Elephantiasis – Sri Lanka


… Prepared by TMA Member Yeppoon, Qld: Megan Young (medical student)

Travelling to third world countries as part of a medical attachment can be a life changing event with life long learned skills and memorable experiences. This 64 year old gent was happy to share his story with Megan Young, our final year medical student, presently attached to a hospital in Sri Lanka. He has suffered this condition for 22 years. The risk to visiting travellers is quite low.

Lymphatic filariasis, also known as Elephantiasis, is a parasitic nematode infection spread me mosquitoes, in which the worms obstruct the lymphatic system, causing severe chronic lymphoedema. It may result in deformity and cause disability and is associated with social stigma. (WHO)

Aetiology:
Wucheria bancrofti is responsible for around 90% of lymphatic filariasis infections, but Brugia malayi and B. timori may also be the cause. Infection occurs when mosquitoes (Culex, Anopheles and Aedes species) carrying the larvae of filaria bite a human, transferring larvae into the blood. The larvae enter the lymphatic system, where they mature into adult worms, where they form ‘nests’ which obstruct the lymphatic system causing lymphoedema, and, in more severe cases, elephantiasis (where the skin and tissues thicken). This occurs over a period of several years. Lymphoedema may occur in the limbs, genital and breasts. (WHO)

Epidemiology:
Lymphatic filariasis occurs in 83 countries in the tropics of Asia, Africa, and the Pacific and in certain regions of the Caribbean and South America.

Risk for Travellers:
Risk for travellers to endemic areas is low; however, lymphatic filariasis can occur in travellers who stay for extended periods in endemic areas.

Prevention:
There is no vaccination or prophylactic medication for lymphatic filariasis. It must be prevented throughprevention of mosquito bites.

Treatment:
Treatment of lymphatic filariasis is through mass drug administration (MDA) of albendazole 400mg with either ivermectin (150 – 200 mcg/kg) diethelcarbamazine citrate (6mg/kg). Treatment also aims to reduce lymphoedema and prevent secondary infections in the affected limb. (WHO)

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