Limb Elephantiasis Research Articles

L’éléphantiasis du membre pelvien : traitement de sept cas selon la technique de Charles modifiée

Lymphedema is an obstructive dysfunction of the lymphatic system characterised by an inability of the lymphatic system to eliminate excess lymphatic load. It can be congenital or secondary. Untreated, it progresses in three stages, the final stage being elephantiasis. We report a short series of 7 cases of elephantiasis of the lower limb treated with the Charles technique. Our aim was to describe the results of the surgical treatment. This was a retrospective descriptive and analytical study from January 2010 to December 2020. Patients with at least one lower limb elephantiasis of any aetiology of any age and gender who underwent excisional surgery with a complete medical record containing clinical and therapeutic data were included. During the study period, we received 710 patients with a prevalence of elephantiasis of 1.69%. The mean age was 43.3±14.5years with a male predominance. No etiology or co-morbidity factors (diabetes, hypertension, VRS) were found. In our mini-series, the average time between the two procedures was 34.3±9.6days. The mean time to healing was 82.3±15.1days. All patients healed with two excellent results. excisional surgery with two-stage repair combined with compression therapy gave satisfactory results.

Lymphatic Filariasis in Communities of Ardo-Kola Local Government Area, Taraba State, Nigeria

Lymphatic filariasis is one of the most important parasitic and neglected diseases in the tropics, that inflicts and underdevelopment especially in sub Saharan Africa. This study was carried out to determine the status of lymphatic filariasis in six rural communities of Ardo-Kola Local Government Area where no epidemiological data exist. Rapid Assessment Method for clinical signs and Standard Parasitological Techniques were used for diagnosis. A total of 464 night blood samples were collected using finger-prick method. Out of the number, 136 (29.31%) were infected with Wuchereria bancrofti. Infection rates among the six communities differed significantly (ANOVA, P<0.05). Chi-square analysis (chi-square, P>0.05) revealed the following: No significant difference in infection between the sexes; significant differences in infection among the different age groups and occupational groups. Pearson correlation analysis showed close association between the presence of W. bancrofti and Itching (r=0.76, P<0.05), ADL (r=0.80, P<0.05), Hydrocoel (r=0.93), Dermititis (r=0.87) and Hernia (r=0.87). However, a weak relationship was observed between the presence of microfilaraemia and elephantiasis of limb (r=0.44, P>0.05) and lymphoedermia of breast (r=0.30, P>0.05). A mean microfilarial density of 2.31mf/60µl was obtained. This finding revealed a very high prevalence of bancroftian filariasis and demands urgent attention on the control of the infection.

Therapeutic Efficacy of Complex Decongestive Therapy in the Treatment of Elephantiasis of the Lower Extremities

ABSTRACT Objective To evaluate the therapeutic efficacy of complex decongestive therapy in the treatment of elephantiasis of the lower extremities. Methods Seventeen patients with unilateral lower limb elephantiasis were included in the study (5 with primary lymphedema and 12 with secondary lymphedema). All patients were treated with one course (4 weeks) of complex decongestive therapy. Changes inextracellular fluid (ECF), BMI, circumferences, and skin properties including skin stiffness (SF), percent water content (PWC), and trans-epidermal water loss (TEWL) were measured before and after treatment. Results The “elephantiasis-like” appearance of the affected limb was greatly improved after treatment. The ECF, BMI, and circumferences were significantly decreased after treatment (P Conclusion Complex decongestive therapy is effective in the treatment of advanced stages of chronic lymphedema.

Anesthetic management for a cesarean section in a parturient with huge vulvar and lower limbs elephantiasis: a case report

Elephantiasis is caused by accumulation of lymph in soft tissues due to long standing lymphatic obstruction. Elephantiasis of female external genitalia is very rare and its association with limb elephantiasis is also quite very rare. A 20 years old, primigravida patient with 38 weeks’ gestation presented with massive swelling of lower limbs along with vulvar edema posted for emergency cesarean section diagnosed as elephantiasis of lower limbs and vulva which is usually rare and has not been reported yet. Elephantiasis in pregnancy poses difficulty for an anesthesiologist while providing neuraxial anesthesia to such a patient. We report the anesthetic management of a primigravida patient with both vulvar and lower limbs elephantiasis posted for emergency cesarean section.Journal of Society of Anesthesiologists of NepalVol. 4, No. 2, 2017, Page: 91-93

Intensive Treatment of Elephantiasis in A Child: A Case Report

Introduction: There are few publications on the treatment of elephantiasis in children. Objective: The aim of this study is to report on the intensive treatment of lower limb elephantiasis of a child in an outpatient setting. Case report: We report the case of an eight-year-old boy who was born with scrotum and lower limb lymphedema. The initial diagnostic difficulty and therapeutic conduct over the years did not produce results and there were complications such as erysipelas. The lymphedema progressed to the most advanced stage, elephantiasis (stage III), with the mobility of the child limited affecting the quality of his life, including academically. A five-day intensive outpatient treatment program was proposed including Cervical Stimulation Therapy, Manual Lymphatic Therapy, Mechanical Lymphatic Therapy and compression using a custom-made stocking made of a grosgrain fabric. Results: There was a reduction of 45% of the limb volume in five days. Conclusion: Intensive treatment of elephantiasis in children is a new therapeutic option that allows significant reductions in volume in a short time.

