Lymphatic Filariasis by Trilok Chandra Goel & Apul Goel

Author:Trilok Chandra Goel & Apul Goel
Language: eng
Format: epub
Publisher: Springer Singapore, Singapore

20.3 Sites of Chronic Lymphedema Elephantiasis (Khanna 1970)

Commonly involved sites1.Lower extremity

2.Scrotum

3.Penis

Less commonly involved sites1.Breast

2.Vulva

3.Upper extremity

Very rare sites – Localized and pedunculated form of elephantiasis (Manson-Bahr 1960)1.Scalp

2.Face

3.Buttocks

4.Lower limb

20.4 Pathology

All the elephantoid process is outside the deep fascial envelope of the extremity, the deep fascia, and the deeper tissues being normal. It is due to the entry and activity of the infective larvae in the subcutaneous plane following mosquito bite.

The skin is markedly thickened (looks like rind of an orange) and firm and cuts like an unripe pear. There is excessive deposition of fibrous tissue, which is maximum in the dermis and becomes less and less as one goes towards the deep fascia.

The subcutaneous fatty tissue is replaced by fibrous tissue superficially and blubbery tissue toward the deep fascia with a lot of watery fluid exuding out from the dilated spaces and dilated lymphatics.

It must be stressed that elephantiasis is by no means the inevitable consequence of lymphatic filarial infection. Even in endemic areas where most of the people are exposed to infection during their entire life do not acquire it. Even all the people who develop microfilaremia, lymphadenopathy, and recurrent attacks of fever and lymphangitis do not develop elephantiasis.

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