I live in Guam, USA. In 1996 I developed some sores on my leg, which finally healed after 3 years. However, since then my legs up to my hips are very swollen and I'm experiencing severe numbness in my feet. But, even though my feet are numb, they are very painful to touch (I can't even cut my toenails). There has never been a day since 1999 that the swelling has ever gone down. I hope you may have an idea as to what the problem is, and what kind of doctor I should see.

Question

I live in Guam, USA. In 1996 I developed some sores on my leg, which finally healed after 3 years. However, since then my legs up to my hips are very swollen and I'm experiencing severe numbness in my feet. But, even though my feet are numb, they are very painful to touch (I can't even cut my toenails). There has never been a day since 1999 that the swelling has ever gone down. I hope you may have an idea as to what the problem is, and what kind of doctor I should see.

Answer

The first thing that came to mind with your description of your leg swelling and the fact that you live in Guam is lymphatic filariasis, also known as elephantiasis. This problem affects over 120 million people in the world - one third of the people infected with the disease live in India, one third in Africa and most of the remainder in South Asia, the Pacific and the Americas. In tropical and subtropical areas where lymphatic filariasis is well established, the prevalence of infection continues to increase. A primary cause of this increase is the rapid unplanned growth of cities, which creates numerous breeding sites for the mosquitoes that transmit the disease.

In its most obvious manifestations, lymphatic filariasis causes enlargement of the entire leg or arm, the genitals, and breasts. In addition, internal damage to the kidneys and lymphatic system can be caused by the filariae organisms. These are thread-like, parasitic worms that cause block the flow of lymph (tissue fluids) through the lymph glands.

The initial infection causes sores at the insertion site, such as you described. The disease is transmitted by mosquitoes that bite infected humans and pick up immature microfilariae that develop, inside the mosquito, into the infective stage. These larvae then migrate to the mosquitoes' biting mouth-parts, ready to enter the punctured skin following the mosquito bite. The mature worm then produces millions of microfilariae hat circulate in the blood.

There may be other causes for your leg swelling. However, elephantiasis should be easily diagnosed by any physician in your area; if it is indeed due to something else, your physician will find the real cause on examination. See your family doctor first, and he/she will then refer you to a specialist in the area that deals with parasitic diseases.