Elephantiasis

Elephantiasis is a disease that is characterized by the thickening of the skin and underlying tissues, especially in the legs and genitals.

Causes
Elephantiasis generally results from obstructions of the lymphatic vessels. It is most commonly caused by a parasitic disease known as lymphatic filariasis.

Alternatively, elephantiasis may occur in the absence of parasitic infection. This nonparasitic form of elephantiasis, known as nonfilarial elephantiasis or podoconiosis, generally occurs in the mountains of central Africa. Nonfilarial elephantiasis is thought to be caused by persistent contact with volcanic ash.

Cultural aspects
Elephantiasis is associated in the public mind with "The Elephant Man", the carnival stage name of Joseph Merrick. The name refers to the resemblance of the sufferer's limbs to the thick, baggy skin on the limbs and trunks of elephants. However, it is now believed that Merrick's deformity was not actually caused by elephantiasis, but by a completely different medical problem called Proteus Syndrome.

Treatment
The current first-line treatment of lymphatic filariasis is diethylcarbamazine. Medicines to treat lymphatic filariasis are most effective when used soon after infection, but they do have some toxic side effects. In addition, the disease is difficult to detect early.

Another form of effective treatment involves rigorous cleaning of the affected areas of the body. Several studies have shown that these daily cleaning routines can be an effective way to limit the symptoms of lymphatic filariasis. The efficacy of these treatments suggests that many of the symptoms of elephantiasis are not directly a result of the lymphatic filariasis but rather the effect of secondary skin infections.

Also, surgical treatment may be helpful for issues related to scrotal elephantiasis and hydrocele. However, surgery is generally ineffective at correcting elephantiasis of the limbs.

A vaccine is not yet available and is likely to be developed in the near future.

Antibiotics as a possible treatment
In 2003 it was suggested that the common antibiotic doxycycline might be effective in treating elephantiasis. The parasites responsible for elephantiasis have a population of symbiotic bacteria, Wolbachia, that live inside the worm. When the symbiotic bacteria are killed by the antibiotic, the worms themselves also die. Clinical trials in June 2005 by the Liverpool School of Tropical Medicine reported that an 8 week course almost completely eliminated microfilariaemia.

Genome deciphered
On September 20, 2007, scientists mapped the genome or genetic content of Brugia malayi, worm which cause elephantiasis (lymphatic filariasis). Figuring out the content of the genes might lead to development of new drugs and vaccines.