Lymphatic filariasis

From WikiMD's Wellness Encyclopedia

(Redirected from Pachydermia)

Alternate names[edit | edit source]

Filariasis; Elephantiasis; Wuchereria Bancrofti infection; Filarial elephantiasis; Malayi tropical eosinphilia; Wuchereriasis; Bancroftian filariasis; Elephantitis

Definition[edit | edit source]

Lymphatic filariasis is a parasitic disease caused by microscopic, thread-like worms that only live in the human lymph system, which maintains the body's fluid balance and fights infections. Lymphatic filariasis, considered globally as a neglected tropical disease (NTD).

Lymphatic filariasis world map - DALY - WHO2002.svg
Elephantiasis.png

Cause[edit | edit source]

The causative agents of lymphatic filariasis (LF) include the mosquito-borne filarial nematodes Wuchereria bancrofti, Brugia malayi, B. timori An estimated 90% of LF cases are caused by W. bancrofti (Bancroftian filariasis).

Epidemiology[edit | edit source]

Lymphatic filariasis affects over 120 million people in 72 countries throughout the tropics and sub-tropics of Asia, Africa, the Western Pacific, and parts of the Caribbean and South America. You cannot get infected with the worms in the United States.

Spread[edit | edit source]

  • The disease spreads from person to person by mosquito bites.
  • When a mosquito bites a person who has lymphatic filariasis, microscopic worms circulating in the person’s blood enter and infect the mosquito.
  • When the infected mosquito bites another person, the microscopic worms pass from the mosquito through the skin, and travel to the lymph vessels.
  • In the lymph vessels they grow into adults.
  • An adult worm lives for about 5–7 years.
  • The adult worms mate and release millions of microscopic worms, called microfilariae, into the blood.
  • People with the worms in their blood can give the infection to others through mosquitoes.

Risk factors[edit | edit source]

  • Repeated mosquito bites over several months to years are needed to get lymphatic filariasis.
  • People living for a long time in tropical or sub-tropical areas where the disease is common are at the greatest risk for infection.
  • Short-term tourists have a very low risk.
  • An infection will show up on a blood test.

Signs and symptoms[edit | edit source]

Most infected people are asymptomatic and never develop clinical symptoms. A small percentage of people develop lymphedema, which may affect the legs, arms, breasts, and genitalia; bacterial infections that cause hardening and thickening of the skin, called elephantiasis; hydrocele (swelling of the scrotum) in men; and pulmonary tropical eosinophilia syndrome.

Clinical presentation[edit | edit source]

For most diseases, symptoms will vary from person to person. People with the same disease may not have all the symptoms listed. 80%-99% of people have these symptoms

30%-79% of people have these symptoms

5%-29% of people have these symptoms

  • Abnormal lung morphology(Abnormality of lung structure)
  • Cough(Coughing)
  • Fever
  • Hydrocele testis
  • Lymphangiectasis
  • Opportunistic bacterial infection
  • Orchitis(Inflammation of testicles)
  • Restrictive ventilatory defect(Stiff lung or chest wall causing decreased lung volume)
  • Vaginal hydrocele
  • Wheezing

1%-4% of people have these symptoms

Diagnosis[edit | edit source]

  • The standard method for diagnosing active infection is the examination of blood under the microscope to identify the microscopic worms, called microfilariae.
  • This is not always feasible because in most parts of the world, microfilariae are nocturnally periodic, which means that they only circulate in the blood at night.
  • For this reason, the blood collection has to be done at night to coincide with the appearance of the microfilariae in the blood.
  • Serologic techniques provide an alternative to microscopic detection of microfilariae for the diagnosis of lymphatic filariasis.
  • Because lymphedema may develop many years after infection, lab tests are often negative with these patients.

Treatment[edit | edit source]

  • People infected with adult worms can take a yearly dose of medicine, called diethylcarbamazine (DEC), that kills the microscopic worms circulating in the blood.
  • While this drug does not kill all of the adult worms, it does prevent infected people from giving the disease to someone else.
  • People with lymphedema and elephantiasis are not likely to benefit from DEC treatment because most people with lymphedema are not actively infected with the filarial parasite.
  • Physicians can obtain DEC from CDC after lab results confirm infection.
  • People with lymphedema and hydrocele can benefit from lymphedema management, and in the case of hydrocele surgical repair.
  • Even after the adult worms die, lymphedema can develop.
  • You can ask your physician for a referral to see a lymphedema therapist for specialized care.

Prevent the lymphedema from getting worse by following several basic principles:

  • Carefully wash and dry the swollen area with soap and water every day.
  • Elevate the swollen arm or leg during the day and at night to move the fluid.
  • Perform exercises to move the fluid and improve lymph flow.
  • Disinfect any wounds. Use antibacterial or antifungal cream if necessary.
  • Wear shoes adapted to the size of the foot to protect the feet from injury.
  • Men with hydrocele can undergo surgery to reduce the size of the scrotum.

Prevention[edit | edit source]

Avoiding mosquito bites is the best form of prevention. The mosquitoes that carry the microscopic worms usually bite between the hours of dusk and dawn . If you live in or travel to an area with lymphatic filariasis:

  • Sleep under a mosquito net.
  • Wear long sleeves and trousers.
  • Use mosquito repellent on exposed skin between dusk and dawn.

NIH genetic and rare disease info[edit source]

Lymphatic filariasis is a rare disease.


Lymphatic filariasis Resources

Contributors: Prab R. Tumpati, MD