Podoconiosis: Lymphedema from exposure to clay soil

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Podoconiosis: Lymphedema from exposure to clay soil

Postby patoco » Fri Nov 16, 2007 12:44 pm

Podoconiosis: Lymphedema from exposure to clay soil

Traditionally when we think of elephantiasis, we think of the mosquito spread parasitic infection that is so common in the tropical world.

Here's an interesting abstract about elephantiasis cause by exposure to certain clay soils.


Podoconiosis: non-infectious geochemical elephantiasis.

Trans R Soc Trop Med Hyg. 2007 Dec

Davey G, Tekola F, Newport MJ.
Department of Community Health, Addis Ababa University, P.O. Box 9806, Addis Ababa, Ethiopia.

Keywords: Podoconiosis; Elephantiasis; Geochemical; Non-filarial

Corresponding author. Present address: P.O. Box 26905/1000, Addis Ababa, Ethiopia. Tel.: +251 911 388835; fax: +251 116 627876.

This article reviews peer-reviewed publications and book chapters on the history, epidemiology, genetics, ecology, pathogenesis, pathology and management of podoconiosis (endemic non-filarial elephantiasis).

Podoconiosis is a non-infectious geochemical elephantiasis caused by exposure of bare feet to irritant alkalic clay soils. It is found in at least 10 countries in tropical Africa, Central America and northwest India, where such soils coexist with high altitude, high seasonal rainfall and low income. Podoconiosis develops in men and women working barefoot on irritant soils, with signs becoming apparent in most patients by the third decade of life.

Colloid-sized silicate particles appear to enter through the skin, are taken up into macrophages in the lower limb lymphatics and cause
endolymphangitis and obliteration of the lymphatic lumen. Genetic
studies provide evidence for high heritability of susceptibility to
podoconiosis. The economic burden is significant in affected areas
dependent on subsistence farming. Podoconiosis is unique in being an entirely preventable non-communicable disease. Primary prevention entails promoting use of footwear in areas of irritant soil; early stages are reversible given good foot hygiene, but late stages result in considerable economic and social difficulties, and require extended periods of elevation and occasionally nodulectomy.

Science Direct



Predictive value of clinical assessment of patients with podoconiosis in an endemic community setting.

Kelemu Destaa, Meskele Ashinea and Gail Daveyb, ,
aMossy Foot Prevention and Treatment Association, P.O. Box 311, Sodo, Wolaitta, Ethiopia
bDepartment of Community Health, Addis Ababa University, P.O. Box 26905/1000, Addis Ababa, Ethiopia

Received 19 October 2006; revised 4 December 2006; accepted 5 December 2006. Available online 21 February 2007.


Podoconiosis is a geochemical condition resulting in lower limb elephantiasis similar to that seen in chronic filarial disease. In podoconiosis-endemic areas, diagnosis of the condition must often take place in the community setting, where laboratory facilities are unavailable. In this study, 205 patients in Wolaitta zone, southern Ethiopia, were examined according to standard clinical practice. A capillary blood sample was taken at midnight for thick film examination. In a subsample of 117 patients, rapid antigen testing using Binax™ antigen cards was also performed. Both tests were negative in all patients. In podoconiosis-endemic areas, clinical examination is a valid means of diagnosing podoconiosis.

Keywords: Podoconiosis; Non-filarial elephantiasis; Geochemical disease; Diagnosis; Ethiopia

Elsevier Science Direct

http://www.sciencedirect.com/science?_o ... 00edf2405d


Podoconiosis: a tropical model for gene-environment interactions?

Gail Daveya, , , , Ewenat GebreHannaa, Adebowale Adeyemob, Charles Rotimib, Melanie Newportc and Kelemu Destad
aDepartment of Community Health, Addis Ababa University, P.O. Box 26905/1000, Addis Ababa, Ethiopia
bNational Human Genome Center, Howard University, 2041 Georgia Avenue NW, Cancer Center Building, Room 61, Washington DC 20060, USA
cBrighton and not allowed Medical School, University of not allowed, Falmer, Brighton BN1 9PS, UK
dMossy Foot Prevention and Treatment Association, P.O. Box 251, Sodo, Wolaitta, Ethiopia
Received 30 November 2005; revised 19 May 2006; accepted 19 May 2006. Available online 1 August 2006.


Podoconiosis (endemic non-filarial elephantiasis) is a geochemical disease occurring in individuals exposed to red clay soil derived from alkalic volcanic rock. It is a chronic, debilitating disorder and a considerable public health problem in at least 10 countries in tropical Africa, Central America and northern India. Only a small proportion of individuals exposed to red clay develop disease and familial clustering of cases occurs, so we tested the hypothesis that disease occurs in genetically susceptible individuals on exposure to an environmental element in soil. Using multiple statistical genetic techniques we estimated sibling recurrence risk ratio (λs) and heritability for podoconiosis, and conducted segregation analysis on 59 multigenerational affected families from Wolaitta Zone, southern Ethiopia. We estimated the λs to be 5.07. The heritability of podoconiosis was estimated to be 0.629 (SE 0.069, P = 1 × 10−7). Segregation analysis showed that the most parsimonious model was that of an autosomal co-dominant major gene. Age and use of footwear were significant covariates in the final model. Host genetic factors are important determinants of susceptibility to podoconiosis. Identification of the gene(s) involved will lead to better understanding of the gene–environment interactions involved in the pathogenesis of podoconiosis and other complex multifactorial conditions.

Keywords: Elephantiasis; Podoconiosis; Genetic susceptibility; Gene–environment interaction; Geochemical; Heritability

Elsevier Science Direct

http://www.sciencedirect.com/science?_o ... 546f8ce37d


Podoconiosis: endemic nonfilarial elephantiasis.

Current Opinion in Infectious Diseases. 18(2):119-122, April 2005.
Fuller, L Claire
Purpose of review: Podoconiosis is a noncommunicable disease producing lymphoedema of the lower limbs; it affects predominantly barefoot agricultural workers in the tropics. Why should this be of interest to a journal of infectious disease? For many years this disease has not been widely recognized as distinct from lymphatic filariasis and yet it may affect about 10% of populations in volcanic tropical highlands. It produces considerable morbidity associated with limb lymphoedema, impacting on economically productive age groups. As it does not fall into the briefs of infectious or chronic disease initiatives of the World Health Organization, it has been difficult to attract funds for research and for the development of community management approaches. The aim of this review is to describe details of the clinical features, management, epidemiological significance and evidence for the underlying aetiology of this poorly understood condition.

Recent findings: A recent comprehensive study in Ethiopia by Destas et al. identified a mean zonal prevalence of 5.46% of the population with 64% being in the economically productive age group. Otherwise there are no other contemporary epidemiological publications in this field.

Summary: Podoconiosis is thought to be a geochemical disease induced by the absorption of ultrafine silica particles from the soil (konia) through the skin of the feet (podos) in susceptible individuals, leading to a progressive obliterative endolymphangitis.

http://www.co-infectiousdiseases.com/pt ... 29!8091!-1

Lippincott, Williams & Wilkins


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