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The mosquito-borne parasitic infection, lymphatic filariasis, and the chronic stage of filariasis with lymphedema, is a major concern in Maharashtra state, India, as more than 100 cases were reported, according to a NYOOOZ report.

Elephantiasis of leg due to filariasis/CDC
Elephantiasis of leg due to filariasis/CDC

In 2016,  2245 newly diagnosed cases of lymphatic filariasis were recorded in 2016, including 132 cases of chronic filariasis with lymphedema. This is evidence of patients not following through with the full course of treatment.

State entomologist Mahendra Jagtap said, “A patient found infected with microfilariae usually do not progress to full-blown stage if he/she completes 4 cycles of treatment in a year. The rise in the full-blown filariasis cases is a serious concern”, the report states.

“This rise only shows that patients found with early stage (minute larva) of the disease were not adequately treated,” health activist Sanjeev Dabhade said.” Lymphatic filariasis is a slow-progressing disease.

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There are three species of parasites that cause lymphatic filariasis–Wuchereria bancrofti; which is more widely distributed; Asia, Africa, India, South America and some Caribbean Islands and Brugia malayi and B. timori which are more restricted to parts of Asia.

These parasites are transmitted by several species of mosquito; Culex, Anopheles, Aedes and Mansonia depending on the geographic area.

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When the mosquito takes a blood meal on a person, it injects parasitic larvae onto the skin, where it penetrates the bite wound.

After which in time the larvae develop into adults (females can be up to 100 mm in length) and reside in the lymphatic system of the upper or lower limbs or groin (all species). With W. bancrofti, in human males the adult worms may end up in the lymphatic channels of the spermatic cord.

Here the adult male and female worms mate and produce eggs (microfilariae) which circulate in the blood and lymph. The microfilariae only appears in blood at certain times; Wuchereria at night, Brugia during the day.

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Most infections are asymptomatic. Any disease present may be due to immune response. If the infection persists the chronic stages of disease develop.

It will then go into an inflammatory stage where lymphadema, orchitis and hydrocele occur.

The obstructive stage of the disease is called elephantiasis. In this stage, which may take years, there is a blockage of lymph flow due to masses of worms. Tissue becomes fibrotic and skin thickens.

Enlarged legs, arms, mammory glands and genitalia are classic appearances of elephantiasis.