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PubMed1988

Endemic non-filarial elephantiasis in Iringa District, Tanzania: a study of 30 patients.

Endemic non-filarial elephantiasis has not yet been described in the central tableland of Tanzania. We report the results of a clinical study in Tosamaganga Hospital, located in the middle of Tanzania (Iringa District). 30 patients with elephantiasis of the lower limbs were studied parasitologically (by blood smears) and clinically. Inguinal lymph nodes were removed from 10 patients and histologically examined. The mineral content of soil samples collected from 4 different areas of the region was assayed by X-ray fluorescence. The clinical, histological, parasitological and epidemiological data prompted us to conclude that in these patients elephantiasis was not of the filarial type, and that endemic non-filarial elephantiasis is present in the Central District of Tanzania.

Adolescent↗
PubMed2002

Evaluation of the pathology, pathogenesis and aetiology of auricular elephantiasis in slaughter pigs.

Ears from slaughter pigs with auricular elephantiasis (n = 24) and the corresponding lymph nodes (lnn.) (n = 26) were grossly, histopathologically and microbiologically examined. Immunostaining for IgM, IgG, Cd3epsilon and bacterial antigens of Arcanobacterium pyogenes and Staphylococcus aureus was performed by indirect enzyme-based techniques. Ears were variably thickened depending on the sampled area (basis, centre and apex). However, at all locations the thickness, the length from basis to apex and the weigh of whole ears with elephantiasis were significantly increased (P < 0.01). The corresponding lnn., that is, ln. parotideus superficialis and profundus, had also increased significantly (P < 0.01) in volume. Histopathologically, lesions of the ears and the corresponding lnn. revealed changes characterized by diffuse fibrosis intermingled with multiple pyogranulomatous foci containing asteroid bodies. In the majority of lesions, four distinct zones due to different cellular infiltrates encircled the central core of the asteroid bodies. In several lesions, the pyogranulomatous foci were contained within the lymph vessels. Immunohistochemically, only the bacterial antigen of S. aureus was detected within the cytoplasm of the macrophages and/or in the asteroid bodies of the ears (41.5%) and in the regional lnn. (30.8%). An abundant number of IgM, IgG and CD3epsilon-positive cells were present in all the pyogranulomatous lesions, whereas a positive IgG-staining was observed only in a single asteroid body. Thus, porcine auricular elephantiasis is a chronic pyogranulomatous inflammation that is frequently positive for S. aureus and is lymphogenically spread. Therefore, the lesions of the ears with auricular elephantiasis and the corresponding lnn. should be termed auricular botryomycosis and botryomycotic lymphadenitis, respectively. Moreover, as the disease is observed frequently in slaughter pigs it must also be considered according to the welfare of the animals and in relation to post-mortem meat inspection.

Abattoirs↗
PubMed1993

Treatment of filarial lymphoedema and elephantiasis with 5,6-benzo-alpha-pyrone (coumarin).

OBJECTIVE: To study efficacy of treatment of filarial lymphoedema and elephantiasis with 5,6-benzo-alpha-pyrone. DESIGN: Randomised, double blind, placebo controlled study with matching for grade and duration of disease, age, and sex. Treatment was given for 367 days, and subjects were followed up for another year. SETTING: A town in Shandong Province, China. SUBJECTS: 104 men and women with chronic unilateral filarial lymphoedema or elephantiasis of the leg: 64 were randomised to benzopyrone and 40 to placebo. By the end of the study 19 patients had dropped out of the treatment group and two out of the placebo group. INTERVENTIONS: Two 200 mg tablets of 5,6-benzo-alpha-pyrone or two placebo tablets given daily. MAIN OUTCOME MEASURES: Volumes of the affected and normal legs estimated every three months, and daily listing of any side effects. RESULTS: Benzopyrone reduced oedema for all grades of lymphoedema during the year of treatment (pW0.001) and the follow up year (p = 0.026). During treatment the mean monthly reductions in leg volume were 0.62% (95% confidence intervals 0.4% to 0.85%), 1.1% (0.71% to 1.6%), and 1.6% (0.89% to 2.3%) of the volume of the normal leg for grades 1, 2, and 3-5 (elephantiasis) of lymphoedema respectively. During follow up the mean monthly reductions were 0.18% (0.01% to 0.35%), 0.54% (0.27% to 0.82%), and 0.87% (0.51% to 1.2%). At the end of the trial the total reduction in oedema was 100%, 95%, and 45% for grades 1, 2, and 3-5. Symptoms and complications were considerably reduced, including attacks of secondary acute inflammation, while side effects were minor and disappeared after one month. In the placebo group there were no changes in the severity of lymphoedema. CONCLUSIONS: 5,6-benzo-alpha-pyrone reduces the oedema and many symptoms of filarial lymphoedema and elephantiasis. It has few side effects, and its relatively slow action makes it ideal for use without compression garments.

