worms.
2. Next is the stage of disease onset: symptoms are not obvious depending on each case and easily confused with other diseases. Patients often present with fever, vasculitis in the axillary or inguinal legs with lymphadenopathy.
3. Finally, the full-blown stage: this stage the lymphatic system has been damaged leading to complications.

Manifestations of full-blown/complicated stage:

1. Elephant foot edema appears. Patients will have episodes of edema appear continuously, the skin gradually becomes thick, edema gradually from bottom to top. The majority of cases of swelling on one leg, the most common is the swelling of the whole foot, which can spread to the thigh. The patient's skin is increasingly thick and hard, on the skin may appear ulcers due to lack of nutrition.
2. Genital inflammation: including epididymitis, orchitis, hydrocele. In severe cases, the genitals may be swollen like elephant scrotum, elephant breast but not red and completely painless (so called elephant edema). Genital inflammation severely affects the patient's quality of life. In addition, the patient severely reduces the ability to work, live, physiological activities and greatly affect aesthetics.
3. Chilli urine: cloudy urine like rice water, but not settling for a long time, sometimes there may be blood mixed in. In some cases, there are too many chylous in the urine, then the urine can be frozen for a long time.

Methods to diagnose elephantiasis

Elephantiasis can be easily recognized clinically when enlarged feet are present, but in other cases some tests can be performed to make an early diagnosis.

1. Blood test: have filariasis larvae.
2. Chylous test: can detect filariasis larvae.
3. Immunosorbent assay with ELISA.
4. Lymph node biopsy for pathology.
5. Ultrasound, lymphangiography: detecting lesions of the lymphatic system.

Swollen feet are one of the symptoms of elephantiasis.

Methods to treat elephant foot disease

Treatments for elephantiasis include:

Complex decongestive therapy (CDT)

CDT is still considered the international standard of care for the treatment of lymphedema in general or elephantiasis in particular, consisting of two phases: induction and maintenance.

The goal of CDT is to increase lymphatic drainage; to reduce swelling, discomfort, fibrosis and the risk of cellulitis; and to improve functional status and quality of life. The attack phase includes the use of a massage technique known as manual lymphatic drainage (MLD), short dressings, exercises to create and strengthen the internal pumping mechanism, skin care, and education in self-management. Skin care is necessary to prevent infections, control bacterial and fungal invasion, eliminate bacterial overgrowth in skin crevices, and moisturize skin to prevent dryness and cracking. .

The maintenance phase typically involves the use of compression garment(s) during the day, with more advanced patients requiring nocturnal compression by bandaging or replacement with a compression device and device. custom compression. MLD and exercise continue to play an important role in the maintenance treatment of lymphedema.

Surgical method

Although surgery is not a cure-all, they are sometimes considered when CDT and other methods fail to relieve symptoms. Surgical removal or deburring and liposuction to help reduce excess tissue, and is usually reserved for patients whose mobility and quality of life are severely reduced due to the disease. In addition, several newer microsurgical lymphatic reconstructions, including lymphatic bypass, lymph node transfer, and lymph node transplantation, are gaining attention.

Transmission route of elephant foot disease

Elephant's foot disease is not transmitted directly from an infected person to a healthy person but must be transmitted by mosquitoes. If a mosquito bites an infected person and becomes infected with the larvae and then bites another person, it can spread the disease to others.

Subjects susceptible to elephantiasis

Hot and humid climate, poor sanitation, humid place: is a favorable environment for the development of mosquitoes, so areas with hot and humid climate are at higher risk of disease.
Sleeping without a net: creating conditions for mosquitoes to transmit filariasis larvae into the body.

Prevention of elephant foot disease

Elephant's foot disease is a mosquito-borne disease, so prevention plays an important role in reducing the incidence of the disease: to prevent the disease, it is necessary to do the following:

1. Clean the surroundings regularly, clear the bushes, clear the drains, dispose of broken pots around the house.
2. Avoid mosquito bites by sleeping with a mosquito net, choosing light-colored clothes, wearing long pants and long sleeves at night to limit mosquito bites.
3. Killing mosquitoes, eliminating sources of disease: Join the authorities in launching campaigns to kill mosquitoes.

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