Elephantiasis is typically

characterized by a thickening of the

skin and subcutaneous tissue that
gives rise to the grossly enlarged and
swollen limbs that earn the condition
its name.

Elephantiasis refers to a parasitic

infection that causes extreme swelling
in the arms and legs.

The disease is caused by the filarial

worm, which is transmitted form
human to human via the female
mosquito when it takes a blood meal.
The parasite grows into an adult worm

that lives in the lymphatic system of

humans.

HISTORY
Lymphatic filariasis is thought to have affected
humans for about 4000 years. Artifacts from
ancient Egypt (2000 BC) and the Not
civilization in West Africa (500 BC) show
possible elephantiasis symptoms. The first clear
reference to the disease occurs in ancient
Greek literature, wherein scholars differentiated
the often similar symptoms of lymphatic
filariasis from those of leprosy.
The first documentation of symptoms occurred
in the 16th century, when Jan Huyghen van
Linschoten wrote about the disease during the
exploration of Goa. Similar symptoms were
reported by subsequent explorers in areas of
Asia and Africa, though an understanding of the
disease did not begin to develop until centuries
later.
In 1866, Timothy Lewis, building on the work
of Jean Nicolas Demarquay (de) and Otto

Henry Wucherer, made the connection between

microfilariae and elephantiasis, establishing the
course of research that would ultimately explain
the disease. In 1876, Joseph
Bancroft discovered the adult form of the worm.
In 1877, the lifecycle involving an arthropod
vector was theorized by Patrick Manson, who
proceeded to demonstrate the presence of the
worms in mosquitoes. Manson incorrectly
hypothesized that the disease was transmitted
through skin contact with water in which the
mosquitoes had laid eggs. In 1900, George
Carmichael Low determined the actual
transmission method by discovering the
presence of the worm in the proboscis of the
mosquito vector.

SIGN
OF SYMPTOMS
1. The most spectacular symptom of
lymphatic filariasis is elephantiasis, a stage
lymph edema with thickening of the
skin and underlying tissues. This was the
first mosquito-borne disease to be
discovered.

2. The skin condition the disease causes is

called "elephantiasis tropica" (also known
as "elephantiasis arabum")
3.Elephantiasis mainly affects the lower
extremities; the ears, mucous membranes,
and amputation stumps are affected less
frequently. However, various species of
filarial worms tend to affect different parts of
the body: Wuchereria bancrofti can affect
the arms, breasts, legs, scrotum, and vulva

(causing hydrocele formation), while Brugia

timori rarely affects the genitals.
4.Those who develop the chronic stages of
elephantiasis are
usually amicrofilaraemic and often have
adverse immunological reactions to the
microfilariae as well as the adult worms.
5. Elephantiasis results when the parasites
lodge in the lymphatic system and cause
blockages to the flow of lymph. Infections
usually begin in childhood.
6.Skin rashes, urticarial papules, and arthritis,
as well
as hyper- and hypopigmentation macules.
7.Serous cavity filariasis presents with
symptoms similar to subcutaneous
filariasis, in addition to abdominal pain,
because these worms are also deep-tissue
dwellers.
8.Those who develop the chronic stages of
elephantiasis are

usually amicrofilaraemic and often have

adverse immunological reactions to the
adult worms..
9. Elephantiasis leads to marked swelling of the
lower half of the body

CAUSES
1. Elephantiasis occurs in the presence
of microscopic, thread-like parasitic
worms such as Wuchereria bancrofti
2. Brugia malayi , and Brugia
timori (also known as B. timori), all of
which are transmitted by bites from
infected mosquitoes. It is a type

ofhelminth infection. Three types of

worm cause the disease and damage
the lymphatic system.
3. The disease itself is a result of a
complex interplay between several
factors: the worm,
the endosymbiotic Wolbachia bacteria
within the worm, the hosts immune
response, and the numerous
opportunistic infections and disorders
that arise.
4. The parasite infects the lymph nodes
and blocks the flow of lymph throughout
the body; these results in chronic
lymphedema, most often noted in the
lower torso (typically in the legs and
genitals).

