Lymphatic filariasis (elephantiasis)

What it is

Mosquito-borne threadworms (Wuchereria, Brugia) living in the lymph vessels; most infections are silent, but years of damage leave elephantiasis of the legs or a hydrocele of the scrotum.

Symptoms & signs

• Often none for years
• recurrent attacks of fever with painful red limb and nodes
• swelling of a leg or arm, later thick folded skin (elephantiasis)
• hydrocele in men, breast or vulval swelling in women
• milky urine (chyluria)
• cough and wheeze (tropical eosinophilia)

Where it strikes

• Lymphatic network
• Lymph nodes
• Lower limb

Medical treatment

• Night blood smear, antigen card test or ultrasound
• Yearly mass treatment: ivermectin + diethylcarbamazine + albendazole where river blindness and Loa loa are absent, albendazole with ivermectin in much of Africa trials support
• diethylcarbamazine is avoided with river blindness or heavy Loa loa — it can cause severe reactions and encephalopathy
• Doxycycline 4–6 weeks — kills the worms' Wolbachia bacteria and slowly the adult worms mixed evidence
• hydrocele surgery
• antibiotics for acute attacks

Natural & lifestyle

• Daily washing and drying of the swollen limb, skin and nail care, elevation and exercise — fewer acute attacks trials support
• bed nets and repellent
• shoes to prevent wounds

Emerging & experimental

• Macrofilaricides that kill adult worms quickly
• triple-drug mass treatment in more regions

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

• Integrative Ayurveda-and-yoga lymphoedema care (Kerala) — uncontrolled reports of smaller limbs early / small studies
• Herbal pastes and poultices on swollen legs — traditional; broken skin lets bacteria in anecdotal / traditional

ICD codes

• ICD-10 B74.9
• ICD-11 1F66.3Z Lymphatic filariasis, unspecified