A disfiguring and distorting disease that leaves its victims with monstrous appearance. Elephantiasis is a sporadic but horrible disease that gives its affected person a resemblance to an elephant, characterized by terrible swelling of tissues and skin thickening of various body parts. Elephantiasis occurs due to parasitic invasion of filarial worms through bites of bloodthirsty mosquitoes, leading to the astonishing, grotesque ailment that shatters the lives of its victims. Elephantiasis, also known as lymphatic filariasis, turns beauties into beasts, exhibiting real-life nightmares and a cascade of irreversible symptoms. Let’s move into depths to unravel the secrets of this unseen enemy and how this parasite could have this much strength to turn humans into elephants.

Role of the lymphatic system in lymphatic filariasis

Lymphatic filariasis, or elephantiasis, is a disease caused by obstruction of the lymphatic system in humans.

The human lymphatic system is a subsystem of the circulatory system. It comprises a vast network of vessels and tissues responsible for keeping a healthy fluid volume in the body. The lymphatic system consists of several organs like the thymus, spleen, lymph nodes, and bone marrow that collaborate to balance blood fluid volume.

Figure 1. A Close-up of a Person’s Leg With Elephantiasis.

Lymph is a transparent white fluid consisting mainly of white blood cells and fluid from the intestine containing proteins and fats. Lymph escapes from blood vessels and enters into tissues; the lymphatic system then takes this lymph from tissues and returns it to the lymphatic vessels. Once in the human body, parasites responsible for lymphatic filariasis move directly toward the lymphatic system, wherein these parasites grow in the lymph nodes.

As a result, the lymphatic system becomes weakened, obstructed, and unable to perform function properly. This obstruction results in the swelling and enlargement of lymph nodes due to the accumulation of lymph. The enlarged lymph nodes can be easily observed in certain body parts, including limbs, breasts, and genitals. These indications cause distorted and disfigured body parts, resembling an elephant, a reason why lymphatic filariasis is also referred to as elephantiasis.

Figure 2. A Person Sitting in a Chair With Swollen and Blocked Lymph Nodes due to Elephantiasis.

The tropical and sub-tropical regions of Asia, Africa, the Caribbean, and South America have reported most filariasis cases. To date, approximately 120 million people are affected by filariasis. According to a report by the World Health Organization (WHO), the prevalence of filariasis has decreased, reaching 40 million people infected globally with this disease.

What causes lymphatic filariasis?

The actual cause of this illness is nematodes, particularly the filarial worms. These roundworms look like threads and are too small to be seen with the naked eye. Filarial worms live inside mosquitoes, and when an infected mosquito bites humans, the worms are transferred from the mosquito to a healthy human. These worms belong to the family Onchocercidae, and only three, such as Wuchereria bancrofti, Brugia malayi, and Brugia timori, are reported to be responsible for causing elephantiasis. The Wuchereria bancrofti affects breasts, legs, arms, scrotum, and vulva and is the most common cause of lymphatic filariasis, causing 9 out of 10 infections.

Transmission of filarial worms

The transmission of filarial worms from one infected person to another healthy person occurs in a cyclic form. Here is its elaboration:

  • Lymphatic filariasis is a mosquito-borne disease, meaning that it spreads through an infected mosquito bite to a healthy human.
  • Mosquitoes of different genera, prominently Aedes, Anopheles, Culex, and Mansonia, serve as the hosts of these pesky filarial worms.
  • When a mosquito infected with filarial larvae bites a healthy human, the L3 stage infective larvae land on the human skin.
  • Then, they enter into the bloodstream through the wound site.
  • In the bloodstream of the host, the mature infective larvae find their way into the lymphatic system, subcutaneous tissues, and serous cavities, where the friendly environment assists them to develop and grow into adult worms.
  • These worms can survive in the lymphatic system for approximately 6 to 8 years. Adult worms reproduce multiple immature larvae called microfilariae.
  • These microfilariae circulate in the blood and are taken up by another mosquito when it bites an infected individual for a blood meal.

That’s how this cycle continues, and transmission occurs from person to person.

Symptoms of Elephantiasis or Lymphatic Filariasis

Severe inflammation

Symptoms include severe inflammation due to the reactive response of the immune system against microfilariae and adult worms.