Life cycle of parasite

Wuchereria bancrofti is a human

parasitic roundworm that is the major
cause of lymphatic filariasis. It is one of
the three parasitic worms, together
with Brugia malayi and B. timori, that
infect the lymphatic system to cause
lymphatic filariasis. These filarial worms
are spread by a variety
of mosquito vector species. W.
bancrofti is the most prevalent of the
three and affects over 120 million
people, primarily in Central Africa and
the Nile delta, South and Central
America, the tropical regions of Asia
including southern China, and the
Pacific islands. If left untreated, the
infection can develop into a chronic
disease called elephantiasis. In rare

conditions it also causes tropical

eosinophilia, an asthmatic disease.
Limited treatment modalities exist and
no vaccines have been developed.
W. bancrofti carry out their life cycle in
two hosts. Human beings serve as
the definitive host and mosquitoes as
their intermediate hosts. The adult
parasites reside in the lymphatics of the
human host. They are found mostly in
the afferent lymphatic channels of the
lymph glands in the lower part of the
body. The first-stage larvae, known
as microfilariae, are present in
the circulation. The microfilariae have a
membrane "sheath". This sheath, along
with the area in which the worms reside,
makes identification of the species of

microfilariae in humans easier to

determine. The microfilariae are found
mainly in the peripheral blood and can
be found at peak amounts from 10 p.m.
to 4 a.m. They migrate between the
deep and the peripheral circulation
exhibiting unique diurnal periodicity.
During the day, they are present in the
deep veins, and during the night, they
migrate to the peripheral circulation. The
cause of this periodicity remains
unknown, but the advantages of the
microfilariae being in the peripheral
blood during these hours may ensure
the vector, the nighttime mosquito, will
have a higher chance of transmitting
them elsewhere. Physiological changes
also are associated with sleeping, such

as lowered body temperature, oxygen

tension and adrenal activity, and an
increased carbon dioxide tension,
among other physical alterations, any of
which could be the signals for the
rhythmic behavior of microfilaria
parasites. If the hosts sleep by day and
are awake at night, their periodicity is
reversed. In the South Pacific, where W.
bancrofti shows diurnal periodicity, it is
known as periodic.
The microfilariae are transferred into
a vector, which are most commonly
mosquito species of the
genera Culex, Anopheles, Mansonia,
and Aedes. Inside the mosquito, the
microfilariae mature into
motile larvae called juveniles. When the

infected mosquito has its next blood

meal, W. bancrofti is egested via the
mosquitos proboscis into the blood
stream of the new human host. The
larvae move through the lymphatic
system to regional lymph nodes,
predominantly in the legs and genital
area. The larvae develop into adult
worms over the course of a year, and
reach sexual maturity in the afferent
lymphatic vessels. After mating, the
adult female worm can produce
thousands of microfilariae that migrate
into the bloodstream. A mosquito vector
can bite the infected human host, ingest
the microfilariae, and thus repeat the life
cycle.

Wuchereria bancrofti

Diagnosis
The standard method for diagnosing active
infection is by finding the microfilariae via
microscopic examination. This may be
difficult, as in most parts of the world,
microfilariae only circulate in the blood at
night. For this reason, the blood has to be
collected nocturnally.

The blood sample is typically in the form of

a thick smear and stained with Giemsa
stain. Testing the blood serum for
antibodies against the disease may also be
used.
For this reason, the blood has to be
collected nocturnally.
The Carter Center's International Task
Force for Disease Eradication declared
lymphatic filariaisis one of six.

PREVENTION
The World Health Organization recommends mass
dewormingtreating entire groups of people who
are at risk with a single annual dose of two
medicines, namely albendazole in combination with
either ivermectin or diethylcarbamazine citrate. With
consistent treatment, since the disease needs a
human host, the reduction of microfilariae means the
disease will not be transmitted, the adult worms will
die out, and the cycle will be broken. In sub-Saharan

Africa, albendazole (donated by GlaxoSmithKline) is

being used with ivermectin (donated by Merck &
Co.) to treat the disease, whereas elsewhere in the
world, albendazole is used with diethylcarbamazine.
Transmission of the infection can be broken when a
single dose of these combined oral medicines is
consistently maintained annually for a duration of
four to six years. Using a combination of treatments
better reduces the number of microfilariae in blood.
Avoiding mosquito bites, such as by
using insecticide-treated mosquito bed nets, also
reduces the transmitted.

