Elephantiasis (/ˌɛləfənˈtaɪəsɪs, -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, male genitals and female breasts. In some cases, the disease can cause certain body parts, such as the
scrotumIn some male mammals the scrotum is a protuberance of skin and muscle containing the testicles. It is an extension of the abdomen, and is located between the penis and anus. In humans and some other mammals, the base of the scrotum becomes covered with curly pubic hairs at puberty...
, to swell to the size of a
softballSoftball is a team sport popular especially in the United States. It is a direct descendant of baseball. Some key differences between softball and baseball are that softballs are larger than baseballs, and pitches are thrown underhand rather than overhand. Softball was invented by George Hancock...
or
basketballA basketball is an inflated ball used in the game of basketball. Basketballs typically range in size from very small promotional items possibly only a few inches in diameter to extra large balls nearly a foot in diameter used in training exercises to increase the skill of players.Nearly all...
. "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).
Elephantiasis (/ˌɛləfənˈtaɪəsɪs, -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, male genitals and female breasts. In some cases, the disease can cause certain body parts, such as the
scrotumIn some male mammals the scrotum is a protuberance of skin and muscle containing the testicles. It is an extension of the abdomen, and is located between the penis and anus. In humans and some other mammals, the base of the scrotum becomes covered with curly pubic hairs at puberty...
, to swell to the size of a
softballSoftball is a team sport popular especially in the United States. It is a direct descendant of baseball. Some key differences between softball and baseball are that softballs are larger than baseballs, and pitches are thrown underhand rather than overhand. Softball was invented by George Hancock...
or
basketballA basketball is an inflated ball used in the game of basketball. Basketballs typically range in size from very small promotional items possibly only a few inches in diameter to extra large balls nearly a foot in diameter used in training exercises to increase the skill of players.Nearly all...
. "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). The proper medical term is Elephantiasis, and it is caused by lymphatic filariasis.
Causes
Elephantiasis occurs in the presence of microscopic, thread-like parasitic worms such as
Wuchereria bancroftiWuchereria bancrofti or Filaria, is a parasitic filarial nematode worm spread by a mosquito vector. It is one of the three parasites that cause lymphatic filariasis. Named for Otto Wucherer and Joseph Bancroft, it affects over 120 million people, primarily in Africa, South America, and other...
,
Brugia malayiBrugia malayi is a roundworm nematode, one of the three causative agents of lymphatic filariasis in humans. Lymphatic filariasis, also known as elephantiasis, is a condition characterized by swelling of the lower limbs. The two other filarial causes of lymphatic filariasis are Wuchereria bancrofti...
, and
B. timoriBrugia timori is a human filarial parasite which causes the disease "Timor filariasis." While this disease was first described in 1965, the identity of Brugia timori as the causative agent was not known until 1977...
, all of which are transmitted by
mosquitoMosquito is a common insect in the family Culicidae...
es. However, the disease itself is a result of a complex interplay between several factors: the worm, the symbiotic
WolbachiaWolbachia is a genus of inherited bacteria which infects arthropod species, including a high proportion of insects. It is one of the world's most common parasitic microbes and is possibly the most common reproductive parasite in the biosphere...
bacteria within the worm, the host’s immune response, and the numerous opportunistic infections and disorders that arise. Consequently, it is common in tropical regions and
AfricaAfrica is the world's second-largest and second most-populous continent, after Asia. At about 30.2 million km² including adjacent islands, it covers 6% of the Earth's total surface area and 20.4% of the total land area. With a billion people in 61 territories, it accounts for about 14.8% of the...
. The adult worms only live in the human
lymphatic systemThe lymphatic system in vertebrates is a network of conduits that carry a clear fluid called lymph. It also includes the lymphoid tissue through which the lymph travels. Lymphoid tissue is found in many organs, particularly the lymph nodes, and in the lymphoid follicles associated with the...
. 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 is known as "nonfilarial elephantiasis" or "podoconiosis", and areas of high prevalence have been documented in
UgandaThe Republic of Uganda is a landlocked country in East Africa. It is bordered on the east by Kenya, on the north by Sudan, on the west by the Democratic Republic of the Congo, on the southwest by Rwanda, and on the south by Tanzania...
,
TanzaniaThe United Republic of Tanzania is a country in central East Africa bordered by Kenya and Uganda to the north, Rwanda, Burundi and the Democratic Republic of the Congo to the west, and Zambia, Malawi and Mozambique to the south. The country's eastern borders lie on the Indian Ocean.The United...
,
KenyaThe Republic of Kenya is a country in East Africa. Lying along the Indian Ocean, at the equator, Kenya is bordered by Ethiopia , Somalia , Tanzania , Uganda plus Lake Victoria , and Sudan . The capital city is Nairobi. Kenya spans an area about 85% the size of France or Texas...
,
RwandaThe Republic of Rwanda is a small landlocked country in the Great Lakes region of east-central Africa, bordered by Uganda, Burundi, the Democratic Republic of the Congo and Tanzania. Home to approaching 10 million people, Rwanda supports the densest population in continental Africa, most of whom...
,
BurundiBurundi , officially the Republic of Burundi, is a country in the Great Lakes region of Eastern Africa bordered by Rwanda to the north, Tanzania to the east and south, and the Democratic Republic of the Congo to the west. Its size is just under 28,000 km² with an estimated population of...
,
SudanSudan is a country in northeastern Africa. It is the largest country in Africa and in the Arab World, and tenth largest in the world by area...
,
EgyptEgypt , officially the Arab Republic of Egypt, is a country mainly in North Africa, with the Sinai Peninsula forming a land bridge in Western Asia...
and
EthiopiaEthiopia , officially the Federal Democratic Republic of Ethiopia, is a landlocked country situated in the Horn of Africa. Ethiopia is bordered by Eritrea to the north, Sudan to the west, Kenya to the south, Somalia to the east and Djibouti to the northeast. Its size is 1,100,000 km² with an...
