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Jack Prior, Ryan M. Murphy, and Aliya Robbins What is Lymphatic Filariasis? Parasitic disease where worms enter the blood stream through numerous mosquito bites over a number of years. Affects 120 million individuals in over 80 countries in the tropical regions due to stagnant water and poor irrigation systems Infected Regions History Pre-1876 The only known symptom of this disease was elephantiasis because of its outward appearance. 600BC Ancient Hindu medical workers referred to elephantiasis in Sanskrit texts. 600- 250BC Men affected by elephantiasis were not allowed to become Buddhist priests. 10th- 13th Centuries Persian and European physicians have accurate descriptions of elephantiasis. 1876 Joseph Bancroft discovered the parasite that causes lymphatic filariasis in an abscess on the arm of a butcher. Parasites White, slender roundworms Three types: Wuchereria bancrofti, Brugia malayi, Brugia timori Live for 5-7 years, produce millions of offspring Block the lymphatic system Network of channels and lymph nodes that help maintain fluid levels in the body Blockage leads to edema (collection of fluid in tissues) Process of Infection Symptoms Fever Kidney damage Skin abnormalities due to bacterial infection. Elephantiasis Swelling of limbs and genitalia Male: Enlargement of scrotum, penis retracted under skin, spermatic cords thickened Female: Long tumorous mass covered by thickened ulcerated skin develops on the vulva Social Impact of Disease Sexual Disability Communities frequently shun those disfigured. Inability to work Women with visible signs may never marry or spouses and families will reject them. Personal Account June/July 1996: 29-participant study done by Jennine Coreil in Haiti Lack of Mobility: “I had a child to be baptized and I had to send someone to stand in my place as father” Embarrassment: “When I went to school I felt very embarrassed. I didn’t have the desire to go back.” “The hardest part for me is having to get help from someone to pee” Personal Accounts Lack of Knowledge: “When I was little I was playing in the street and a truck’s tire ran over my feet.” “I thought the injury made my foot ‘cold’ and that is what made my foot become big.” Lack of Trust in Doctors: “When you go to the hungan’s house, your foot gets even bigger.” Severity: “I ask for death because it makes me very sick. I have been suffering with this for 35 years.” Diagnosis Until recently, very difficult to diagnose Nocturnal periodicity: The worms can only be detected in the blood of those infected around the hour of midnight. New specific card test: Detects parasites using only finger prick blood tests any time of day. Ultrasound can identify rapidly moving adult worms. Treatment and Management of Elephantiasis Prevention Mosquito nets, insect repellents Voodoo healing techniques Elevate and exercise affected body part Skin treatment Wash area twice daily Antibacterial cream CDP (Complex decongestive physiotherapy) Lymph drainage, massage, compressive bandages Management and Treatment of Lymphatic Filariasis Currently Used: Antifilarial drugs (DEC and ivermectin) are useful against larval offspring Testing: Doxycycline • Tested on a Tanzanian village. • Found to almost completely eliminate adult worms 14 months after treatment. • Sustained loss of larval offspring for 8-14 months after treatment. Albendazole and DEC • Given together once a year • Found to be 99% effective in removing microfilariae from blood for full year after treatment World Epidemic Continuing to grow throughout the global community. Global Alliance to Eliminate Lymphatic Filariasis Strategy: stop spread of infection, alleviate suffering of infected individuals by using albendazole and DEC Other plans: Papua, New Guinea: utilization of church eldership Work Cited http://www.who.int www. Wikipedia.com http://www.filariasis.org http://www.cdc.gov/ncidod/dpd/parasites/lymphaticfilariasis/default.htm http://elephantiasis.freeyellow.com/ http://www.healthatoz.com/healthatoz/Atoz/ency/elephantiasis.jsphttp:// http://www.medicalnewstoday.com/medicalnews.php?newsid=26197 http://www.jcu.edu.au/school/sphtm/documents/lfreview/lfreview.pdf http://elephantiasis.freeyellow.com/pictures.html http://www.emedicine.com/med/images/2251elephantiasis3.jpg http://www.liv.ac.uk/images/newsroom/press_releases/2005/06/elephantias http://www.biosci.ohio-state.edu/~parasite/wuchereria.html http://www.scienceblog.com/cms/node/8267 Seppa, Nathan Attack on Elephantiasis, Science News; 6/25/2005, Vol. 167 Issue 26, p404-405, 2p