Coumarins↗
PubMed1975

[Surgical treatment of elephantiasis of the upper extremities].

According to the author' data elephantiasis of the upper extremities was observed in 13 (6.2%) among 215 patients, operated upon for elephantiasis of the extremities. There were 3 males and 10 females. The patients' age ranged from 3 to 56 years. Five patients suffered elephantiasis of the upper extremity since their birth, 8 patients showed acquired elephantiasis, in particular after mastectomy and operative procedures in the axillary region. Late results of surgical treatment proved to be quite satisfactory.

Adolescent↗
PubMed1994

Elephantiasis in São Tomé and Príncipe.

Podoconiosis or endemic non-filarial elephantiasis is produced by deposits of inorganic materials in the lymph node of the lower extremities. The presence of elephantiasis in São Tomé Island and its prevalence in two districts are documented. Epidemiological aspects of the disease as well as clinical and pathological data of some of the cases are illustrated. With all these data and the physical characteristics of the island we suggest that elephantiasis in São Tomé is of geological obstructive origin: podoconiosis. The importance of non-medical measures to eradicate this disease are underlined.

Adolescent↗
PubMed1976

The association of endemic elephantiasis of the lower legs in East Africa with soil derived from volcanic rocks.

Endemic elephantiasis of the lower legs in Ethiopia, which reaches a maximum of 86-7 per 1,000 adults in affected areas, is related to the distribution of red clay soil derived from volcanic rocks, particularly basalt. Prevalence falls rapidly on leaving these areas. This observation has been tested in regions of non-filarial elephantiasis reported in Kanya and north-western Tanzania and further investigated in volcanic areas of Rwanda where the disease had not previously been reported. The same relationship is found to occur in these areas. The limitation to the lower legs of the barefooted section of the farming community suggests that the aetiological factor or factors enter by the feet. The occurrence at high altitude (over 1,200 metres) is noted and the predominance of basalt or basalt-like lava in each case is considered significant. The altitude governs rainfall and temperature and thus governs the type of soil produced. The soil produced from these rocks is rich in colloidal iron oxide, alumina and silica, to which a number of metallic ions are adsorbed. This soil is a reddish-brown clay which, when wet, is strongly adherent to the skin. The derived ions are known to be toxic to human tissue and absorption through intact human skin has been shown to occur experimentally. It is suggested that absorption of these irritants through the bare feet is responsible for the irreversible damage to the lymphatic channels. The present studies support the hypothesis that "high-altitude" elephantiasis of the lower legs in East Africa is a geochemical disease.

Elephantiasis↗
PubMedDate not supplied

Lay reporting of elephantiasis of the leg in northern Ghana.

Within a large scale community trial in northern Ghana lay interviewers were trained to inquire about and identify elephantiasis of the leg by the use of local terms and simple examination of respondents. This was repeated a year later after moving the interviewers to different geographical areas. The proportions of extended family compounds reported to have at least one member with elephantiasis of the leg were 12.2% and 12.1 % respectively in the first and second surveys (kappa = 0.60). 'Blind' re-examination of a sub-sample by a physician showed a high level of agreement with the lay interviewer's findings in the first and second surveys (kappa = 0.67 and 0.82 respectively). This study has shown that lay people, even with minimal training, can obtain repeatable and valid estimates of the prevalence of elephantiasis of the leg, at least within an area where local terms for the condition are available. This method could potentially be used for other diseases with visible manifestations.

Adolescent↗
PubMedDate not supplied

Adverse reactions following diethylcarbamazine (DEC) intake in 'endemic normals', microfilaraemics and elephantiasis patients.

This paper reports on adverse reactions following a 12-day course of 6 mg/kg diethylcarbamazine (DEC) therapy in brugian filariasis patients in Indonesia. Microfilaria-positive individuals (n = 26), 'endemic normals' (n = 12) and elephantiasis patients (n = 17) were included in the study. Fever, headache and body aches started between 2 and 24 h after DEC intake. Adverse reactions were categorized into 'no or mild', 'moderate' or 'severe' depending on the total reaction score. Four microfilaraemic individuals (15.4%) suffered from severe adverse reactions and their pre-treatment microfilarial levels (geometric mean, GM = 3060 mf/10 mL) were significantly higher than in the 5 microfilaraemic individuals (19.2%) suffering from moderate reactions (GM = 1268 mf/10 mL) and in the 17 microfilaraemic patients (65.4%) who experienced no or mild reactions (GM = 6 mf/10 mL)(P < 0.001 and P < 0.001, respectively). Endemic normals showed no or mild adverse reactions. No or mild adverse reactions were also recorded in all but 2 elephantiasis patients after DEC intake. Two elephantiasis patients with moderate reactions had high levels of circulating microfilariae at pre-treatment (2097 and 7375 mf/10 mL). Concentrations of DEC were measured in plasma, but could not explain the differences in the severity of adverse reactions.

