Microbiology & Parasitology

Elephantiasis
Lymphatic Filariasis

In Partial Fulfillment of the Requirement

in MicroPara 101 Lec

Submitted to :
Ms. Raquel M. Fernandez, RMT, MSPH
MicroPara 101 Lec

Submitted by:
Dela Luna, Ken Gabriel D.
Francisco, Kyle Adriann M.
Garcia, Precioux Lheneen Lein R.
Gatdula, Nicole P.
Roncal, Matthew Sean M.
Villanueva, Caszandra Miles U.

February 14, 2025

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Introduction: Elephantiasis

Elephantiasis, also known as lymphatic filariasis, is a medical condition characterized by

the severe swelling and thickening of the skin and underlying tissues, typically affecting the
legs, genitals, and arms. It is caused by parasitic worms transmitted to humans through mosquito
bites, leading to long-term damage to the lymphatic system. The disease results in the
accumulation of lymph fluid, causing profound swelling in affected areas. Elephantiasis is often
associated with a social stigma and disability due to its visible and disabling nature. These
following are what causes lymphatic filariasis, commonly known as, elephantiasis:

a. Mosquito Transmission: The disease is transmitted through mosquito bites, primarily by

species like Culex, widespread across urban and semi-urban areas; Anopheles,
mainly found in rural areas; and Aedes, mainly in endemic islands in the Pacific
b. Parasitic Worms: The infection is caused by parasitic worms, mainly
Wuchereria bancrofti, Brugia malayi, and Brugia timori.
a. Lymphatic Obstruction: The adult worms live in the lymphatic system, blocking
the normal flow of lymph, which leads to fluid buildup and swelling.
b. Chronic Inflammation: Long-term blockage and infection cause inflammation
and damage to the lymphatic vessels.
c. Immune Response: The body’s immune reaction to the worms can further
damage tissues and exacerbate the condition.
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Causative Agent

Lymphatic filariasis is a helminthic disease caused by the filarial nematodes

Wuchereria bancrofti, Brugia malayi, and Brugia timori. It is transmitted to humans by
various mosquito genera, including Anopheles, Aedes, Culex, and Mansonia (Silvestri, Mushi,
& Ngasala, 2024). This mosquito-borne disease remains a significant global health concern,
leading to severe physical and psychological disabilities (Sungpradit & Sanpraset, 2020).
Wuchereria bancrofti is responsible for approximately 90% of infections worldwide, while
Brugia malayi and Brugia timori account for the remaining cases, primarily in Southeast
Asia and the Pacific Islands (Chandy et al., 2020).

Life Cycle

(CDC - DPDX - Lymphatic Filariasis, n.d.)

When a mosquito bites an infected human, it ingests microfilariae (the early-stage larvae)
present in the person’s bloodstream. Inside the mosquito, the microfilariae shed their
sheaths, penetrate the midgut (stomach), and migrate to the thoracic muscles. And over
approximately 7-21 days, they develop into first-stage larvae all the way up to an infective
third-stage larvae (L3). The third stage larvae which are the infective L3 larvae migrate to the
mosquito’s head and proboscis. During a subsequent blood meal, the mosquito deposits these
larvae onto the human
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skin, where they enter the body through the bite wound. Once inside the human host, the larvae
migrate to the lymphatic system, maturing into adult worms over several months. Adult worms
can live for years in the lymphatic vessels and nodes. Female worms release microfilariae
into the bloodstream, continuing the cycle when another mosquito bites the infected person.
(Centers for Disease Control and Prevention, 2019)

Breaking the chain of infection

I. Infectious Agent (Filarial Parasites: Wuchereria bancrofti, Brugia malayi, Brugia timori)

Action : Implement mass drug administration (MDA) programs using

antifilarial medications such as ivermectin, diethylcarbamazine (DEC), and
albendazole. Annual single-dose co-administration of these drugs can reduce blood
microfilariae by 99% for a full year, significantly decreasing transmission(WHO).

II. Reservoir (Infected Humans)

Action : Implement preventive chemotherapy through mass drug administration (MDA)

to eliminate microfilariae from the bloodstream, reducing transmission. In 2020,
despite challenges, 344.6 million people received treatment as part of global
efforts(WHO).

III. Portal of Exit (Bloodstream via Mosquito Bite)

Action: Encourage the use of insecticide-treated bed nets, wearing loose-fitting,

long-sleeved clothing and socks, and applying EPA-registered insect repellents to
reduce mosquito bites, especially during peak biting times(CDC).

