The word elephantiasis is a vivid and accurate term for the syndrome as it describes the enlargement of the arms, legs, or genitals to elephantoid size. It is also called as "Lymphatic Filariasis". Elephantiasis is a parasitic disease which is transmitted from human to human by mosquito bites. It is a disease that is characterized by the thickening of the skin and underlying tissues, especially in the legs and genitals. It causes certain parts to swell to the size of a beachball in some cases. Elephantiasis is most commonly found in African nations.

Elephantiasis can be very painful and uncomfortable and reduces the sufferer's ability to lead a normal life. A serious complication of elephantiasis can be obstructed blood vessels, which limit blood supply and cause the skin to become infected and gangrenous.

Other terms used for Elephantiasis are Barbados leg, Elephant leg, Morbus Herculeus, Mal de Cayenne, and Myelolymphangioma.

Elephantiasis has two main forms:

• Lymphatic Filariasis: It is the most common form of elephantiasis which is caused by a parasitic disease resulting from a bite from an infected mosquito. Lymphatic filariasis affects people primarily in the tropics and is concentrated in Africa. It is estimated that 122 million people spread over 80 countries are affected by Elephantiasis.
• Nonfilarial Elephantiasis: This is second type of elephantiasis. It is non-parasitic. It is more common in Africa. It is caused by repeated contact with volcanic ash in the area. Primarily barefooted population receives chemicals from the soil into their feet, and the chemicals travel to the lymphatic vessels and irritate and block them.

Causes of Elephantiasis

• Elephantiasis is caused by several different types of parasitic worms, including Wuchereria bancrofti, Brugia malayi, and B. timori.
• Elephantiasis is caused by obstruction of the lymphatic system, which results in the accumulation of a fluid called lymph in the affected areas.
• Elephantiasis is transmitted by female mosquitoes. When an infected female mosquito bites a person, she may inject the worm into the bloodstream. The worm reproduces and spread throughout the bloodstream.

Other situations that can lead to elephantiasis are:

• A protozoan disease called leishmaniasis
• A repeated streptococcal infection 
• The surgical removal of lymph nodes (usually to prevent the spread of cancer) 
• A hereditary birth defect

Signs & Symptoms of Elephantiasis
In many cases, symptoms of elephantiasis do not appear until years after infection. As the parasites accumulate in the blood vessels, they can restrict circulation and cause fluid to build up in surrounding tissues. Symptoms can appear 5-18 months after a mosquito bite.

Symptoms of acute infection of elephantiasis are:

• Blocked lymph ducts
• Brawny skin color 
• Enlarged groin lymph nodes
• Fever
• Fibrotic skin tissue 
• Impaired lymphatic drainage 
• Massive leg swelling 
• Massively swollen genitalia and breasts
• Pain above testicles
• Pebbly skin appearance 
• Severe swelling 
• Skin ulceration 
• Swollen liver 
• Swollen spleen 
• Thickened skin tissue 
• Verrucous skin appearance
• White urinary discharge

Diagnosis of Elephantiasis
The only sure way to diagnose lymphatic filariasis is by detecting the parasite itself, either the adult worms or the microfilariae.

Microscopic examination of the person's blood may reveal microfilariae. Many times, people who have been infected for a long time do not have microfilariae in their bloodstream. The absence of them, therefore, does not mean necessarily that the person is not infected. In these cases, examining the urine or hydrocele fluid or performing other clinical tests is necessary.

Other ways of diagnosis of elephantiasis are:

• Serologic testing sometimes helpful
• Tropical pulmonary eosinophilia
  1. Increased blood eosinophils
  2. High filarial antibody titers
  3. High IgE levels
  4. Chest X-Ray shows increased bronchovascular markings

Preventions of Elephantiasis
Medicines must be taken early after the primary infection. The two main ways to control this disease are to take DEC preventively, which has shown to be effective, and to reduce the number of carrier insects in a particular area.

Avoiding mosquito bites with insecticides and insect repellents is helpful, as is wearing protective clothing and using bed netting.

Much effort has been made in cleaning the breeding sites (stagnant water) of mosquitoes near people's homes in areas where filariasis is found.

Before visiting to the countries where elephantiasis is found, it would be recommended to consult a travel physician to learn about current preventative measures.

Treatments of Elephantiasis
Treatment of elephantiasis depends on the type of the disorder the person is afflicted with. 

• Lymphatic filariasis is treated with medication designed to kill the parasite. DEC kills the microfilariae quickly and injures or kills the adult worms slowly, if at all. In India, DEC has been given in the form of a medicated salt, which helps prevent spread of the disease.
• Surgery for massive leg swelling (elephantiasis) with a fluid shunting procedure.
• Other means of managing lymphatic filariasis are pressure bandages to wrap the swollen limb and elastic stockings to help reduce the pressure. Exercising and elevating a bandaged limb also can help reduce its size.
• Another form of effective treatment involves rigorous cleaning of the affected areas of the body.

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