Elephantiasis is caused by infection with the filarial worm, which is transmitted to humans by the mosquito and lives in the human lymphatic system.
The disease is typically characterized by the thickened skin and grossly enlarged limbs that earn the illness its name. The infection is uncommon in certain areas of the world, while it is endemic in others. Treatment may take around 8 weeks to eliminate all microfilariae in the blood.
General treatment measures include bed rest, elevation of affected limbs and wrapping the limbs in compression bandages. This helps to bring down the swelling. If there are signs of infection, generally the next measure is taking care of the skin on the foot and leg to prevent any infection that may worsen the swelling. The skin should be washed carefully and dried. Nails are clipped and cleaned to avoid injury and inadvertent infection.
As far as medications are concerned, the treatment differs by area, as follows:
- In the United states, the drug of choice is diethylcarbamazine or DEC, which kills the microfilariae and also some adult worms.
- For areas outside of the United States, a combination of albendazole and ivermectin is generally used.
Another major consideration during treatment of elephantiasis is the presence of Wolbachia bacteria, which live in symbiosis with the filarial parasite. When an antibiotic is used to kill the bacterial population, the worms also die off.
DEC is capable of killing both microfilariae and adult worms. However, rapid elimination of the worms, can trigger immunological reactions such as fever, sore throat and muscle pain. A low dose is therefore often used in combination with steroids, anti-inflammatory agents that can combat the initial immunological reactions. One of the regimens recommended by the global filariasis elimination programme is single-dose ivermectin with or without albendazole.
Reviewed by Sally Robertson, BSc