IV. Mode of Transmission (Mosquito Vectors)

Action : Implement vector control measures such as indoor residual

spraying, environmental management to eliminate mosquito breeding sites, and
community education on reducing standing water. These strategies help
decrease mosquito populations and interrupt transmission(CDC).
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V. Portal of Entry (Mosquito Bite into Human Skin)

Action : Promote personal protective measures like using insect repellents, sleeping
under insecticide-treated bed nets, and ensuring living areas are well-screened to
prevent mosquito entry(CDC).

VI. Susceptible Host (People in Endemic Areas)

Action : Provide health education to raise awareness about lymphatic

filariasis transmission and prevention. Encourage communities to participate in MDA
programs and adopt protective behaviors to reduce susceptibility (CDC).

Signs, Symptoms, and Diagnosis

Usually, to get elephantiasis, you would have to be bitten by a lot of mosquitoes over
a longtime, in a country where certain types of roundworms are known to exist. It starts
when mosquitoes infected with the roundworm larvae bite you. The tiny larvae survive
in your bloodstream and grow. They finish maturing in your lymph system. They can live there
for years and cause a lot of damage to your lymph system. This is what causes the swelling.

The worms affect the lymphatic system in the body. The lymphatic system is responsible
for removing waste and toxins. If It becomes blocked, then it doesn’t properly remove
waste. This leads to a backup of lymphatic fluid, which causes swelling.

Most people infected with the worms that cause lymphatic filariasis never show
symptoms. Others may not develop symptoms until several years after infection. But for those
who do, the signs and symptoms of lymphatic filariasis may include: Lymphedema, a swelling
of the legs (severe cases are sometimes known as elephantiasis), arms, breasts, or
genitalia; Hydrocele, or swelling in the scrotal sac, usually of adult men; Hardening or
thickening of skin; Persistent coughing, wheezing, or shortness of breath; and Bacterial
infections of the skin or lymph system.
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Some of these symptoms occur many months or even years after initial infection with the
parasite. And the legs are the most commonly affected area. The swelling and enlargement
of body parts can lead to pain and mobility issues. The skin is also affected and may be: dry,
thick, ulcerated, darker than normal, and pitted. Some people experience additional symptoms,
such as fever and chills. Elephantiasis affects the immune system. People with this condition
are also at increased risk for a secondary infection.

Elephantiasis can be diagnosed with a blood test. However, even if someone has
the disease, their test results may be negative. This is because the swelling may not start until
many years after they are infected. Sometimes an ultrasound of the lymphatic system can
find adult worms moving around.

Management and Treatment (including Parasitic Drugs)

Not all patients who were diagnosed with Elephantiasis may no longer require to intake
medicine. This is due to the fact that even while the symptoms are present, they may no
longer harbor worms in their system. In these given situations, individuals can treat or
manage the edema (swelling) and skin infections by the following:

1. Using soap and clean water, and gently wash the swollen in their body, especially
the limbs and also the injured skin each day.
2. Hydrating the skin using moisturizers (non-irritating & fragrance-free); improves
skin elasticity and may prevent further skin cracking and ulceration.
a. reduces the risk of secondary infections
b. enhances relief and mobility (ability to move)
3. Lifting swollen limbs; to enhance lymph and fluid flow
4. As directed by a physician, bandage the limbs to avoid further swelling
5. Cleaning the wounds each day to prevent such recurrent skin infections
6. As prescribed by a physician, engaging in a regular exercise to maintain the
lymphatic system.

Medication can be used by those who are infected, to eradicate the worms in their
blood. While these drugs prevent the disease from spreading to other people, they do not
eradicate all
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parasites (Leonard, 2023). The treatment for this usually may recommend either a single-
day treatment or taking the drug for 12 days or may take up to year—the following are
antiparasitic medications that may be prescribed by a physician for treatment: Anthelmintics,
used to treat complications caused by a wide span of parasites; Diethylcarbamazine (DEC)
primary drug for treating lymphatic filariasis—killing both microfilariae and adult worms;
Albendazole (Albenza) enhance the efficiency against adult worms; and Mectizan, that kills
the microfilariae produces by the adult worms

In rare instances, surgery could be advised to remove the damaged lymphatic tissues
or release pressure in specific regions, such the limbs. The elephantiasis may be associated
with different physical and emotional complications, such as disability, secondary
infections, and emotional distress. That is why, people who have this condition may need and
should seek help from a doctor—to prevent further complications (Leonard, 2023). The
symptoms of elephantiasis can be controlled with medicine, dietary adjustments and emotional
support.

