Ghana's path towards eliminating lymphatic filariasis.

Lymphatic filariasis, also known as elephantiasis, is a debilitating parasitic disease that has been prevalent in various parts of the world, including China and Ghana. This paper explores the historical context of lymphatic filariasis in Ghana and China, as well as the fights towards eliminating the disease in both countries. The review also covered the strategies employed by the Chinese government to eliminate lymphatic filariasis and the key lessons that Ghana can learn from China's success. The discussion highlights the importance of political commitment, multisectoral collaboration, tailoring control strategies to local contexts, adopting a comprehensive approach, and emphasising health education and community mobilisation. By adopting these lessons and fostering a robust national strategy, engaging diverse stakeholders, and ensuring active community involvement, Ghana can work towards achieving lymphatic filariasis elimination, improving public health, and fostering sustainable development.

Sero-antigen prevalence of lymphatic filariasis and risk factors of podoconiosis in Busiriba sub-county, Kamwenge district, Southwestern Uganda, August-September 2018.

OBJECTIVE: Given the neglected nature of filariasis, especially in Uganda where data are scarce, this cross-sectional study aimed to determine the sero-antigen prevalence of lymphatic filariasis and risk factors associated with non-lymphatic filariasis (podoconiosis) in Busiriba Sub-county, Kamwenge District, Uganda, during August-September 2018, to inform targeted elimination efforts. RESULTS: We enrolled 101 participants, among whom 35 (34.7%) had podoconiosis. The sero-antigen prevalence of lymphatic filariasis was 1.0%. Older age and walking barefoot were associated with increased podoconiosis risk. Specifically, individuals aged 25-49 years with had 7.38 times higher odds of podoconiosis (adjusted odds ratio [aOR] = 7.38, 95% CI: 1.36-40.13) compared to those under 25 years, while those aged ≥ 50 years had even higher odds (aOR = 8.49, 95%CI: 1.44-50.15). Additionally, individuals who reported walking barefoot had 14 times higher odds of podoconiosis (aOR = 14.08; 95% CI: 2.49-79.50).

Unraveling Lymphatic Filariasis in an Old Man: A Case Report.

Lymphatic filariasis, caused by filarial worms such as Wuchereria bancrofti, Brugia malayi, and Brugia timori, represents a significant public health burden in endemic regions. The disease primarily affects the lymphatic system, leading to lymphatic dysfunction and chronic morbidity. This abstract provides a comprehensive overview of lymphatic filariasis, including its transmission dynamics, pathogenesis, clinical manifestations, diagnostic approaches, and treatment options. Special attention is given to the socioeconomic impact of the disease and the challenges associated with its control and elimination. The patient in this particular case is a 58-year-old man who had lower limb swelling and pain, characteristic of chronic lymphatic obstruction. Additionally, the swelling tends to worsen during the evening hours often resulting in difficulty in walking and discomfort. Lymphatic filariasis was diagnosed based on clinical presentation.

Elephantiasis Nostras Verrucosa of the Lower Limb: A Case Report and Literature Review.

Elephantiasis nostras verrucosa (ENV) is a rare complication of chronic lymphedema, leading to progressive cutaneous hypertrophy and disfigured lower extremities. We present an unusual case of a 79-year-old man with ENV, who had an episode of erysipelas treated and cured with antibiotics. The patient presented with progressive painless lymphedema of the lower limb years ago, complicated with skin changes. The biology and radiology test does not objective any causes. The compression therapy was proposed to the patient. ENV is characterized by lymphedema and skin anomaly. Management of ENV is often challenging, but a variety of successful medical and surgical treatment strategies have been reported.

Elephantiasis Nostras Verrucosa in a Patient With Lymphedema Tarda.

This case report presents a rare and complex clinical scenario of a 42-year-old male diagnosed with elephantiasis nostras verrucosa in the context of lymphedema tarda. The patient's seven-year history of insidious and progressively worsening swelling over the left lower limb, inguino-scrotal region, and left upper limb posed diagnostic challenges, leading to a multidisciplinary evaluation. Clinical examination, imaging studies, and laboratory investigations were integral in confirming the diagnosis. The manifestation of elephantiasis nostras verrucosa, characterized by extensive hyperkeratosis, added a unique dimension to the clinical presentation. A comprehensive treatment approach involving nutritional supplementation and pharmacological interventions was initiated to address the multifaceted aspects of lymphatic dysfunction. This case underscores the importance of a collaborative and holistic approach to managing complex lymphatic disorders, contributing valuable insights to the medical literature.