Lymphoedema –tissue swelling

Besides that, microfilariae and adult worms block the lymphatic vessels, which causes excessive lymph accumulation in the lymphatic system. This condition, known as lymphoedema, is the most apparent symptom of this illness. Simultaneously, edema is also observed, which leads to severe swelling of arms and legs or any of the body parts like breasts or genitals due to obstruction of lymphatic vessels and buildup of excess lymph in nearby tissues. This swelling thickening of skin and tissues is similar to that of an elephant.

 Ascites is also another associated symptom, characterized by fluid buildup in the abdominal cavity.

 Hydrocele is also a common complication in which fluid accumulates in the scrotum.

Complications of Elephantiasis or Lymphatic Filariasis

The lymphatic system is responsible for fighting against pathogenic invasions. In lymphatic filariasis, the lymphatic system is not functioning properly, so the patient will be more prone to bacterial infections.

Excessive enlargement of body parts due to fluid accumulation is the most severe complication of this ailment.

Sometimes, pulmonary eosinophilia syndrome is also an indication of lymphatic filariasis. The number of eosinophils increases abnormally to counter infections that will eventually lead to trouble breathing and severe coughing.

Diagnosis of Elephantiasis or Lymphatic Filariasis

If you are experiencing any symptoms of elephantiasis, a step-by-step diagnosis will be performed by your doctor:

Firstly, your healthcare providers will observe the most apparent symptoms, like swollen body parts and thickened tissues.

Secondly, he will recommend tests to confirm the presence of filarial worms. These tests include:

  1. Microscopic testing of the patient’s blood will give evidence of filarial worm infection. Filarial worms move in blood only at night time, making them nocturnally periodic in nature. So, it is recommended that blood samples be taken at night. Blood samples on a glass slide smeared and stained with Giemsa stain will make filarial worms easily visible under the microscope. 
  2. Antibody testing is also suggested for diagnosing lymphatic filariasis because filarial worms evoke the immune system, so the antibody count will provide a better approach to confirming the presence of nematodes in blood.
  3. Polymerase chain reaction (PCR) is also used to detect filarial worms’ DNA.
  4. Ultrasonography is also recommended for capturing the movement of worms in blood specimens.

Treatment of Elephantiasis or Lymphatic Filariasis

Anthelmintic agents are the first choice for treating lymphatic filariasis. Anthelmintic or antiprotozoal, such as Albendazole used with ivermectin or diethylcarbamazine, have shown potential synergistic effects in alleviating the symptoms.

Wolbachia bacteria inhabit the guts of microfilariae, providing them with specific nutrients and assisting them in their survival. An antibiotic like doxycycline kills Wolbachia bacteria, thus limiting the survival rate of microfilariae and ceasing their transformation into adult worms. Treatment with doxycycline requires 4 to 6 weeks to eliminate the microfilariae from the patient’s body.

Surgery is suggested in case of hydrocele or scrotal enlargement due to fluid buildup in lymph nodes near the genitals. However, surgery is ineffective if limbs are swollen due to excess lymph accumulation.

Prevention of Elephantiasis or Lymphatic Filariasis

  • No vaccine has been made to prevent lymphatic filariasis.
  • Protect yourself from mosquito bites by using insect-repellent mosquito nets and by wearing clothes that fully cover your body.
  • Use insect sprays to kill mosquitos in nearby areas.
  • Do exercise regularly in order to run the fluid thoroughly in the body
  • If you require it, then using any antibacterial or antifungal cream would be beneficial

Final Thoughts

Elephantiasis is a lymphatic system disease dating back to 1877 when the doctor Timothy Lewis discovered it. It occurs when a worm blocks the lymphatic system, which leads to a buildup of fluids and ultimately causes severe swelling. The most common this disease is in tropical regions. A recent Jan 2023 research report by WHO reveals that over 884 million people in 44 countries are at risk of elephantiasis, and they require chemotherapy to stop spreading it.

Frequently Asked Questions – FAQs

Is there any vaccine for elephantiasis?

No, there is no treatment or vaccine for this disease. The leading cause of swelling of body parts is a filarial worm, which forms nests in lymph vessels and lymph nodes, which causes swelling.

Does elephantiasis need surgery?

What is another name for elephantiasis?

The second name for elephantiasis is lymphatic filariasis, which is a tropical disease. It occurs when filarial parasites are transmitted to humans by mosquitoes.

About the author

Dr. Madilyn Adams has a Ph.D. in molecular medicine from Harvard University and has been working as a medical blogger for seven years.








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