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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 scrotum, to swell to the size of a softball or basketball. "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

An East African man with elephantiasis of the scrotum
Elephantiasis occurs in the presence of microscopic, thread-like parasitic worms such as Wuchereria bancrofti, Brugia malayi, and B. timori, all of which are transmitted by mosquitoes. However, the disease itself is a result of a complex interplay between several factors: the worm, the symbiotic Wolbachia 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 Africa. The adult worms only live in the human lymphatic system. 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.
Elephantiasis of the legs due to filariasis.
Luzon, Philippines.
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 Uganda, Tanzania, Kenyamarker, Rwandamarker, Burundimarker, Sudanmarker, Egyptmarker and Ethiopiamarker. 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 sodium and potassium and associated with volcanic activity.

Cultural aspects

Elephantiasis is associated in the public mind with "The Elephant Man", the carnival stage name of Joseph Merrick. 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 syndrome instead, possibly combined with neurofibromatosis type I.

Treatment

Treatments for lymphatic filariasis differ depending on the geographic location of the endemic area. In sub-Saharan Africa, albendazole is being used with ivermectin to treat the disease, whereas elsewhere in the world, albendazole is used with diethylcarbamazine. 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.

In addition, surgical treatment may be helpful for issues related to scrotal elephantiasis and hydrocele. However, surgery is generally ineffective at correcting elephantiasis of the limbs.

A vaccine is not yet available but is likely to be developed in the near future.

Antibiotics

In 2003 it was suggested that the common antibiotic doxycycline might be effective in treating elephantiasis.. The parasites responsible for elephantiasis have a population of symbiotic bacteria, Wolbachia, 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 Medicinemarker in June 2005 reported that an 8 week course almost completely eliminated microfilariaemia.

Genome deciphered

On September 20, 2007, scientists mapped the genome or genetic content of Brugia malayi - the roundworm which causes elephantiasis (lymphatic filariasis). Figuring out the content of the genes 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.

See also



References

  1. http://www.who.int/mediacentre/factsheets/fs102/en/ Retrieved on May 17, 2009
  2. http://news.bbc.co.uk/2/hi/health/7659222.stm


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