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Filariasis (Elephantiasis): Causes, Symptoms & Prevention

Lymphatic filariasis (elephantiasis) is a mosquito-borne parasitic disease caused by Wuchereria bancrofti (90%), Brugia malayi, B. timori.

Transmission Cycle

  1. Infected mosquito bites human → deposits L3 larvae.
  2. Larvae migrate to lymphatics → mature to adults (6–12 months).
  3. Adults mate → produce microfilariae (MF) → enter bloodstream (nocturnal periodicity).
  4. Mosquito ingests MF → develop to L3 in mosquito → cycle continues.

Clinical Manifestations

  • Asymptomatic Microfilaremia: Most infections; subclinical lymphatic damage.
  • Acute: Filarial fever, lymphangitis, lymphadenitis, epididymoorchitis.
  • Chronic: Lymphedema (legs, arms, scrotum, breast) → elephantiasis (skin thickening, fissures, disability). Hydrocele (males). Chyluria (lymphatic-urinary fistula).
  • Tropical Pulmonary Eosinophilia: Hypersensitivity to MF → cough, wheeze, eosinophilia.

Diagnosis

  • Night blood smear (MF detection).
  • Antigen test (Og4C3) — day blood, high sensitivity.
  • Ultrasound (filarial dance sign — adult worms).

Treatment & Elimination

  • Individual: DEC + albendazole (or ivermectin + albendazole in onchocerciasis areas). Doxycycline (anti-Wolbachia) for chronic lymphedema.
  • Mass Drug Administration (MDA): Annual community-wide treatment (WHO strategy) interrupts transmission.
  • Morbidity Management: Hygiene, elevation, exercise, skin care, surgery (hydrocele).
  • Vector Control: Bed nets, insecticides.

Global Programme to Eliminate LF (GPELF) has reduced prevalence by >70% since 2000.

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