'My feet cannot stand on their own': podoconiosis patient healthcare expenditures and income impacts in Rwanda.

BACKGROUND: Podoconiosis is a progressive and debilitating form of tropical lymphoedema endemic to Rwanda. Although the physical and psychological consequences are well known, few studies have evaluated the financial burden of podoconiosis. METHODS: This cross-sectional, quantitative study aimed to characterize direct treatment costs and impacts on annual earnings among individuals living with podoconiosis. Participants from two highly endemic districts were invited to complete a survey focused on health-seeking history, insurance status, out-of-pocket costs and income changes. Direct treatment costs included medical expenditures (consultation, diagnostics, medication) and non-medical expenditures (food, transportation, accommodation). RESULTS: Overall, 226 adults (≥18 y of age) diagnosed with podoconiosis participated. Most had access to community-based health insurance (91.6%) but were unable to work (71.7%). Respondents sought care from health centres/posts (61.9%), hospitals (25.1%), traditional healers (5.8%) and/or community health workers (4.0%). On average, study participants paid US$32.50 (range US$0-779.23) annually, or 11.7% of their household salary, on podoconiosis treatments. CONCLUSIONS: This study demonstrates the significant financial burden of podoconiosis on individuals and their communities. Increased attention on integrating podoconiosis management into primary care systems and testing cost-effective solutions is needed to protect those who are most vulnerable.

Case report: Remarkable efficacy of negative-pressure wound therapy in giant lower extremity elephantiasis neuromatosa for vascularization, skin grafting, and fluid control.

INTRODUCTION AND IMPORTANCE: Neurofibromatosis type 1 is a benign peripheral nerve tumor, often manifests as plexiform neurofibroma that may cause severe dysfunction, pain, and disfigurement. Bleeding has been reported as a complication of plexiform neurofibroma due to vascular fragility and vasculopathy that may develop into life-threatening bleeding especially after excision procedure. Consequently, post excision complications also include dehiscence and infection. CASE PRESENTATION: We report a 23-year-old male with elephantiasis of the left lower extremity due to giant plexiform neurofibroma who underwent preoperative embolization followed by serial surgical mass reduction. There were postoperative complications consisting of hematoma, wound dehiscence, and infection. CLINICAL DISCUSSION: Negative pressure wound therapy is often used to accelerate wound healing, including infected wounds. However, negative pressure wound therapy has been a debatable modality for wound care of neurofibroma due to reported risks of profuse bleeding during its use. CONCLUSION: In this case, despite the size, negative-pressure wound therapy has shown good results for infected neurofibroma wounds and as an adjunct as wound dressing for defect closure of neurofibroma with split-thickness skin graft.

Isolated scrotal lymphedema in a 43-year old male patient: A case report.

INTRODUCTION: Lymphedema of the external genitalia is a rare condition characterized by swelling of the scrotal skin and subcutaneous tissue, resulting from a pathology in lymphatic drainage. Over time, the development of fibrosis leads to a considerable impairment in the patient's quality of life. While conservative management is generally the first-line approach, surgical cases may necessitate surgical intervention to achieve comprehensive and lasting improvements. CASE PRESENTATION: We present the case of a 43-year-old obese male patient who presented to the clinic with a complaint of persistent bilateral scrotal swelling for three months. Clinical examination revealed a pressure-indolent, soft, and massively enlarged swelling of the scrotum on both sides. Ultrasound findings confirmed a diffusely thickened edematous scrotal wall. The patient was advised to start physiotherapy and adhere to conservative management. Due to the debilitating size of the mass, the patient opted for excision of the scrotal swelling followed by scrotoplasty. CLINICAL DISCUSSION: This case report explores the presentation, signs and symptoms, impact on patients' lives, and various management options for scrotal lymphedema. It underscores the intricacies involved in the diagnosis and treatment decision-making process, emphasizing the need for a tailored and multidisciplinary approach. CONCLUSION: It is imperative to initially rule out life-threatening causes of scrotal lymphedema to ensure optimal patient care. The integration of surgical interventions should be carefully considered in the overall management strategy for optimal and comprehensive results. Scrotoplasty, in the context of scrotal lymphedema, not only improves the quality of life but also positively influences sexual function. COMPETENCIES: Interpersonal and communication skills, Medical knowledge, Patient care, Practice-based learning and improvement.