Health Indicator

In November of 2020, the incidence rate of Lymphatic Filariasis in South Cotabato

was approximately 5. 74

The incidence rate is the rate of occurrence of an event in a specific period of time in
a defiance population over a specific period. This would include the new cases of disease
within a particular point in time. The function of an incidence rate is to see or track the
spread or new case over time of a disease and assess the success of the public health
interventions.

To take the incidence rate, we use this formula:

56 cases of lymphatic filariasis were detected and confirmed in November of 2020 in

the communities in barangays Maan and Mongacayo in T’boli (Barroquillo Jr., 2020) These
cases coexisted in South Cotabato in 2020, which made that year’s total number of new cases,
56.
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As for the total population at risk for the disease in South Cotabato, the entirety of
the population qualifies, as everyone is vulnerable to the infection via mosquito bites.
The population of South Cotabato from the census of The Philippine Statistic Authority that
was conducted on May 01, 2020 was 975,476.

Overall, in November 2020, South Cotabato reported an incidence rate of 5.74 cases per
100,000 people for filariasis. This signifies that for every 100,000 people individuals in
the province, approximately 5.74 new cases of the disease were reported within the given
year. Considering that there were 975,476 total population at risk overall, the confirmed 56 new
cases in November 2020 shows that lymphatic filariasis transmission remains present, but
at a relatively low level. The incidence rate result proposes that the mentioned disease is not
at an outbreak level, but could still pose a public health concern.
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References

Centers for Disease Control and Prevention. (n.d.). Lymphatic filariasis. CDC Division of

Parasitic Diseases and Malaria.

https://www.cdc.gov/dpdx/lymphaticfilariasis/index.html

Centers for Disease Control and Prevention. (n.d.). Parasites - lymphatic filariasis: Prevention

& control.

https://www.cdc.gov/filarial-worms/prevention/index.html

Elephantiasis: What to know. (2022, August 19). WebMD.

https://www.webmd.com/a-to-z-guides/elephantiasis-what-to-know

Estabillo, A. (2020, november 12). SoCot intensifies interventions to contain new filariasis

cases. Philippine news agency.

https://www.pna.gov.ph/articles/1121597

Healthdirect Australia. (n.d.). Elephantiasis. Healthdirect.

https://www.healthdirect.gov.au/elephantiasis

Leonard, J. (2023, June 20). Can you treat elephantiasis?

https://www.medicalnewstoday.com/articles/321797

Mandal, A. (2023, June 12). Elephantiasis causes. News-Medical.

https://www.news-medical.net/health/Elephantiasis-Causes.aspx

Treatment of lymphatic filariasis. (2024, May 13). Filarial Worms.

https://www.cdc.gov/filarial-worms/treatment/index.html#:~:text=Treatment%20overvie

w,the%20drug%20for%2012%20days
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World Health Organization. (n.d.). Lymphatic filariasis.

https://www.who.int/health-topics/lymphatic-filariasis

World Health Organization. (2021, September 24). Neglected tropical diseases: 2020

preventive chemotherapy treatment coverage declines due to COVID-19 disruptions.

https://www.who.int/news/item/24-09-2021-neglected-tropical-diseases-2020-preventive-

chemotherapy-treatment-coverage-declines-due-to-covid-19-disruptions

World Health Organization (WHO). (2021). Elephantiasis (Lymphatic Filariasis). World

Health Organization.

https://www.who.int/news-room/fact-sheets/detail/lymphatic-filariasis

Silvestri, V., Mushi, V., & Ngasala, B. (2024, July 4). Lymphatic filariasis. Lymphatic Filariasis.

https://link.springer.com/chapter/10.1007/978-3-031-53353-2_5

South Cotabato | Philippine Statistics Authority. (2022, July 21). Psa.gov.ph.

https://rsso12.psa.gov.ph/southcotabato?page=3

SoCot intensifies interventions to contain new filariasis cases | Philippine News Agency.

(2020). Pna.gov.ph.

https://www.pna.gov.ph/articles/1121597

Sungpradit, S., & Sanprasert, V. (2020, May 27). Lymphatic filariasis. Chapter 4 -

Lymphatic filariasis.

https://www.sciencedirect.com/science/article/abs/pii/B9780128212028000049