Elephantiasis, or lymphedema, is a rather rare disease characterized by impaired lymphatic drainage and stagnation.
The pathological process most often affects the lower limbs, significantly disfiguring them. But hyperplasia can occur in other parts of the body. With elephantiasis, stagnation of the lymph leads to the fact that metabolic products and protein molecules are not excreted from the body, but begin to gradually stratify.
Also formed fibrin fibers, which cause an increase in the affected part of the body. Along with this, the skin in the affected area is also changing. It starts to crack, becomes covered with warts, erosions appear on its surface.
Modern medicine has effective methods of treating such a disease, but it is equally important to know the reasons why elephantiasis develops.
What it is?
Elephantiasis is a pathology in which the increase in a certain part of the body due to hyperplasia of the skin and subcutaneous tissue is observed. The disease manifests itself against the background of long-term stagnation of the lymph with the concomitant formation of edema.
Against this background, products of metabolism and protein molecules are retained in the body. The latter, disintegrating, form fibrin fibers. Gradually, at the site of the edema formed, between the muscles, a thick layer of connective tissue is formed. As a result, the affected limb acquires a cylindrical shape, and its appearance resembles the leg of an elephant.
In 95% of cases, it is the legs that are affected, and only in 5% - other areas of the body. However, in 70% of patients the lesion is one-sided.
Causes of the disease
Elephantiasis can be primary or secondary. Each of these forms has its own reasons for development.
The primary form of the pathological process may be due to:
- developmental anomalies or lymphatic dysplasia;
- Milroy-Meyzh disease;
- Shereshevsky-Turner syndrome;
- hypersecretion of lymph.
These are hereditary pathologies for which anomalies of the structure of the lymphatic vessels are characteristic. Against this background, the outflow of lymph is disturbed, edema is formed and elephantiness develops. Congenital diseases provoke lymphedema, so elephantiasis occurs on both limbs at the same time. Most often, such a violation is detected in adolescents and women younger than 35 years.
Secondary form of elephantiasis
In this case, the development of elephant disease is associated with impaired activity of the lymphatic system. Such disorders, in turn, may have a different etiology. It occurs at any age. Main reasons:
- Violations of the passage of the lymph nodes, which became the result of:
- tumor processes;
- undergoing a course of chemotherapy;
- removal of lymph nodes.
- Streptococcal infection, triggered by golden streptococcus - erysipelas or phlegmon. Reproduction of streptococci occurs in the lymphatic capillaries. Bacteria release toxins that provoke a powerful allergic reaction. An attack of antibodies on the tissues of the affected area leads to active cell division, followed by an increase in tissue volume.
- Damage to the lymphatic vessels in the background of extensive injuries, burns and frostbite. This leads to vascular obstruction, so the lymph begins to accumulate in the tissues. When untimely response to the problem develops elephantiasis. This risk is also increased in people suffering from recurrent erysipelas.
- Varicose veins and postthrombotic syndrome. With the defeat of the deep veins of the lower extremities, trophism and the functioning of soft tissues are disturbed. Next, lymphatic vessels are involved in the process, the permeability of which is disturbed, which leads to stagnation of lymph. In the altered cells of the blood and lymph vessels, bacteria begin to multiply, and the toxins secreted by them provoke an allergy. As a result, there is marked pathological proliferation of tissues with the concomitant formation of allergic rashes.
- Infection with filarias. It occurs when insect bites are carriers of these worms. These helminths inhabit the lymphatic vessels, which they occlude, weaving into tangles. Subsequently, the affected vessel becomes inflamed and stretched. There is a toxic-allergic reaction, causing edema and uncontrolled growth of tissues.
Elephant sickness begins without noticeable symptoms, but after physical exertion a person may feel tired in the feet and ankles. With a long stay in motion, he feels discomfort, edema appears on his feet. As a rule, pain during this period does not occur, and the swelling completely disappears after a good rest. But the disease is able to progress, and over time, the first symptoms of elephantiasis will begin to appear in patients.
- in ancient times, elephantiasis was believed to be a contagious disease transmitted by the respiratory tract;
- women suffer from pathology more often than men;
- the disease affects not only humans, but also animals. Elephantiasis is often diagnosed in horses.
The main clinical picture of elephant disease is characterized by the following features:
- Unilateral lesion of the limb. Bilateral leg augmentation is observed only with the innate nature of the disease.
- Constant fatigue, feeling of distention in the legs.
- Severe edema. They develop in stages: swelling at the ankle is first formed, after which they move into the thigh tissue. The skin is smooth and tense.
- Swollen lymph nodes due to inflammation and bacterial infection.
- The hardness of the affected limb. As the disease progresses, stagnant fluid is transformed into connective tissue, so the foot feels dense to the touch. When you press on the affected area does not form a fossa, and the skin is almost impossible to gather in the fold.