. The worst affected area is Ethiopia, where up to 6% of the population is affected in endemic areas. Nonfilarial elephantiasis is thought to be caused by persistent contact with irritant soils: in particular, red clays rich in alkali metals such as
sodiumSodium is a metallic element with a symbol Na and atomic number 11. It is a soft, silvery-white, highly reactive metal and is a member of the alkali metals within "group 1"...
and
potassiumPotassium is the chemical element with the symbol K , atomic number 19, and atomic mass 39.0983. Potassium was first isolated from potash...
and associated with volcanic activity.
Cultural aspects
Elephantiasis is associated in the public mind with "The Elephant Man", the carnival stage name of
Joseph MerrickJoseph Carey Merrick was an Englishman who became known as "The Elephant Man" because of his physical appearance caused by a congenital disorder. Because of his condition, he would garner the sympathy of the United Kingdom of Great Britain and Ireland during the Victorian era...
. 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, and that it may have been
proteus syndromeProteus syndrome is a congenital disorder that causes skin overgrowth and atypical bone development, often accompanied by tumors over half the body.Proteus syndrome is highly variable, and is named after the Greek sea-god Proteus, who could change his shape....
instead, possibly combined with
neurofibromatosis type INeurofibromatosis type I , formerly known as von Recklinghausen disease after the researcher who first documented the disorder, is a human genetic disorder. It is possibly the most common inherited disorder caused by a single gene...
.
Treatment
Treatments for lymphatic filariasis differ depending on the geographic location of the endemic area. In sub-Saharan Africa,
albendazoleAlbendazole, marketed as Albenza, Eskazole, and Zentel, is a member of the benzimidazole compounds used as a drug indicated for the treatment of a variety of worm infestations. Although this use is widespread in the United States, the U.S. Food and Drug Administration has not approved albendazole...
is being used with
ivermectinIvermectin is a broad-spectrum antiparasitic medication.It is sold under brand names Stromectol in the United States, Mectizan in Canada by Merck and Ivexterm in Mexico by Valeant Pharmaceuticals International.-Uses:It is traditionally used against worms, but more recently found to be effective...
to treat the disease, whereas elsewhere in the world, albendazole is used with
diethylcarbamazineDiethylcarbamazine is an anthelmintic drug that does not resemble other antiparasitic compounds. It is a synthetic organic compound which is highly specific for several parasites and does not contain any toxic metallic elements.-Uses:...
. Geo-targeting treatments is part of a larger strategy to eventually eliminate lymphatic filariasis by 2020.
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
hydroceleA hydrocele denotes a pathological accumulation of serous fluid in a bodily cavity.* A hydrocele testis is the accumulation of fluids around a testicle, and is fairly common. A hydrocele testis is due to fluid secreted from a remnant piece of peritoneum wrapped around the testis, called the tunica...
. However, surgery is generally ineffective at correcting elephantiasis of the limbs.
A
vaccineA vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains a small amount of an agent that resembles a microorganism...
is not yet available but is likely to be developed in the near future.
Antibiotics
In 2003 it was suggested that the common antibiotic
doxycyclineDoxycycline is a member of the tetracycline antibiotics group and is commonly used to treat a variety of infections. Doxycycline is a semi-synthetic tetracycline invented and clinically developed in the early 1960s by Pfizer Inc. and marketed under the brand name Vibramycin. Vibramycin received...
might be effective in treating elephantiasis.. The parasites responsible for elephantiasis have a population of symbiotic bacteria,
WolbachiaWolbachia is a genus of inherited bacteria which infects arthropod species, including a high proportion of insects. It is one of the world's most common parasitic microbes and is possibly the most common reproductive parasite in the biosphere...
, that live inside the worm. When the symbiotic bacteria are killed by the antibiotic, the worms themselves also die.
Clinical trials by the
Liverpool School of Tropical MedicineThe Liverpool School of Tropical Medicine , England, was founded on 12 November 1898, by a donation from Sir Alfred Lewis Jones, a Liverpool Shipowner...
in June 2005 reported that an 8 week course almost completely eliminated microfilariaemia.
Genome deciphered
On September 20, 2007, scientists mapped the
genomeIn modern molecular biology the genome refers to all of its hereditary information encoded in DNA .The genome includes both the genes and the non-coding sequences of the DNA. The term was adapted in 1920 by Hans Winkler, Professor of Botany at the University of Hamburg, Germany...
or
geneticGenetics, , a discipline of biology, is the science of heredity and variation in living organisms. The fact that living things inherit traits from their parents has been used since prehistoric times to improve crop plants and animals through selective breeding...
content of
Brugia malayiBrugia malayi is a roundworm nematode, one of the three causative agents of lymphatic filariasis in humans. Lymphatic filariasis, also known as elephantiasis, is a condition characterized by swelling of the lower limbs. The two other filarial causes of lymphatic filariasis are Wuchereria bancrofti...
- the roundworm which causes elephantiasis (lymphatic filariasis). Figuring out the content of the
genesGênes is the name of a département of the First French Empire in present Italy. It was named after the city Genoa. It was formed in 1805, when Napoleon Bonaparte occupied the Republic of Genoa. Its capital was Genoa. It was divided into the arrondissements of Genoa, Bobbio, Novi Ligure, Tortona and...
might lead to development of new drugs and vaccines.
Possible elimination
According to medical experts the worldwide efforts to eliminate this disease is on track to potentially be successful 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.
Impact on endemic communities
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 suffer from mutilating genital disease.
External links