Elephantiasis is a severely disfiguring and disabling condition in which thearms, legs, or genitals swell so much that they can resemble an elephant's foreleg in size, texture, and color. True elephantiasis is caused by a parasitic infection from three kinds of round worms. These worms block the body's lymphatic system--a network of channels, lymph nodes, and organs that helps maintain proper fluid levels in the body by draining lymph from tissues into the bloodstream. This blockage causes fluids to collect in the tissues, which can lead to great swelling, called "lymphedema." Elephantiasis is also called Barbados leg, elephant leg, morbus herculeus, mal de Cayenne, and myelolymphangioma. Most cases of elephantiasis are caused by filarial worms found in tropical and subtropical places and transmitted by mosquitoes. They occur in the poor in underdeveloped regions of South America, Central Africa, Asia,the Pacific Islands, and the Caribbean. Elephantiasis is more intense in people who don't live in these areas, because many native people have built up some immunity. Other causes of elephantiasis are: A protozoan disease called leishmaniasis, a repeated streptococcal infection, the surgical removal of lymph nodes (usually to prevent the spread of cancer), or a hereditary birth defect. Symptoms of elephantiasis include repeated episodes of fever, shaking chills, sweating, headaches, vomiting, and pain. Enlarged lymph nodes, swellingof the affected area, skin ulcers, bone and joint pain, tiredness, and red streaks along the arm or leg also may occur. Abscesses can form in lymph nodesor in the lymphatic vessels. They may appear at the surface of the skin as well. Long-term infection with lymphatic filariasis can lead to lymphedema, hydrocele (a buildup of fluid in any saclike cavity or duct) in the scrotum, andelephantiasis of the legs, scrotum, arms, penis, breasts, and vulvae. The most common site of elephantiasis is the leg. It typically begins in the ankleand progresses to the foot and leg. The swollen leg eventually becomes hard and thick. The skin may appear darkened or warty and may even crack, allowingbacteria to infect the leg and complicate the disease.
The only sure way to diagnose lymphatic filariasis is to find the parasite. Examining the person's blood under a microscope may show microfilariae. But many times, people who have been infected for a long time do not have microfilariae in their bloodstream. In these cases, it's necessary to examine the urine or hydrocele fluid or perform other tests. Elephantiasis is treated with diethylcarbamazine (DEC), which is known as Hetrazan in the United States. DECkills the microfilariae quickly and injures or kills the adult worms slowly,if at all. If all the adult worms are not killed, they may continue to produce more larvae. Therefore, several courses of DEC treatment over a long time period may be necessary to get rid of the parasites. DEC reduces the size of enlarged lymph nodes and, when taken long-term, reduces elephantiasis. In India, DEC has been used in a medicated salt to help prevent spread of the disease. Side effects of DEC may include fever, chills, headache, dizziness, nausea and vomiting, itching, and joint pain. They usually occur within thefirst few days of treatment and go away as the person continues taking DEC. An alternate treatment, different doses of DEC and steroids, is designed to kill the parasites slowly (to reduce allergic reactions to the dead microfilariae and dying adult worms within the body). Another drug, Ivermectin, has beenshown to be excellent in killing microfilariae in early research studies, but its effects on the adult worms are still being investigated. It is probablethat patients will need to continue using DEC to kill the adult worms. Mildside effects of Ivermectin include headache, fever, and myalgia. Other ways to manage lymphatic filariasis are pressure bandages to wrap the swollen limband elastic stockings to help reduce the pressure. Exercising and elevating abandaged limb also can help reduce its size. Surgery can be performed to reduce elephantiasis by removing excess fatty and fibrous tissue, draining the swelled area, and removing the dead worms. With DEC treatment, the prognosis is good for early and mild cases of lymphatic filariasis. The prognosis is poor, however, for heavy parasitic infestations. Elephantiasis can be controlledby taking DEC preventively and reducing the number of carrier insects in thearea. Avoiding mosquito bites by using insecticides and insect repellent, wearing protective clothing, and using bed netting are helpful. Before visitingcountries where lymphatic filariasis is found, consult a travel physician tolearn about current preventative measures.