Zambia: A Narrative Review of Success and Challenges in Lymphatic Filariasis Elimination.

The establishment of the Global Programme to Eliminate Lymphatic Filariasis (GPELF) to stop the transmission of infection has significantly reduced the incidence of lymphatic filariasis, a debilitating mosquito-borne neglected tropical disease. The primary strategies that have been employed include mass drug administration (MDA) of anthelminthics and morbidity management and disability prevention (MMDP). While some countries have been able to reach elimination status in Africa, there is still active transmission of LF in Zambia. The nematode responsible for the disease is Wuchereria bancrofti, which is transmitted by Anopheles mosquitoes. To alleviate the suffering of those infected by the disease, the Zambian Ministry of Health launched a program to eliminate LF as a public health problem in 2003. This project reviewed the efforts to achieve the elimination of LF in Zambia, past and present government policies, and the anticipated challenges. MDAs have been conducted since 2014 and coverage has been between 87% and 92%. Zambia has now moved towards pre-transmission assessment surveys (PRETAS) and transmission assessment surveys (TAS). MMDP is a major priority and planned to be conducted between 2022 and 2026. COVID-19 presented a new challenge in the control of LF, while climate change, immigration, co-infections, and funding limitations will complicate further progress.

Genital elephantiasis in men.

Penoscrotal elephantiasis (PSE) is defined as an increase, sometimes considerable, in the volume of the external genitalia, which will be responsible for an unsightly appearance, a sexological impact and a psychological harm. The cause may be primary or secondary to a parasitic disease (filarsiosis) or to intrinsic or extrinsic lymphatic obstruction. The diagnosis is essentially clinical, with penoscrotal involvement being the most frequent. The etiological research implies the realization of certain complementary examinations according to the circumstances. Surgical treatment ideally consists of excising the mass. followed by reconstruction using grafts or local flaps of healthy skin, which is an important way of restoring comfort to the patient. We report two cases of penoscrotal elephantiasis treated surgically with good functional and aesthetic results. We update, through our own experience, aspects of the diagnostic and therapeutic care of penoscrotal elephantiasis.

Journey to an Improved Quality of Life: Filarial Lymphoedema and Physiotherapy Rehabilitation.

Filarial lymphoedema is a tropical parasitic worm illness caused mostly by Wuchereria bancrofti. This disease impacts millions of individuals in endemic areas, causing significant impairment and financial discomfort. Elephantiasis is a chronic lymphatic drainage failure causing swelling in the legs and genitalia. It is a chronic condition characterized by the buildup of lymphatic water, causing pain and reduced limb activity. Genetic abnormalities, trauma, surgery, infection, or cancer cause the disease. Treatment options include antiparasitic drugs, surgical interventions, and nonsurgical interventions like compression therapy. Lymphatic system transplantation, liposuction, and vascularized lymph node transfer are surgical procedures that restore lymphatic circulation and reduce swelling, potentially lifesaving for individuals with lymphedema who have not responded well to conservative treatment. The present case report concerns a 30-year-old male with a history of chronic lower leg elephantiasis for 17 years. Duplex color Doppler revealed a large, well-defined collection in the right foot with a heterogeneous group with few solid cystic components suggestive of a solid cystic mass lesion. MRI showed diffuse subcutaneous edema in the dorsum, medial, and lateral aspect of the foot with the medial, lateral, and posterior aspect of the leg appearing hyperintense on T2/proton density spectral attenuated inversion recovery (PDSPAIR), and hypointense on T1. Dilated lymphatic channels were seen coursing through in the cutaneous plane. The patient underwent a comprehensive surgical procedure that included excision of fibrotic tissue and subcutaneous adipose tissue, followed by lymph node transfer. Following the surgeon's clearance, a targeted early physiotherapy intervention could normalize functional potencies and help in recovery. Post-treatment changes such as reduction in lymphoedema, strength, and mobility, which are essential for patients with the activity of daily living, were observed.

