Lymphatic Filariasis(Elephantiasis)

Lymphatic Filariasis (LF), also known as elephantiasis, is a severely disfiguring disease which affects 120m around the world.

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LF causes severe swelling in the limbs

It can be treated, but the drugs are not always available to those most at need.

What are the symptoms?

The condition is associated with huge and disfiguring enlargement of a limb, or areas of the trunk or head. These swellings are known technically as lymphoedema.

In addition, the skin usually develops a thickened, pebbly appearance and may become ulcerated and darkened.

Other symptoms can include fever, chills and a general feeling of ill health.

The disease may also affect the sexual organs. In a man, the scrotum may become enlarged, and the penis may be retracted under the skin.

In women the external genitalia may be covered in a tumourous mass.

People with the condition often have to contend with social as well as physical problems.

Communities frequently shun women and men disfigured by the disease.

Many women with visible signs of the disease will never marry, or their spouses and families will reject them.

They are also frequently are unable to work because of their disability.

Other symptoms can include fever, chills and a general feeling of ill health.

The disease may also affect the sexual organs. In a man, the scrotum may become enlarged, and the penis may be retracted under the skin.

In women the external genitalia may be covered in a tumourous mass.

People with the condition often have to contend with social as well as physical problems.

Communities frequently shun women and men disfigured by the disease.

Many women with visible signs of the disease will never marry, or their spouses and families will reject them.

They are also frequently are unable to work because of their disability.

What causes it?

It is caused by microscopic, thread-like parasitic worms invading the body’s lymphatic system – the network of vessels carrying infection-fighting cells.

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The worm is spread by mosquitoes, who pass it on when they take blood from humans.

The bacteria-containing worms lodge in the lymphatic system, producing millions of minute larvae which spread throughout the bloodstream.

Image of the worm that causes the disease
Parasitic worms cause the disease

These worms disrupt the balance of the lymphatic system, which helps maintain the fluid balance between the tissues and the blood.

What is still not clear is how much this is down to the worms causing obstruction of the lymphatic vessels, or the immune response their presence triggers in the body.

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However, once the tissues have been damaged, they also become vulnerable to other bacterial and fungal infections, which are often responsible for much of the disease seen in LF patients.

Recent studies have also suggested that the disease may be caused by the red soil on which certain barefooted populations live.

It is believed that small chemical particles found in the soil may enter the skin through the bare feet, lodging in the lymphatic tissues and producing irritation which increases the vulnerability to bacterial infection.

Who is most at risk?

Over 120 million have already been affected by it, over 40 million of them are seriously incapacitated and disfigured by the disease.

One-third of the people infected with the disease live in India, one third are in Africa and most of the remainder are in South Asia, the Pacific and the Americas.

In communities where the condition is endemic, 10-50% of men and up to 10% of women can be affected.

Though the infection is generally acquired early in childhood, the disease may take years to manifest itself.

Diagnosis:
The standard method for diagnosing active infection is by finding the microfilariae via microscopic examination. This may be difficult, as in most parts of the world, microfilariae only circulate in the blood at night. For this reason, the blood has to be collected nocturnally.The blood should be in the form of a thick smear and stained with Giemsa. Testing the blood for antibodies against the disease may also be used.

How is it treated?

Drugs such as albendazole and diethylcarbamazine (DEC) have been shown to be effective in killing the parasites.

Their use not only eases symptoms, particularly among people in the early stages of disease, but also prevents the parasites being spread to others in the community.

A study in the Lancet, published in 2005, found that doxycycline, a widely available antibiotic, is also highly effective at killing the parasites.

Careful cleansing can also have a significant impact, helping to heal infected areas, and reversing some of the tissue damage, particularly that associated with secondary bacterial or fungal infections.

Measures to improve the flow of the lymphatic fluid, such as raising and exercising the swollen body part can also help.
Prevention:
Studies have demonstrated transmission of the infection can be broken when a single dose of combined oral medicines is consistently maintained annually, for approximately seven years. With consistent treatment, and since the disease needs a human host, the reduction of microfilariae means the disease will not be transmitted, the adult worms will die out, and the cycle will be broken.

The strategy for eliminating transmission of lymphatic filariasis is mass distribution of medicines that kill the microfilariae and stop transmission of the parasite by mosquitoes in endemic communities. 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. Using a combination of treatments better reduces the number of microfilariae in blood. Avoiding mosquito bites, such as by using insecticide-treated mosquito bed nets, also reduces the transmission of lymphatic filariasis.

In 1993, the International Task Force for Disease Eradication declared lymphatic filariaisis to be one of six potentially eradicable diseases.

According to medical experts, the worldwide efforts to eliminate lymphatic filariasis is on track to potentially succeed by 2020. An estimated 6.6 million children have been prevented from being infected, with another estimated 9.5 million in whom the progress of the disease has been stopped.

For podoconiosis, international awareness of the disease will have to increase before elimination is possible. In 2011, podoconiosis was added to the World Health Organization’s Neglected Tropical Diseases list, which was an important milestone in raising global awareness of the condition.

The efforts of the Global Programme to Eliminate LF are estimated to have prevented 6.6 million new filariasis cases from developing in children between 2000 and 2007, and to have stopped the progression of the disease in another 9.5 million people who had already contracted it. Dr. Mwele Malecela, who chairs the programme, said: “We are on track to accomplish our goal of elimination by 2020.” In 2010, the WHO published a detailed progress report on the elimination campaign in which they assert that of the 81 countries with endemic LF, 53 have implemented mass drug administration, and 37 have completed five or more rounds in some areas, though urban areas remain problematic.

Prognosis:
About 40 million disfigured and incapacitated by the disease. Elephantiasis caused by lymphatic filariasis is one of the most common causes of disability in the world. In endemic communities, approximately 10 percent of women can be affected with swollen limbs, and 50 percent of men can have from mutilating genital disease. In areas endemic for podoconiosis, prevalence can be 5% or higher.

Researchs:
University of Illinois at Chicago (UIC) inventors have developed a novel vaccine for the prevention of lymphatic filariasis. This vaccine has been shown to elicit strong, protective immune responses in mouse models of lymphatic filariasis infection.The immune response elicited by this vaccine has been demonstrated to be protective against both W. bancrofti and B. malayi infection.

On September 20, 2007, geneticists mapped the genome (genetic content) of Brugia malayi, the roundworm which causes elephantiasis (lymphatic filariasis). Determining the content of the genes might lead to development of new drugs and vaccines.

You may click to see:->Filaria

Resources:
BBC NEWS:nov 14,’06
http://en.wikipedia.org/wiki/Lymphatic_filariasis

 

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