- Changing the shape of the affected area. The bulge in the ankle is smoothed, the leg in its shape resembles a pillar, cylinder. It does not lengthen, but increases in size several times - sometimes even up to 150 cm.
- Fistula formation. Excess lymph in the form of transparent exudate appears through the skin, resulting in the formation of holes.
Also, atrophy of the sebaceous and sweat glands occurs in case of elephant disease, along with this, blood circulation is disturbed. Since the skin can no longer perform its protective functions, warts, papillomas, erosion, boils, and trophic ulcers begin to appear on its surface. Often there are allergic rashes caused by the activity of bacteria in the body.
Symptoms depend on the stage of development of elephant disease:
- At an early stage, the patient does not notice any changes, either in his state of health or in appearance. However, at this time, the liquid begins to stagnate, which is manifested by a slight swelling, which can be paid attention to. To normalize the outflow of lymph is enough to perform a few simple exercises.
- At the second stage, dense, pronounced edemas are formed. This is accompanied by smoothing the foot contour and changing the anatomical shape of the fingers. As it progresses, elephantiness goes first to the knee, then to the thigh.
- The third stage of elephantishness is irreversible. The proliferation of connective tissue leads to a partial loss of the ability to manipulate the limb. The skin is rough, trophic changes in the tissues of the legs develop.
What does elephant disease look like: photo
How elephantiasis looks at different stages of development can be seen in the photo:
In most cases, elephant sickness is associated with an infectious lesion, so the patient should seek help from an infectious diseases specialist. When parasitic etiology of the disease is necessary to consult a parasitologist.
Diagnosis of elephantiasis is based on:
- microscopic examination;
- general blood test;
- Ultrasound of the lymph nodes;
- X-ray of the affected limb, which may help in identifying the bone lesions of the diseased leg;
- MRI or / and CT.
Before a detailed examination, the doctor should find out from the patient if he has any abnormalities in the work of the cardiovascular system, kidneys or liver, and ask about the time of edema and their nature. The presence of additional symptoms is of great diagnostic importance.
Important! If a patient has visited countries where insects are carriers of a pathogen of pathology, he must report this to his doctor.
Determine the stage of the pathological process can be based on visual inspection and study of the nature of edema. Mild puffiness is characterized by:
- the appearance of a small fossa after pressing on the swollen tissue;
- blanching of the skin;
- rashes that itch.
Dense swelling is diagnosed with:
- swollen lymph nodes;
- large lesion area;
- hypersensitivity and skin tightening in the damaged area;
- increase in sore limb in size compared with the size of a healthy leg.
Elephantiness is diagnosed based on:
- strong coarsened skin;
- the formation of wounds, ulcers, cracks, warts, papillomas with lymph resulting from them;
- severe limb deformity.
In the later stages of the disease, additional tests are usually not needed. The diagnosis is made on the basis of the obtained data of the anamnesis and visual examination.
Treatment of elephant disease at home
Treatment of elephantiasis is an extremely complex and lengthy process that can last for a lifetime. Equally important is the patient's attitude towards recovery.
The use of conservative therapeutic techniques is possible only at the initial stages of the development of the disease. When the disease passes into stages 2–3, it is recommended that surgery and subsequent pharmacotherapy be performed.
Treatment for elephantiness implies:
- decreased lymph secretion;
- improved tissue trophism;
- removal of toxins and metabolites from the body in general and the affected limb in particular;
- stabilization of lymphatic vessels;
- normalization of lymphatic circulation;
- prevention of further proliferation of connective tissue.
Conservative methods of treating elephantiasis are applied only at the first stage of its development, as well as in the postoperative period. Such therapy is based on several principles.
From the patient's diet is necessarily excluded:
- fatty, salty, smoked, spicy foods;
- fast food;
- pickles and pickles;
- canned food;
- strong tea and coffee;
Instead of junk food in the daily diet, be sure to include fresh fruits and vegetables, cereals, cereals. It is useful to use some kinds of seasonings and spices. In particular, it concerns ginger, garlic, turmeric, coriander.
In the treatment of elephant disease, it is extremely important to quit smoking. Ideally, doctors recommend that this addiction no longer return.
Lymphatic drainage massage
This type of massage is aimed at improving lymphatic drainage and preventing its stagnation. The procedure is performed exclusively by a specialist, and can be carried out both manually and using special massage machines. Such sessions help to activate the lymph nodes and normalize the condition and functioning of the lymphatic vessels. Massage involves the implementation of stroking and tingling movements.
Bandage or elastic bandaging
This procedure is carried out after a massage, or in the morning - after waking up. You can use an elastic bandage to wind the affected part of the limb, or wear special compression underwear such as stockings, pantyhose, etc.
