Elephantiasis is caused due to certain parasitic worms viz. Wuchereria bancrofti, Brugia malayi and Brugia timori. All these worms are microscopic and thread like parasites. They are transmitted by mosquitoes. The adults of these worms live in lymphatic system of only humans. Lymphatic system is very important in maintaining the health of the body. The swelling of the lower parts of body like legs and genitals is due to obstacle in the lymphatic vessels. The lymphatic fluid can not drain adequately due to the presence of the parasite. As the accumulation of the lymphatic fluid increases the inflammation also increases. The exact cause of inflammation is not known, whether it is due to the presence of parasite or the reaction of the immune system against the parasite.
Elephantiasis may also be due to non parasitic infection which is called as non filarial elephantiasis or podoconiosis. This type of elephantiasis is due to constant contact with the irritant soil particularly the red clay which is rich in alkali metals like potassium and sodium. Such soils are seen in the areas with volcanic activity.
There are two types of lymph edema, the primary lymph edema and the secondary lymph edema. In the primary lymph edema the condition occurs on its own. In secondary lymph, edema it is due to some other disease of condition. The causes of primary lymph edema are congenital (Milroy Disease), lymphedema praecox (Meige Disease wherein lymphedema occurs around childhoiod or around puberty) and lymphedema tarda (this occurs rarely after the age of 35 years).
The secondary lymph edema is due to surgery of lymph nodes and /or lymph vessels, cancer (if this blocks the lymphatic vessels), post radiation treatment for cancer, infection in the lymph vessel/lymph nodes and also due to injury to lymph vessels or lymph nodes.
There is a swelling of the entire arm or leg including fingers and toes and in severe cases of the genitals. The skin of the affected area becomes hard and thick, feeling of general heaviness, tightness and discomfort.
There is also repeated infections of the affected limb are the symptoms of elephantiasis.
The infections of the affected limb may range from mild hardly noticeable inflammation to severe infections affection the usage of the limb.
Elephantiasis is diagnosed on the basis of physical examination, medical history and some tests. The tests include Magnetic Resonance Imaging (MRI), Computerized Tomography Scan (CT Scan), Radionucleotide Imaging of the Lymphatic System (Lymphoscintigraphy) and Doppler Ultrasonography.
The treatment for elephantiasis varies depending upon the geographic region. In sub-Saharan Africa albendazole with ivermectin is used as treatment. In other parts of the world albendazole is used with diethylcarbamazine. The used of different combinations in different geographic regions is according to the strategy to eradicate elephantiasis by 2020.
Another effective way is to rigorous daily cleaning of the affected areas. This can limit the symptoms of lymphatic filariasis. This suggests that the symptoms are due to secondary infection than the lymphatic filariasis.
Surgery is useful in scrotal elephantiasis but it is ineffective for limb elephantiasis.
Treatment with antibiotic doxycycline kills the bacteria wolbachia which lives inside the worm which lives in symbiotic relationship with the worm. This results in the death of the worm.
Light exercise help in movement of lymphatic fluid out of the arm. The exercise should be such that it should gently squeeze the muscle. Wrapping the affected arm in bandages so that the lymph fluid flows back towards the trunk is useful. Massage, pneumatic compression and compression garments help in reducing the inflammation.
Surgery may be done to reduce inflammation but it is not the treatment for lymphedema.