Adolescent↗
PubMed1995

Clinical, parasitologic, and immunologic observations of patients with hydrocele and elephantiasis in an area with endemic lymphatic filariasis.

Hydrocele and elephantiasis, major clinical manifestations of bancroftian filariasis, are thought to share a common pathogenesis. The characteristics of 121 patients with hydrocele or elephantiasis in Leogane, Haiti, were compared: 39% of 57 men with hydrocele and 3% of 64 persons with lymphedema of the leg were microfilaria-positive (P < .001). Circulating filarial antigen, presumably from the adult worm, was detected in 15 (43%) microfilaria-negative men with hydrocele and 9 (15%) microfilaria-negative persons with leg edema (P = .004). Microfilaria-positive men had lower levels of filaria-specific IgG1 and hydroceles of significantly smaller volume and shorter duration than did microfilaria-negative men; hydrocele volume was inversely associated with microfilarial density (P = .001). In contrast, filarial antigen but not microfilariae was associated with filaria-specific IgG4 and decreased lymphocyte proliferation. Antigen status was not associated with severity of leg edema. In this filariasis-endemic area, men with hydrocele are more immunologically and parasitologically heterogeneous than are persons with elephantiasis.

Adolescent↗
PubMed1997

Elephantiasis in Pawe settlement area: podoconiosis or bancroftian filariasis?

During a pilot trial of animal trypanosomiasis control in 3 villages in Pawe settlement area of Region 6 found in northwest Ethiopia, a high frequency of people with swollen legs/feet was observed. House-to-house search in one of the villages (Village 24) indicated 68 persons, 28 males and 40 females (age ranging from 15 to 69 years) had elephantiasis of one kind or another. Based on the local population census the prevalence of elephantiasis was estimated to be 6%. Clinical examination of the 68 persons showed that about 63% had lymphoedema and/or groin lymph node swelling while parasitological examination of night blood collected between 21 and 23 hours turned to be negative. The type, magnitude and distribution of elephantiasis in Ethiopia are discussed and further study is suggested to elucidate the aetiology of the one in Pawe settlement area.

Adolescent↗
PubMedDate not supplied

[Elephantiasis of the external genitalia in children].

This study presents an experience with diagnosis and management of external genital elephantiasis in 18 children in the age range of 3 to 15 years. All patients underwent surgical treatment. The type and scope of surgery depended on the extent and severity of elephantiasis. A total of 21 operations were done. Long-term results were evaluated in these 13 patients at 1 to 22 years. The evaluation included physical appearance of the genitalia, scars, secondary deformities, penile and testicular size, the presence of erections and menstruation. Adults of mature ages were evaluated for fertility and reproductive status. Long-term results were good in all 13 patients. This analysis suggests that early radical surgical treatment of children with congenital elephantiasis of the external genitalia enables a normal anatomic and functional genital development and averts severe local and systemic disorders.

Adolescent↗
PubMedDate not supplied

[Filarian elephantiasis in French Polynesia (Wuchereria bancrofti var. pacifica). II. Biological aspects].

Realized in French Polynesia among 274 patients with elephantiasis, this survey studied the microfilaremia, the eosinophily, the immunoglobulin titers and the antifilarian antibodies (done by passive hemagglutination) for Wuchereria bancrofti var. pacifica. Patients with elephantiasis seldom have circulating microfilariae in their blood. Hypereosinophily is frequent but rarely high. It is similar to the one patients with microfilaremia. There is a trend towards neutropenia during lymphangitic crisis that occur on an elephantiasis limb. The IgE titer is clearly increased, the IgG one is lesser elevated. The mean values are identical to those encoutered among microfilariae asymptomatic cariers. On the other hand the serodiagnosis is more frequently positive among elephantiasic patients.

Adult↗
PubMed1977

The site of lymphatic blockade in endemic (non-filarial) elephantiasis of the lower legs.

1. The femoral lymph nodes of 13 patients with endemic (non-filarial) elephantiasis of the lower legs are compared with those of 13 non-elephantiasic adults from the same area. 2. Features characteristic of the disease include reflux of darkly-staining lymphocytes into the afferent lymphatics, crowding of the small lymphocytes into the sinuses with sheets of similar cells in the periphery of the node. The phenomena occur in relation with endolymphangitis of afferent lymphatics in some cases. 3. The picture closely resembles that produced experimentally in animals by occlusion of the incoming lymphatics and is interpreted as indicating delay in, or absence of, transport of the lymphocytes through the node into the central circulation (Gowans cycle). In elephantiasis, the loss of lymph-flow results from endolymphangitis of the afferent lymphatics. 4. The presence of microgranulomata and of birefringent particles was also noted but is not discussed here. 5. The present study indicates that the lesion responsible for the irreversible elephantiasis of the lower legs is in the distal lymphatics.