TREATMENT
Treatments for lymphatic filariasis differ
depending on the geographic location of the
endemic area In sub-Saharan
Africa, albendazole is being used
with ivermectin to treat the disease, whereas
elsewhere in the world, albendazole is used
with diethylcarbamazine Geo-targeting
treatments is part of a larger strategy to
eventually eliminate lymphatic filariasis by 2020

Additionally, 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 but in 2013
the University of Illinois was reporting 95%
efficacy in testing against B. malayi in mice.
Treatment for podoconiosis consists of
consistent shoe-wearing (to avoid contact with
the irritant soil) and hygiene - daily soaking in
water with an antiseptic (such as bleach)
added, washing the feet and legs with soap and
water, application of ointment, and in some
cases, wearing elastic bandages. Antibiotics are
used in cases of infection.
Antibiotics.
The antibiotic doxycycline is effective in treating
lymphatic filariasis. Its drawbacks are that it
requires a 4 to 6 weeks treatment and should
not be used in young children and pregnant
women, which limit its use for mass prevention.
The parasites responsible for elephantiasis
have a population of end
symbiotic bacteria, Wolbachia, that live inside

the worm. When the symbiotic bacteria of the

adult worms are killed by the antibiotic, they no
longer provide chemicals which the nematode
larvae need to develop, which either kill the
larvae or prevent their normal development.
This permanently sterilizes the adult worms,
which additionally die within 1 or 2 years
instead of after their normal 10 to 14 years
lifespan.

CASE STUDIES
1.An18yearold,unmarriedfemalepresentedwith
thecomplaintoflowgradefeveron swelling.The
swelling had been present for 2 years, slowly
increasing to its present size. The patient was a
migrantfromAzamgarh,UttarPradesh,India.
Ongeneralphysicalexamination,thepatientwasa
febrile and there was no lymphadenopathy. Local
examination revealed a polypoidal growth
measuring 5 6cm, arising from the left labium

minus.Thegrowthwassoft,andtheoverlyingskin
showed rigidities . A clinical diagnosis of
fibrolipomawassuggested.
Fineneedleaspirationofthegrowthwasperformed.
Microscopy showed hypocellular smears with an
occasional lymphocyte in a proteinaceous
background.
Subsequently,thegrowthwasexcisedandsubmitted
forhistopathologicalexamination.Grossly,itwasa
single,polypoidalsofttissuemassmeasuring5.2
3.4 2.2cm. The cut section was greywhite to
greyyellow and firm. Microscopic examination
showed a polypoidal lesion covered by acanthotic
epidermis. The dermis and subcutis showed dense
collagenization and contained numerous dilated
lymphatics.Inaddition,deepdermisshowedafew
noncaseating granulomas along with foreign body
giant cells . There was patchy cellular infiltrate
consisting of lymphocytes, plasma cells, and
eosinophils.

2. Life hasnt been easy for 50 year old Mahija

Ali in Tanzania. Shes lived with elephantiasis
for a number of years, a condition that results in
severe swelling of the lower half of the body.
Since then shes has had to give up her shop,
find the money for treatment and deal with
constant pain in her legs.

Lymphatic filariasis (elephantiasis) is just one of

a number of neglected tropical diseases (NTDs)
that collectively affect over a billion people
worldwide. UK aid is at the forefront of ensuring
the diseases are neglected no longer, and is
preventing millions of people becoming infected
through supporting research into new drugs and
mass distribution of current drugs. Its really
good that my children will be saved from getting
the same condition. All my children get the
drugs and I make sure they take them, says
Mahija.
The disease is transmitted by parasites carried
by mosquitoes, and damages the lymphatic
system and kidneys. Over 120 million people
are currently infected by elephantiasis, which
affects the poorest people across many of the
worlds tropical regions. The disease prevents
people from living normal lives; children who
are affected cannot go to school, people
affected often have to stop working and it is

estimated the disease costs Africa 1.3 billion a

year in lost productivity

BIBLOGRAPHY
www.google.com

www.yahoo.com
www.wikipedia.org
www.cbse.nic.in
Ncert text books class 12

ACKNOWLEDGEMENT

I would like to express my special

thanks of gratitude to my teacher
DR.R.K.MEENA as well as our
principal MR. H.R.MEENA who gave
me the golden opportunity to do
this wonderful project on the topic
ELEPHANTIASIS which also helped
me in doing a lot of Research and i
came to know about so many new
things I am really thankful to them.
Secondly I would also like to thank
my parents and friends who helped
me a lot in finalizing this project
within the limited time frame.

RAHUL KUMAR
CLASS XII C
CERTIFICATE

This is to certify that this project has been

made by RAHUL KUMAR of class XII C on
the topic ELEPHANTIASIS under the
guidance of our biology teacher DR.
R.K.MEENA and our lab assistant MR.
MUNSHI HAVE BEEN completed it
sucessfully.

Sign. of examiner

Sign. of subject
teacher

NAME

RAHUL KUMAR

CLASS

XII C

ROLL NO.

PROJECT SUBMITTED TO :
DR. R.K.MEENA