Elephantiasis mimicry in recurrent lower limb skin infections in a diabetic patient: a case report.

BACKGROUND: Chronic edema as a complication of systemic diseases or infections can mimic filarial lymphedema (also known as elephantiasis) and considered so. We describe a case of chronic lymphedema that mimicked elephantiasis in a diabetic man. CASE PRESENTATION: The patient was a 70-year-old black man, bed-bound at the time of admission following a diagnosis of stroke and hypertension in the previous 5 years. He had been diabetic for 20 years with poorly controlled diabetes mellitus. He suffered recurrent bilateral lower limb skin infections for 5 years prior to admission that culminated into progressive lowerlimb edema. The infections eventually complicated into skin edema, hardening, fissuring, and hyperkeratotic plaques. The physical examination revealed Tinea pedis and bilateral non-pitting edema of lowerlimbs to the level of the knees. Investigations confirmed non-filarial lymphedema-related skin changes. The absence of the classic pebbly/cobblestone skin changes ruled out elephantiasis nostra verrucosa (ENV), with a possibility of it being in the early stages of evolution. The patient's skin fissuring and infections were successfully treated with antibiotics and antifungals while compression stockings helped to relieve the edema. CONCLUSIONS: Chronic lymphedema can complicate repeated non-filarial infections of lower limbs. Its fissures are a risk factor for cellulitis, prompting early identification and management of both infections and lymphedema to halt their vicious cycle, especially in at risk populations like diabetics.

"Whenever I tell her to wear slippers, she turns a deaf ear. She never listens": a qualitative descriptive research on the barriers to basic lymphedema management and quality of life in lymphatic filariasis patients in a rural block of eastern India.

BACKGROUND: Chronic lymphatic filariasis patients in Bihar, India, need management of lymphedema to live a disability-free life. For patients who have recurrent attacks of acute dermato-lymphangio-adenitis (ADLA), World Health Organization (WHO) has recommended simple home-based measures that include maintaining hygiene, skin care, and limb movement. However, patients in rural areas are unable to adopt them, resulting in a vicious cycle of ADLA attacks. There might be multiple realities from patients' and healthcare workers' perspectives that were unexplored. Qualitative research was deemed best suitable to identify the barriers to carrying out home-based lymphedema practices that adversely affected quality of life. METHODS: The qualitative descriptive study was conducted in two villages in the rural field practice area under a tertiary care hospital in Bihar. Researchers purposively selected ten participants, including patients affected by lymphedema, their caregivers, the grassroots healthcare workers, and the block health manager. In-depth interviews were conducted using a semi-structured interview guide. Data were entered into QDA Miner Lite, where researchers did attribute, in-vivo, process, descriptive, emotion, and holistic coding, followed by content analysis, where categories and themes emerged from the codes. RESULTS: Three themes emerged: the inherent nature of disease, patient-related factors, and healthcare system-related factors. The fifteen identified barriers were low awareness, low adherence, low health-seeking behavior, poor personal hygiene, and categories like signs and symptoms, seasonal factors, hampered activities of daily living, hopelessness from not getting cured, psychosocial difficulty, lack of capacity building and receipt of incentives by healthcare workers, unavailability of laboratory diagnosis and management of complications at the facility, inconsistent drug supply, and no financial assistance. CONCLUSIONS: Accessibility to WaSH, regular training of home-based care, increasing the capacity and motivation of grassroots workers, and the generation of in-depth awareness among the patients are required to achieve the elimination of filariasis, with MMDP as a key component of that strategy for endemic districts across the whole country.

A case report on rare finding of microfilaria in pus sample of an ulcer over elephantiasis leg.

