Traditionally when we think of type of lymphedema known as elephantiasis, we think of the mosquito spread parasitic infection called lymphatic filariasis that is so common in the tropical world. Here is an interesting collection of abstract about endemic non-filarial elephantiasis cause by exposure to certain alkalic clay soils in Ethiopia and Uganda.
J Dtsch Dermatol Ges. 2010 Jan
Nenoff P, Simon JC, Muylowa GK, Davey G.
Laboratorium für medizinische Mikrobiologie, Mölbis, Germany. pietro.nenoff@gmx.de
Podoconiosis or mossy foot is a form of non-filarial lymphedema. This geochemical elephantiasis is a disabling condition caused by the passage of microparticles of silica and aluminum silicates through the skin of people walking barefoot in areas with a high content of soil of volcanic origin. Podoconiosis is widespread in tropical Africa, Central America and North India, yet it remains a neglected and under-researched condition. The disabling effects of podoconiosis cause great hardship to patients. It adversely affects the economic (reduced productivity and absenteeism), social (marriage, education, etc.) and psychological (social stigma) well-being of those affected. Podoconiosis can be prevented; the main primary preventive measure is protective footwear. Secondary measures include a strict hygiene regimen and compression therapy, which can reverse initial lesions. Tertiary approaches include surgical management, such as shaving operations to reduce hyperplastic and verrucous 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 elephantiasis 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.
J Dtsch Dermatol Ges. 2009 May
Nenoff P, Simon JC, Muylowa GK, Davey G. Laboratory for Medical Microbiology, Mölbis, Germany.
Correspondence to Prof. Dr. med. Pietro Nenoff Laboratorium für medizinische Mikrobiologie Partnerschaft Dr. rer. nat. Jürgen Herrmann, Prof. Dr. med. Pietro Nenoff & Dr. med. Constanze Krüger Straße des Friedens 8 D-04579 Mölbis Tel.: +49-34347-50-323 / Fax: +49-34347-50-123 E-mail: pietro.nenoff@gmx.de
Keywords
geochemical tropical disease • Ethiopia • Uganda • secondary lymphoedema • non-filarial elephantiasis • aluminium silicate • volcanic soil
Summary Podoconiosis or mossy foot is a form of non-filarial lymphedema. This geo-chemical elephantiasis is a disabling condition caused by the passage of microparticles of silica and aluminum silicates through the skin of people walking barefoot in areas with a high content of soil of volcanic origin. Podoconiosis is widespread in tropical Africa, Central America and North India, yet it remains a neglected and under-researched condition. The disabling effects of podoco-niosis cause great hardship to patients. It adversely affects the economic (reduced productivity and absenteeism), social (marriage, education, etc.) and psychological (social stigma) well-being of those affected. Podoconiosis can be prevented; the main primary preventive measure is protective footwear. Secondary measures include a strict hygiene regimen and compression therapy, which can reverse initial lesions. Tertiary approaches include surgical management, such as shaving operations to reduce hyperplastic and verru-cous elephantiasis.
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. Summary
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
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. Summary
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
Current Opinion in Infectious Diseases. 18(2):119-122, April 2005. Fuller, L Claire Abstract: 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. Lippincott, Williams & Wilkins
Trop Doct. 2003 Oct Destas K, Ashine M, Davey G. Mossy Foot Association, PO Box 251, Wolaitta Soddo, Ethiopia.
The survey was undertaken to establish the point prevalence of overt podoconiosis (endemic non-filarial elephantiasis) in Wolaitta zone, Southern Ethiopia, and also to determine whether age- or sex-related prevalence differences exist. A cross-sectional survey was performed during May-September 2001 among 33 678 residents of 4210 households randomly selected from all seven woredas (administrative districts) of Wolaitta zone. Trained data collectors administered a simple questionnaire and examined household residents for signs of podoconiosis. Of the residents 1890 had overt signs of podoconiosis. The mean zonal prevalence weighted for the woreda size was 5.46%. Most of cases (64%) occurred in the economically productive age groups (16-45 years). The male:female ratio was 1:0.98, reflecting the gender ratio of the zone. Podoconiosis is an important chronic public health problem affecting both men and women in areas of irritant soil. Further research is necessary to establish the economic effects of the condition.
PMID: 14620426 PubMed - indexed for MEDLINE
Acta Trop. 2001 Feb 23
Onapa AW, Simonsen PE, Pedersen EM. Vector Control Division, Ministry of Health, PO Box 1661, Kampala, Uganda.
Following reports of a high frequency of elephantiasis in Kwen County (Kapchorwa District) on the slopes of Mt. Elgon in Uganda, a baseline survey for lymphatic filariasis was carried out in three villages in the affected area. Individuals aged 1 year and above were examined for chronic manifestations of lymphatic filariasis, and for specific circulating filarial antigens and microfilariae of Wuchereria bancrofti. Elephantiasis was observed in all age groups from 10 years and above. The overall prevalence was 4.5%, and the prevalence among individuals aged >/=20 years was 8.2%. Males and females were equally affected. However, there were only few cases of hydrocele (overall prevalence in males of 1.0%) and blood examinations were negative for W. bancrofti circulating antigens and microfilariae. Sampling of potential filariasis mosquito vectors revealed low densities of Anopheles gambiae s.l. and An. funestus, and none of these were infected with filarial larvae. In view of the low hydrocele to elephantiasis ratio, the absence of filarial infection in humans and mosquitoes, the high altitude (1500-2200 m above sea level) and the volcanic soil type, it is concluded that elephantiasis seen in this area is not of filarial origin but most likely is due to podoconiosis (endemic non-filarial elephantiasis).
Keywords: Elephantiasis; Podoconiosis; Filariasis; Volcanic soils; Uganda