Lymphatic Filariasis
This article talks about a parasitic disease called lymphatic filariasis. It discusses prevalence, causes, symptoms, transmission and overall impact on patient life. It also mentions the global efforts and national efforts of India to get rid of lymphatic filariasis or elephantiasis.
Introduction
Prevalence of Lymphatic Filariasis
Lymphatic Filariasis in India
Causes
Diagnosis
Transmission of Lymphatic Filariasis / Elephantiasis
Symptoms of Elephantiasis
Treatment of Lymphatic Filariasis
Global Efforts
National Efforts
Conclusion
Introduction
Lymphatic filariasis is a neglected tropical disease. It is popularly known by the names of Elephantiasis and Hathipaon. These names suggest a disease manifested by feet like elephant. The most visible symptom of this disease is swollen legs. This manifestation of Elephantiasis is reflected in its name. The other name lymphatic filariasis suggests the problem of lymphatic system caused by filarial worms.
Prevalence of Lymphatic Filariasis
The disease of lymphatic filariasis is prevalent in mainly tropical countries of Africa and Asia. It is also prevalent in subtropics of Asia, Africa, Western Pacific and parts of Caribbean and South Africa. Since tropical areas are breeding ground for mosquitoes therefore elephantiasis is prevalent there. Globally, 856 million people are threatened by elephantiasis in 52 countries. In 2000, approximately 120 million people got infected with this disease worldwide and out of which 40 million people faced disfigurement and incapacitation.
Lymphatic Filariasis in India
In India, 2.3 Cr people are lifelong incapacitated due to lymphatic filariasis. India bears 40% global burden of lymphatic filariais. Maharashtra has high incidence of elephantiasis. The data of 2017 reports more than 40,000 cases of lymph edema in Maharashtra alone.
Causes
Elephantiasis or lymphatic filariasis is caused by nematodes which are thread like worms. There are three parasitic worms responsible for occurrence of Elephantiasis. These parasitic worms are Wuchereria bancrofti, Brugia malayi and Brugia timori belonging to the family filariodidea. The most common causative agent is Wuchereria bancrofti which is cause of more than 90% cases. The vectors carrying these nematodes are mosquitoes. The species of mosquitoes acting as vectors for lymphatic filariasis are culex, anopheles and aedes. The species predominant for carrying causative parasites vary in different regions. Culex is vector in urban and suburban areas. Anopheles and Aedes species act as vectors in rural areas and pacific islands respectively. Overall, unhygienic conditions breed lymphatic filariasis.
Diagnosis
Lymphatic filariasis is diagnosed using blood samples. Blood sample is observed for presence of filarial worms. Since thread worms circulate in night in blood, therefore their visualization is possible in blood sample taken in night only. Thus, blood sample is collected in night for diagnosing lymphatic filariasis or elephantiasis. The blood test may be even negative for infected patient. Thus, another alternative test is serum test to detect antibodies to worms. It is more accurate than blood test.
Transmission of Lymphatic Filariasis / Elephantiasis
Causative thread worms from an infected mosquito burrow in to human skin while mosquito bite human. The worm mature in to adults and breed. The mature worms cause damage to lymphatic system of human. Male and female worms together form nests in human lymphatic system. Their microfilaria or baby worms enter in to blood circulation. When a mosquito bites this infected human and sucks blood, it ingests microfilaria. The microfilaria mature in to larvae which further migrates to head and proboscis of mosquito. This mosquito further spreads infection by transmitting parasites to humans while biting them. This cycle of parasitic transmission from mosquito to humans and vice versa comprises the whole life cycle of thread worms causing lymphatic filariasis or elephantiasis.
Symptoms of Elephantiasis
The most common visible manifestation of lymphatic filariasis is huge swelling of legs. It may also affect arms, breasts and genitals. It can affect in all ages. Infection can be acquired during childhood but its symptoms may take years to become visible causing temporary or permanent disability. Other issues may appear earlier like fever. The disfigurement and incapacity resulted from this chronic disease make the patient’s life unbearable.
Treatment of Lymphatic Filariasis
The most important treatment is providing symptomatic relief to the swollen parts of body. Maintaining sanitation is important to prevent spread of disease. The recommended treatment is called Triple Drug Therapy (TDT) which is a combination of three drugs. These medicines are ivermectin, DEC (Diethyl Carbamazine) and albendazole. This combination is abbreviated as IDA.
Global Efforts
World Health Organization (WHO) initiated Global Program to Eliminate Lymphatic Filariasis (GPELF) in 2000. The program has twin pillar strategy:
Prevention of spreading infection
Mass drug administration of two drugs, DEC & albendazole was recommended. This combination does not kill worms but prevent spread of disease.
Alleviating sufferings of affected population
Morbidity management and disability prevention (MMDP) are necessary for reducing sufferings of infected people.
In 2017, WHO recommended triple drug therapy for the treatment of lymphatic filariasis. Global deadline for elimination of elephantiasis is 2020.
National Efforts
India also followed the same two components of WHO’s Global Program to Eliminate Lymphatic Filariasis. India hosted two meetings of GAELF (Global Alliance to Eliminate Lymphatic Filariasis) in 2002 and 2018. During hosting of 10th meeting of GAELF in New Delhi in 2018, government of India launched APELF (Accelerated Plan for Elimination of Lymphatic Filariasis). This plan rolled out TDT (Triple Drug Therapy) in phased manner. In November 2019, national symposium for eradication of lymphatic filariasis was conducted which declared national target to end this deadly disease by 2021. The theme of this symposium was “United to eliminate lymphatic filariasis”.
Conclusion
Collective efforts of authorities, medical community and awareness of people can prevent the occurrence of this tropical disease which is really killing the potential of millions of lives.
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