Adult↗
PubMed1986

Filarial lymphoedema and elephantiasis of lower limb: a review of 44 cases.

Twenty patients with early lymphoedema due to filariasis and twenty-four patients with elephantiasis of the lower limb were subjected to lymph nodovenous shunt (LNVS) and Charles' operation respectively. In 62 per cent of cases subjected to LNVS operation, there was a rapid relief of lymphoedema followed by slow reduction, 24 per cent had slow and gradual reduction and 14 per cent had very slight reduction in volume and circumference. Patients subjected to Charles' operation had immediate volume and circumference reduction and skin graft 'take' was 88 per cent. There were no operative and a few minor postoperative complications in both the procedures, infection being most notable in those who had undergone Charles' operation. The hospital stay was 7-10 days in LNVS and 21-36 days in Charles' operation. There was no mortality. The long-term results of the present study in terms of volume and circumference reduction, skin condition and freeness of joint movement were encouraging. It is concluded that, while excisional surgery such as Charles' operation becomes necessary for late states of lymphoedema which have progressed to elephantiasis, nodovenous shunt alone is sufficient to relieve early stages of lymphoedema due to filariasis.

Adolescent↗
PubMed1985

Microlymphaticovenous anastomosis for treating scrotal elephantiasis.

Scrotal elephantiasis can be physically disabling and psychologically distressing to the victim. Ablative procedure has been used in its treatment and has achieved limited success. The authors developed a microlymphaticovenous procedure to treat elephantiasis of the scrotum and applied it clinically in three patients. The immediate and long-term (13-24 months) results have been very satisfactory. The scrotum size was dramatically reduced to a nearly normal level, and subjective symptoms and objective signs were improved. The operative techniques are described, the three case histories are illustrated, and the advantages of microlymphaticovenous anastomosis, the selection of patients, and the factors required for success of the surgery are discussed.

Adult↗
PubMed1994

Potential use of IgG2-ELISA in the diagnosis of chronic elephantiasis and IgG4-ELISA in the follow-up of microfilaraemic patients infected with Brugia malayi.

Sera from fifty subjects with different presentations of Brugian filariasis and from common soil-transmitted helminth infections were tested for specific anti-filarial IgG and its subclasses. Anti-filarial IgG, IgG1 and IgG3 showed cross-reactivities with soil-transmitted helminthic infections and no significant differences in optical densities among the various groups of filarial patients. In comparison with other groups of subjects, IgG4-ELISA of sera from microfilaraemic patients and some previously microfilaraemic patients showed a significant increase in optical density readings, while IgG2-ELISA showed elevated optical density readings in sera of patients with chronic elephantiasis. Therefore IgG2-ELISA is potentially useful in the diagnosis of brugian chronic elephantiasis while IgG4-ELISA may be beneficial for follow-up diagnosis of treated microfilaraemic patients.

Animals↗
PubMed1986

The possible role of soil particles in the aetiology of non-filarial (endemic) elephantiasis: a macrophage cytotoxicity assay.

A link between the incidence of non-filarial elephantiasis and tropical red clay soil has been suggested after epidemiological surveys in Ethiopia and other African countries, although the mode of action of these soils in disease induction is unknown. We have thus investigated the physical composition of soils from both endemic and non-endemic areas of Ethiopia and their effect on the viability of macrophages using in vitro systems. Endemic and non-endemic soils were avidly phagocytosed by the macrophages. Cell shape was seen to change over a 144-hour period, the cells changing from approximately circular to spindle or stellate shape. Both groups of soils were cytotoxic towards the macrophages. Greatest cell death occurred during the first 48-hour period although some cells were viable after 96 hours. The soil groups could be divided by assessing their contents of silicon and aluminium, as well as observing the number of sub-2 micron particles they contained. The present study gives support to the epidemiological studies implicating soils as the cause of non-filarial elephantiasis.

Aluminum↗
PubMed2005

Giant scrotal elephantiasis.

How much can a man carry? Penoscrotal elephantiasis is a debilitating syndrome. This is a case report of a patient with giant genital elephantiasis secondary to long-standing lymphogranuloma venereum infection in Ethiopia. Complete surgical resection of the pathologic tissue and penile reconstruction was undertaken with good cosmetic and functional results.

Elephantiasis↗