Skin ulcerations are a significant cause of morbidity and can be challenging to manage. Among the various causes of chronic non-healing ulcers, lymphedema is also considered a possible diagnosis in countries such as Nepal. Lymphatic filariasis has been a significant public health issue in endemic areas. Wuchereria bancrofti is a common nematode parasite that causes lymphatic filariasis. Excessive retention of lymphatic fluid in the interstitial compartment can cause localized tissue swelling, known as lymphedema, which is caused by impaired lymphatic drainage. Microfilariae can be detected in peripheral blood, body fluids, and needle aspirates. Microfilaria is not commonly found in ulcers on elephantiasis legs. We discuss here a case of 73-year-old women with elephantiasis legs with pus discharging ulcers in the thighs. Microscopic examination of pus discharge revealed microfilaria which highlights the importance of pus examination as diagnostic modality in endemic countries.

Linfedema escrotal gigante / Giant scrotal lymphedema

RESUMEN La elefantiasis escrotal es una condición que ha sido históricamente descripta en áreas endémicas de filariasis, pero es menos frecuente su presentación idiopática o asociada a otras entidades. Presentamos un caso de elefantiasis escrotal gigante de causa adquirida idiopática, al que se le practicó la exéresis de la estructura linfedematosa y la reconstrucción del defecto con colgajos locales y autoinjerto cutáneo. El motivo de su divulgación radica en que se trata de un caso muy poco frecuente, ya sea por la baja incidencia y etiología, así como por la importante magnitud del problema para el individuo. El objetivo principal en el tratamiento del linfedema, en el caso presentado, fue devolverle al paciente funciones primarias y elementales de vida, además de disminuir la morbilidad y otorgarle una mejor calidad de vida.

ABSTRACT Scrotal elephantiasis is a condition that has been historically described in areas where filariasis is endemic, but idiopathic cases or those associated with other entities are rare. We report a case of a patient with idiopathic acquired giant scrotal elephantiasis who underwent excision of the lymphedematous structure and reconstruction of the defect with local flaps and skin autograft. The reason for this presentation is the uncommon nature of the case due to its low incidence, rare etiology and the magnitude of the problem experienced by the patient. The main goal in the treatment of lymphedema in this case was to restore primary and elementary functions of life to the patient, reduce morbidity and provide him with a better quality of life.

How I do it: Radical debulking of lower extremity end-stage lymphedema.

Debulking procedures have been a last-resort therapy for end-stage lymphedema for more than a century. Multiple techniques have been described, and the approach as a whole has fallen in and out of favor as providers have tried to maximize quality of life outcomes. We describe our technique for radical debulking of the lower extremity for the treatment of severe end-stage lymphedema.

Treatment of Elephantiasis with Physiological Retraction of the Skin to Clinical Standards of Normality.

Stage III lymphedema, also known as elephantiasis, is the most advanced stage and involves the occurrence of large deformities. This article reports the case of a 30-year-old woman with bilateral stage III lymphedema who weighed 109 kg. The largest circumference measurements below the knee were 97 cm on the right leg and 76 cm on the left leg. Intensive treatment was performed, involving 8 hour per day of mechanical lymphatic therapy with the RAGodoy® device, which performs passive plantar flexion and extension, 15 min of cervical lymphatic therapy per day, and the use of non-elastic laced compression stockings. Treatment resulted in a considerable loss of edema as well as the occurrence of folds of excess skin, which were resolved by continuing treatment in a slower, non-intensive manner. Folds of excess skin are common during the treatment of large lymphedemas until reaching standards of normality or near normality but can be resolved with further clinical treatment.

Kaposi Sarcoma: A Rare Presentation of Elephantiasis Nostras Verrucosa.

Although a low-grade vascular tumor, Kaposi sarcoma (KS) can have mucosal, and visceral involvement. Additionally, disfiguring disseminated lesions can be seen in patients with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). KS may cause lymphatic obstruction leading to chronic lymphedema that further contributes to progressive cutaneous hypertrophy and severe disfigurement in the form of non-filarial elephantiasis nostras verrucosa (ENV). This report highlights a case of a 33-year-old male with AIDS who presented in acute respiratory distress with bilateral lower extremity nodular lesions. We confirmed a diagnosis of KS with overlying ENV via a multi-disciplinary approach. Collaboratively, we optimized our patient and observed adequate treatment response and overall improvement in clinical status. Our report emphasizes the importance of a multi-disciplinary approach in recognizing a rare presentation of ENV. Recognition of the disease and understanding the extent of the disease are crucial in preventing irreversible disease progression and allowing for maximum response.