HEWLETT-PACKARD

Elephantiasis
Lymphatic Filariasis
Eunice Yoon 3/10/2012

There are no written records of elephantiasis, or lymphatic filariasis, before the 16th century. Therefore, evidence cannot be confirmed. However, ancient artifacts suggest that elephantiasis existed as early as 2000B.C. Statues and other artifacts from Egypt and West Africa may depict swollen limbs and scrotal swelling, which are common symptoms of lymphatic filariasis. The first written record of elephantiasis came from the ancient Greeks and Romans. The first documentation of the symptoms associated was written in the exploration of Goa, which took place between 1588 and 1592. Soon after, more records were written in parts of Africa and Asia. Microfilariae (pre-larvae, or advanced embryos) were discovered in the blood in 1863 and in urine in 1866. The connection between elephantiasis and the microfilariae was made by Timothy Lewis. Joseph Bancroft discovered the adult worm, which was named after him. The discovery of life cycle of the parasites was the made by Patrick Manson, while the discovery of the transmission was made by George Carmichael Low in 1900, who discovered microfilariae in the feeding mechanisms of mosquitoes. Lymphatic Filariasis is caused by parasitic worms such Wuchereria bancrofit (the most common) , Brugia malayi, and B. timori. Mosquitoes spread this disease by introducing the larval nematodes in the bloodstream. However, there are several factors involved in the disease: the worm, the symbiotic Wolbachia bacteria, the immune system's response, and opportunistic infections and disorders. This conditions occurs in tropical regions and Africa. In the nonparasitic form, nonfilarial elephantiasis, is thought to be caused by constant contact with irritant soils, especially red clays that are rich in alkali metals like sodium and potassium, and those associated with volcanic activity. These soils are absorbed into the lymphatic system. The adults worm live in the human lymphatic system. They infect the lymphnodes and blocks the flow, causing chronic edema, mostly in the lower torso. When the worms block the

lymphatics, an allergic reaction occurs. Symptoms include: fevers, chills, shaking, sweating, headaches, vomiting, and localized pain. Additional symptoms are red streaking, joint pain, enlargement of lymph nodes, and skin ulcers. The skin eventually hardens and becomes warty and cracked. The lymphatic damage results in impaired lymph flow, which allows secondary bacterial infections to occur. A protein secreted by the nematode may stimulate the B cells, not enough for them to fight the disease, but enough for the B cells to be unaware of any other pathogens. Lymphatic blockage caused fluid to be unable to drain, which results in extreme swelling. Tissues may become gangrenous from the lack of oxygen and the buildup of carbon dioxide due to obstructed blood supply. Treatment include the use of albendazole with ivermectin in sub-Saharan Africa, and albendazole with diethylcarbamazine. Rigorous cleaning of affected areas have shown to be effective. This suggests that many of the symptoms are the effect of secondary skin infections. There have been use of antibiotics that kill the symbiotic bacteria, which, in turn, causes the worm to die. Dietyhlcarbamazine kills the larvae, while the adult worms die on their own. Several bouts of treatment are used to kill all the larvae. Consistent shoe-wearing, good hygiene, use of antiseptics, application of ointment, use of elastic bandages, and antibiotics to prevent infections are some of the ways to treat and prevent the nonfilarial form of elephantiasis. There are several stages in the infections. The infective filariform larvae are transmitted through mosquitoes during blood meals. The larvae move to the lymphatic vessels and lymph nodes. They then develop into microfilariae producing adults, which can live for several years. The microfilariae circulate through the bloodstream. Mosquitoes become infected during a blood meal of the infected human. It takes one to two weeks for the microfilariae to develop into infective larvae.

Several steps can be taken to prevent and reduce the chance the of getting elephantiasis. Since this disease is mainly spread through mosquitoes, sleeping with mosquito netting and reducing the mosquito population would be effective. To reduce the number of people contracting nonfilarial elephantiasis, wearing shoes and practicing good hygiene is recommended.

Resources : Wikipedia; Elephantiasis http://en.wikipedia.org/wiki/Elephantiasis

Dan Heeren's Elephantiasis Page http://www.bio.davidson.edu/courses/immunology/Students/spring2006/Heeren/eleph.html

Central for Disease Control http://www.cdc.gov/parasites/lymphaticfilariasis/biology.html

Stanford University http://www.stanford.edu/class/humbio103/ParaSites2006/Lymphatic_filariasis/Discovery.htm