LYMPHATIC FILARIASIS

Elephantiasis in the tropics may have a number of causes ranging from
bacterial or fungal lymphangitis and adenitis to Price’s disease. In the
latter silicates in red volcanic soil which enter the skin through the soles
cause an immune reaction which blocks the lymph nodes. A common
cause of elephantiasis is the parasitic worm Wuchereria Bancrofti, which
is transmitted by mosquitoes. It presents after an incubation period of 5
to 15 months with mild lymphangitis and lymphadenitis, and pitting
oedema of one or more extremities or genitals. The lymphadenitis is
descending rather than ascending. At first there are attacks of swelling
but later the symptoms become chronic. Adult worms are present in the
lymphatics and the resulting inflammatory response is thought to be the
cause of the obstruction. The late effects include firm lymphoedema of
the extremities, the vulva, scrotum, arms and breasts. The legs at this
stage often have a warty appearance with folds and cracks in the lower
legs and feet. Active infection can be diagnosed with a rapid card test
using fingerprick blood.
Management of lymphatic filariasis
- Keep clean and manage intercurrent infections.
- Exercises to improve lymphatic flow.
Lymphmassage, intermittent compression,
elastic compression bandages and stockings or
lace-up boots may all be helpful.
- Ivermectine 12 mg plus albendazole 400 mg in a
single dose for adults (see onchocerciasis) will
kill microfilariae but not the adult worms.
This treatment therefore needs to be repeated
yearly until all adult worms have died of old age
(3-4 years).