A set of exercises is developed individually, taking into account the degree of damage to the limbs and the general well-being of the patient. It is necessary to conduct physical education sessions daily for 15–20 minutes. Under the influence of exercise therapy, the muscles begin to actively contract, thereby having a positive effect on the blood and lymphatic vessels.
Of all the physiotherapy at elephantiasis, preference is given to:
- lidaza electrophoresis;
- magnetic therapy;
- phonophoresis with longidase or streptokinase;
- laser therapy.
Such manipulations normalize blood circulation, promote the return of tissue fluid back to the tissues, improve the circulation of lymph, remove edema and promote resorption of connective tissues.
If elephantiasis was provoked by filarias, the patient is prescribed anthelmintic drugs:
- Diethyl carmazine;
In parallel, the use of antihistamine drugs is recommended:
- Erius, etc.
Drugs in this group prevent the development of an allergic reaction that occurs in response to the ingestion of parasites.
For erysipelas and the accession of a secondary infection, parenteral administration of penicillin and cephalosporin antibiotics is carried out. Also appointed:
- angioprotectors that strengthen the vascular wall.
Perhaps the appointment of NSAIDs (Butadion, Indomethacin) and GCS (Dexamethasone, Hydrcortisone). They stop inflammation, relieve pain and swelling.
To improve blood and lymph circulation, as well as to cleanse the body of toxins, you can use the following folk remedies:
- Honey-garlic mixture. Peel 250 g of garlic and chop, then put in a glass dish and add 350 honey. Mix thoroughly and let stand for a week. Take 1 tbsp. l 3 times a day for half an hour before meals. The duration of therapy is 30 days.
- Chicory with ginger. Boil a glass of water, pour in there 1 tsp. powdered chicory root and a pinch of ginger. Take 1 time per day for 10 days. After that, you should take a week break and repeat therapy. This drink removes excess fluid and toxins from the body.
- Hazel leaf tea. Grind the leaves of hazel and 2 tbsp. l fresh raw materials brew in a thermos 0.5 liters of boiling water. Infuse for 2 hours, then strain. Take 200 ml per hour before meals 4 times a day.
Surgical treatment of elephantiasis
Surgical intervention for elephantiness is necessary when there is a need to create new ways for lymph outflow and reduce the affected leg. Surgical treatment is mandatory in the case of:
- active progression of lymph stagnation;
- proliferation of connective tissue in the leg;
- formation of lymphatic bags;
- often exacerbated erysipelas;
- severe pain.
The operation is contraindicated in patients with:
- hematological diseases;
- cardiovascular pathologies;
- severe lesions of the liver and bronchopulmonary system.
There is no surgical treatment of elephantiasis in elderly patients and young children.
The operation requires preliminary preparation, based on the following rules:
- To make a chest WG, a cardiogram, a blood test for coagulability, sugar, a Wasserman reaction, as well as a feces and urine tests. In parallel, an MRI of the affected limb should be performed.
- Within a few days you should follow a diet with the use of vitamin and protein foods. Salt intake should be kept to a minimum.
- If an infectious process caused by pathogenic bacteria is detected, the patient is prescribed a course of antibiotic therapy. In this case, the operation is performed 4 to 6 weeks after the end of treatment.
- 72 hours before the operation, the following drugs are administered to the patient: Trental - 5 ml, Complamin - 2-4 ml, Reopolyglucin - 400 ml (infusion). Droppers are placed daily to stabilize the general well-being of the patient.
- 3 days before surgery, a course of antibiotics is prescribed, which continues after surgery, and in general is 10 days.
The operation for elephantishness can be performed by different methods:
- Intervention aimed at restoring the patency of the veins and lymphatic vessels.
- The joining of the lymphatic vessels to the great saphenous vein in order to enhance lymphatic drainage.
- Excision of overgrown skin, fiber, fascia. Such an operation is carried out to reduce the limb in size. 2 semilunar incisions are made in the direction from the knee to the ankle, after which the excess tissue is removed and the incision is sutured.
After surgery, tight bandaging of the diseased limb is performed. During the first 2–3 days, the patient is shown bed rest, after which he can begin to walk on crutches little by little, but without much stress on the operated leg. For 5-7 days it is allowed to give a metered load on the limb.
Sutures are removed only 12 to 14 days after surgery. Gradually, you need to increase the load on the foot. To speed up the recovery of the limb, a course of physiotherapy is prescribed.
Specific prophylaxis of the development of elephantiasis does not exist. All preventive measures are reduced to:
- timely treatment of skin lesions;
- body weight control;
- prompt treatment for medical attention when the first alarming symptoms appear that may indicate the development of elephantiasis.
In the formation of minor edema should be a light foot massage. But if it helps, it is acceptable to use diuretic drugs, which will contribute to the accelerated removal of excess fluid from the tissues of the lower extremities.