The diagnostic challenge of mapping elephantiasis in the Tigray region of northern Ethiopia.

In Ethiopia, lymphatic filariasis and podoconiosis are the two neglected tropical diseases planned to be mapped together within the recently launched Ethiopian neglected tropical diseases master plan (2013-2015). However, other disorders cause tropical lymphedema, and this report aims to identify clinical epidemiological aspects of limb swelling in northern Ethiopia and to provide an algorithm orienting the clinical diagnosis. Medical records of patients with lower limb elephantiasis attending the Italian Dermatological Centre of Mekele, Tigray capital city, over a 4-year period (2005-2009) were retrospectively analyzed. Nine variables were collected from the charts comprising demographic data, job, origin, literacy, clinical, histopathologic, microscopic, and cultural findings. Over a total of 511 patients, lymphedema resulted from trauma (40.7%), chronic venous insufficiency (12.5%), deep mycoses (10.8%), lymphatic filariasis (9.2%), elephantiasis nostras verrucosa (7.0%), tropical ulcer (6.3%), leprosy (4.9%), recurrent infections (3.1%), podoconiosis (1.8%), tuberculosis (1.0%), malignancy (1.3%), Kaposi's sarcoma (1.0%), leishmaniasis (0.2%), and neurofibromatosis (0.2%). Advanced-stage elephantiasis, chronic osteomyelitis, and podoconiosis not previously reported in Tigray were observed. Further epidemiological investigation and training programs addressed to healthcare providers at the peripheral level are needed to detect elephantiasis early, prevent disabilities, and improve patients' quality of life.

Complex decongestive therapy for secondary lymphoedema in women after breast cancer treatment

AbstractSecondary lymph edema occurs in abort 6-40% of women treated for breast cancer. This is not the only an aesthetic problem. Edema makes serious health complications for example recurrent inflammation and rose, limb elephantiasis, which leads to degenerative changes in the joints, nerve plexus damage and angiosarcoma – cancer with poor prognosis. Early diagnosis and implementation of therapy is very important. Too late intervention difficult the rehabilitation and increases the possibility of complications also. The most important in the reduction of swelling and remove the lymph balance is a complex decongestive therapy (CDT): lymphatic drainage, compression therapy, skin care and exercises. Lymphatic drainage results in increased production of the lymph and movement of the lymph. Compression therapy leads to the reduction in the effective pressure ultrafiltration. Skin care is to prevent bacterial and fungal infections. Exercises makes increase muscle pump action and transport of the lymph. CDT consist of two phase: reduction phase and consolidation phase. It is a most popular method of treatment lymph edema around the world. It is most effective therapy also.

Lymphatic filariasis and associated morbidities in rural communities of Ogun State, Southwestern Nigeria

Lymphatic filariasis caused by Wuchereria bancrofti is a serious public health problem in rural communities of Nigeria. The study assessed the prevalence of lymphatic filariasis and associated clinical morbidities in Ado-Odo Ota Local Government Area of Ogun State. Microscopic examination of thick blood smears of 500 participants of both sexes and age ranging from 1 to 79 years was conducted. Visual observations of clinical manifestations of chronic infection were also conducted. The overall prevalence and intensity of infection were 21% and 21.4 mf/mL of blood respectively. Microfilaraemic prevalence was significantly higher in males (27.1%) than in females (16%) (P < 0.001). However, intensity of infection was not gender and age dependent (P > 0.05). The overall prevalence of all clinical manifestations of infection due to W. bancrofti is 15% with hydrocele, limb and breast elephantiasis constituting 16.9%, 4.6% and 5.1% of the total population respectively. Prevalence of hydrocele and limb elephantiasis was significantly higher in the older age groups (P < 0.05). Occurrence of elephantiasis of the breast in women however was not associated with age (P > 0.05). Integrated approach through chemotherapy and vector control is therefore advocated to reduce morbidity due to infection in this study area.

