We often treat patients with wounds related to lymphedema in our clinics and educate providers on treatment for this condition. Lymphedema is not uncommon and affects 1 in 1,000 Americans, so full-time providers are bound to encounter this condition in our wound care careers.
Lymphedema can be caused by a wide spectrum of things, including cancer surgery that affects lymph nodes, radiotherapy, genetic predisposition, infections, venous disease, trauma, and more. But there is a common cause of lymphedema you may have never heard of!
Lymphatic filariasis, commonly known as elephantiasis, is a common tropical disease. Infection occurs when filarial parasites are transmitted to humans through mosquitoes. Infection is usually acquired in childhood and causes hidden damage to the lymphatic system, leading to profound edema that generally will not be present until adulthood.
The painful and disfiguring visible manifestations of the disease – lymphoedema, elephantiasis, and scrotal swelling can lead to permanent and severe disability.
Fortunately, this disease can be treated with prophylactic chemotherapy to stop the spread of the infection. As of 2021, 882.5 million people in 44 countries were living in areas that require this treatment.
Over 36 million people worldwide are afflicted with chronic manifestations of previous filarial infection, and according to WHO, more than 51 million were infected as of 2018.
Let’s now talk a little about the transmission, cause, and treatment of this illness;
The parasite Wuchereria bancrofti is responsible for 90% of the cases, with Brugia malayi causing most of the remainder and Brugia timori causing a small percentage.
All three of these organisms are nematodes of the family Filariodidea. Lymphatic filariasis is transmitted by various types of mosquitoes, which cause mature parasite larvae to be deposited on the skin, from where they can enter the body.
The larvae then migrate to the lymphatic vessels, developing into adult worms, continuing the transmission cycle. Adult worms nest in the lymphatic vessels and disrupt the normal function of the lymphatic system.
When lymphatic filariasis becomes chronic, it leads to progressive lymphedema or elephantiasis of limbs and hydrocele (scrotal swelling).
Acute episodes of local inflammation involving skin, lymph nodes, and lymphatic vessels often accompany chronic lymphedema or elephantiasis, often due to an immune response to the parasite.
Eliminating lymphatic filariasis is possible by stopping the spread of the infection through preventive chemotherapy. This is done through MDA or mass drug administration. After the implementation of this program by WHO, preventive chemotherapy is now only required in 44 countries. Within 9 of these countries, MDA has not yet been delivered to all endemic areas as of the end of 2021.
Only lymphedema management is possible once a patient has developed lymphedema through filarial infection. Clinical severity and progression of the disease, including acute inflammatory episodes, can be reduced and prevented through hygiene, skin care, compression, and elevation of affected limbs.
Currently, Lymphatic filariasis affects over 120 million people in 72 countries throughout the tropics and sub-tropics of Asia, Africa, the Western Pacific, and parts of the Caribbean and South America.
Fortunately, these parasites are not found in the United States, however, as providers you may want to take a moment to inquire about travel or residence in affected areas for patients with lymphedema. You just might be surprised to find a case of this important tropical disease.