Question

Is there a condition of low-grade elephantiasis? I was in Kerala, India briefly 40 years ago. My legs have had pitting edema for 10 years. A thorough search for cause was done when I retired from federal service 7 years ago. Absolutely nothing was found. But I never thought of elephantiasis then.

Answer

Lymphatic filariasis, also known as elephantiasis, is best known from dramatic photos of people with grossly enlarged or swollen arms and legs. The disease is caused by parasitic worms, including Wuchereria bancrofti, Brugia malayi, and B. timori, all transmitted by mosquitoes. When an infected female mosquito bites a person, she may inject the worm larvae, called microfilariae, into the blood. The microfilariae reproduce and spread throughout the bloodstream, where they can live for many years. Often disease symptoms do not appear until years after infection. If the patient is not initially treated with antibiotics delayed or recurrent infection may occur. I have seen no studies on "low-grade" elephantiasis, but it can recur.

As the parasites accumulate in the blood vessels, they restrict circulation and cause fluid to build up in surrounding tissues. The most common, visible signs of infection are excessively enlarged arms, legs, genitalia, and breasts. There is an abnormal accumulation of watery fluid in the tissues (edema) causing severe swelling. The skin usually develops a thickened, pebbly appearance and may become ulcerated and darkened. Fever, chills and a general feeling of ill-health (malaise) may be present.

The extreme enlargement of the limbs and other areas of the body characterized by elephantiasis is the result of obstruction of the lymph flow and possibly of blood circulation. The lymphatic blockage can be due to recurrent attacks of a bacterial infection that causes inflammation of the lymphatic vessels (streptococcal lymphangitis).

When the lymphatic obstruction is large enough, backpressure in the lymphatic channels produces dilation of the superficial vessels, resulting in extreme swelling. Without medical intervention, the cycle continues until the affected area is grotesquely enlarged. If you saw a physician and tests were done, I wonder if they checked for microfilariae in the blood or lymphatic fluid. This would prove filariasis as the cause of elephantiasis.

There are other causes of swollen legs with pitting edema such as cardiovascular disease, kidney disease and poor venous outflow from the legs. If you suspect elephantiasis, convey this to your physicians so that they can rule it out. Antibiotics can be given to help ease the swelling and prevent reoccurrences.