An elephant's foot in the OPD???

What are the chances of accidentally bumping into a patient's leg that looks like an elephant's feet? Although seems like a rare phenomenon, finding an elephant feet like leg is not a rare event in at least 70 countries in the world where this particular disease is endemic. The disease is "Lymphatic filariasis" and the condition is "Elephantiasis."

Along with massive legs, patients may also present with microfilaremia (larva of filaria worms dispersed in blood), hydrocele (genitals affected only when infected with W. bancrofti), acute adenolymphangitis (ADL), and chronic lymphatic disease.
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It is caused by thread like worms -
  • Wuchereria bancrofti
  • Brugia malayi
  • Brugia timori

The disease can surface in any part of the world. Reasons that contribute to the same are
  1. Globalization permits people to travel from endemic areas to non endemic areas.
  2. The adult parasites may reside in lymphatic channels or lymph nodes, where they may remain viable for more than twenty years. The patient may be asymptomatic for a long time period and suddenly become symptomatic.
A single case of Filaria cannot serve as the carrier for the disease since repeated bites by mosquitoes carrying the parasite for several months to years is the prerequisite for infection.

There is a similarity between the young microfilariae and I: both enjoy partying at night. Hence the peripheral blood contains more microfilariae at night than during the day hours.

In 2015, three scientists shared the nobel prize for medicine. Two of them were awarded with the prize for their discovery of drug that can kill the filarial worm. The drug is Avermectin, the medicine also used to treat river blindness. The usual treatment schedule is Albendazole with either Diethylene Carbamazepine or Avermectin.

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