Bancroftian filariasis in the lower Imo River Basin, Nigeria

Wuchereria bancrofti is present in the Lower Imo River Basin with a prevalence of 6.7%. Microfilaraemia was higher among older than younger individuals and there was no significant difference in prevalence between sexes. Microfilarial intensities varied significantly between sexes and also between age groups. On the overall, prevalence of clinical filariasis was higher than prevalence of microfilaraemia. Clinical manifestations related to W. bancrofti were hydrocele, limb and scrotal elephantiasis in that order of importance. Limb elephantiasis was higher among females than among males. Chyluria was not found in the Lower Imo River Basin study population. AJAZEB Vol. 6 2004: pp. 61-65

Predictive value of clinical assessment of patients with podoconiosis in an endemic community setting

Podoconiosis is a geochemical condition resulting in lower limb elephantiasis similar to that seen in chronic filarial disease. In podoconiosis-endemic areas, diagnosis of the condition must often take place in the community setting, where laboratory facilities are unavailable. In this study, 205 patients in Wolaitta zone, southern Ethiopia, were examined according to standard clinical practice. A capillary blood sample was taken at midnight for thick film examination. In a subsample of 117 patients, rapid antigen testing using Binax antigen cards was also performed. Both tests were negative in all patients. In podoconiosis-endemic areas, clinical examination is a valid means of diagnosing podoconiosis.

Lymphatic filariasis in Uganda: baseline investigations in Lira, Soroti and Katakwi districts

Baseline epidemiological investigations on lymphatic filariasis were conducted for the first time in Uganda in 3 communities in the districts of Lira (Alebtong area), Soroti (Lwala area) and Katakwi (Obalanga area), located to the north of Lake Kyoga at an altitude of 1000–1100 m above sea level. Individuals from the communities were examined, in April–August 1998, for Wuchereria bancrofti specific circulating antigen (by ICT card test), microfilaraemia (by counting chamber and stained blood-smear techniques) and chronic clinical manifestations of lymphatic filariasis. Endophilic mosquitoes were sampled and dissected for filarial larvae. Prevalences of circulating filarial antigen positivity were 29%, 18% and 30% in the Alebtong, Lwala and Obalanga communities, respectively. Microfilaria (mf) prevalences were 18%, 9% and 21%, and geometric mean mf intensities among mf-positive individuals were 306, 171 and 402 mf/mL blood, in the same communities. Examination of stained blood smears revealed mf of both W. bancrofti and Mansonella Perstans, but more than 80% of mf-positive individuals harboured the first of these parasites. Prevalences of hydrocoele in adult (⩾20 years) males were 28%, 7% and 17%, and prevalences of limb elephantiasis in adults were 9%, 4% and 4%, in the Alebtong, Lwala and Obalanga communities, respectively. Anopheles gambiae s.l. (mainly An. gambiae s.s.) and An. funestus were common in all 3 communities, and showed W. bancrofti infectivity rates of 1·1–1·7% and 1·3–2·9%, respectively. It is concluded that lymphatic filariasis is highly endemic in these high-altitude areas of Uganda, with An. gambiae s.l. and An. funestus being the main vectors.

Parasitological and clinical aspects of bancroftian filariasis in Kassena-Nankana District Upper East Region, Ghana

A survey of the prevalence of bancroftian filariasis was conducted in August–September 1992 in the northern part of the Kassena-Nankana District, Upper East Region, Ghana. 200 compounds from 3 different communities were randomly selected from the vitamin A trial database. All resident compound members were examined for clinical manifestations of lymphatic filariasis and capillary blood was obtained between 21:00 and 01:00 and examined using the counting chamber technique. 1603 people were examined, 741 males and 862 females. The overall prevalence of microfilaraemia was 32·4% (95% confidence interval 30·1–34·7). Geometric mean microfilaria density (infected persons only) was 794 per mL. The most important clinical manifestation was hydrocele (in 32% of males) followed by limb elephantiasis (in 3·6% of the study population). There was no significant difference between the 3 communities in clinical or parasitological findings.

Bancroftian filiariasis in two villages in Dinajpur District, East Pakistan. I. Infections in man.

Abstract Blood and clinical surveys were made on the total populations of two villages in Thakurgaon thana, Dinajpur District, East Pakistan, an endemic area for bancroftian filariasis. Infection rates in the two villages were 15.6% and 16.4%, with male disease rates of 21.7% and 20.6% respectively. Disease manifestations were almost exclusively hydrocele, with only a rare case of scrotal or limb elephantiasis. Only one female was found to have elephantiasis, but over one-third of the adult males had hydroceles. Possible reasons for this preponderance of hydroceles in a highly endemic area are discussed. Historical data and the finding of long-standing hydroceles in older males native to the area indicates that filariasis pre-dated the large influx of immigrants from neighboring endemic areas of India during the past 20 years.