domingo, 1 de mayo de 2022

WHAT IS THE DIFFERENCE BETWEEN LYMPHATIC FILARIASIS/PODOCONIOSIS AND ELEPHANTIASIS? - What is Elephantiasis? - Myths & Truths - Clinical Recommendations - Best First-line Treatment - Low-Cost Management Care Package – Ethics & Economic/Political Interests - Pediatric and Primary Lymphedema - Secondary Lymphedema – Lymphatic Circulatory System

WHAT IS THE DIFFERENCE BETWEEN LYMPHATIC FILARIASIS/PODOCONIOSIS AND ELEPHANTIASIS

Some international health organizations portray lymphatic filariasis or Podoconiosis and elephantiasis, as if they were different unrelated diseases. The term Lymphatic filariasis, which is commonly but erroneously known as elephantiasis, is a mosquito-transmitted disease that occurs when filarial parasites (roundworms) damage the lymphatic system causing lymphedema (lymphatic dysfunction). Podoconiosis is a non-filarial, noninfective disease, usually caused by crystalline minerals clogging regional lymph nodes and vessels, affecting especially agrarian people who work barefoot, particularly in the neighborhood of volcanic soil. These two conditions are usually acquired in childhoodRead more about childhood elephantiasis prevention HERE.

WHAT IS ELEPHANTIASIS

The medical term Elephantiasis (skin/tissue thickening) represents lymphedema (tissue swelling) in its most advanced degree of severity, whatever its cause or setting. There are some health organizations and clinical guides that make reference to lymphedema and elephantiasis as if they were two distinct and isolated conditions, referring to them as “lymphedema or elephantiasis” which can give rise to confusion. Lymphedema and elephantiasis should not be portrayed as if two different conditions, for they are the same disease, one is the consequence of the other, first comes lymphedema, and then late severe stage elephantiasis, principally due to nontreatment or undertreatment. Read more about what is the best treatment option for elephantiasis HERE.

Elephantiasis (Stage III lymphedema) is a public health problem and represents the worst disfiguring visible manifestations of the disease, which causes not only physical disability and financial hardship, but also social stigma and isolation due to the deformities/disfigurement, and thus loss of Quality of Life (QoL). Regarding Filariasis it is important to prevent the spreading, but just as much to prevent unnecessary suffering to individuals that already have established disorders of the lymphatic circulation. Read about why the world is not treating a treatable disease like elephantiasis HERE.

WHAT IS LYMPHATIC EDEMA

Lymphedema is a symptom of lymphatic failure and manifests as chronic connective tissue disease. Fluids, cells, and proteins usually removed by lymphatic pumping accumulate in the tissue spaces between the skin and underlying muscle, and over time chronic inflammatory processes change the tissue composition and architecture. Early fluid-rich stages are followed by fibrosis and fatty deposits in the middle stages, and advanced stages are marked by hyperkeratosis, papillomatosis, and other skin diseases. Lymphedema, whatever the cause or setting, is incurable and requires life-long care, and effective lymphedema management to gain and improve Quality of Life (QoL). Lymphedema in its advanced form, known as elephantiasis, is a significant cause of disability disfigurement, morbidity, and suffering, and is principally due, to nontreatment or undertreatment.

PRIMARY, SECONDARY, AND TERTIARY PREVENTION OF CIRCULATORY VASCULAR SYSTEM DISEASES

Two distinct fluids move through and form part of the circulatory system: blood and lymph. The blood system carries oxygen and nutrients to the body's cells, and carries hormones, antibodies, and waste materials away. The lymphatic system serves as a defense system for the body, filtering out organisms that cause disease, producing white blood cells, generating antibodies, and supporting the circulatory system by draining excess fluids and proteins from tissues back into the bloodstream. Although being totally different hemodynamic mechanisms, they are mutually dependent and complementary circulation systems.

Like most other clinical conditions, diseases of the circulatory system like Chronic Venous Insufficiency (CVI) in Peripheral Vascular Disease, and Lymphedema (LE) in Lymphatic Vascular Disease, is most treatable in their earliest stages. The goals of preventive treatment in diseases of the Blood Vascular System, are to reduce the pooling of blood in venous disease, and the goals of preventive treatment in diseases of the Lymphatic Vascular System, are to reduce the pooling of lymph fluid (dermal backflow) in lymphatic disease, thus preventing limb swelling, skin complications, and disease progression.

Evidence-based research provides the basis for sound clinical practice guidelines and recommendations for diseases of the circulatory system. Vascular medicine or vascular surgery specialists recommend a combination of preventive treatments for people with Venous and Lymphatic Dysfunction. Some of the simple basic daily self-care preventive treatment strategies include:

  • Avoid long periods of standing or sitting.
  • Exercise regularly.
  • Control weight.
  • Elevate limbs while sitting and lying down.
  • Wear Compression Garments all day.
  • Take antibiotics as needed to treat skin infections.
  • Practice good hygiene and skincare.
  • Use adequate clothing and footwear.

THE BEST FIRST-LINE TREATMENT FOR LYMPHATIC DYSFUNCTION

Treatment for lymphedema is an evidence-based clinical need, that centers around reducing the edema which then influences all of the other problems. Education and improving access to health services are keys to the successful prevention of stage elephantiasis. The First-line non-surgical reduction strategy for patients with established lymphedema is Complete Decongestive Therapy (CDT). Manual Lymphatic Drainage (MLD) and compression (multilayer low-stretch bandages and gradient compression garments) are the cornerstones of therapy. Treatment is to control the clinical severity and progression of the disease

Scientific studies highlight the importance and implications of compression therapy in controlling the progression of Lymphoedema, and evidence also supports that Compression Garments are essential. On the other hand, clinical outcomes on interventions to manage lymphedema, show that simple hygiene-based measures (washing and elevation of limbs, antifungal creams, exercise, and use of footwear) are necessary, but these alone without compression therapy, are not enough to reduce the limb volume in the majority of cases. People with lymphedema need access to continuing care throughout their lives, both to manage the disease and to prevent progression to more advanced stages. Read more about what is the best treatment option for lymphedema HERE.


If the conservative therapy does not respond,
when applied correctly and conducted by specialized physiotherapists, then microsurgery could be the next option for selected cases. Regarding genital lymphedema (including hydrocele), early lymphedema symptoms (edema) should be treated as soon as possible to reduce the necessity of surgery. Radical reductive ablative surgery (Charles Procedure), aimed to remove the diseased skin and subcutaneous tissue in limbs with Stage elephantiasis, should always be the last option for it is frequently associated with significant blood loss, morbidity, infections, permanent disfigurement, and recurrence of symptoms. Complete Decongestive Therapy (CDT) is not limited to lymphoedema stages 0 and I, and even late Stage III lymphoedema (elephantiasis) improves greatly with good results in the majority of cases, thus preventing the need for debulking techniques. 
See video of treatment of elephantiasis HERE.

With reference to dermatolymphangioadenitis (DLA), also known as Infectious Cellulitis, studies have found that the control of swelling is associated with a lower risk of cellulitis, and that advanced stages of chronic edema are a strong risk factor. Infectious cellulitis can lead to sepsis (septicemia). Read more about what are the preventive measures for Infectious Cellulitis in lymphedema HERE.

The psychological stress factors in Lymphedema must also be taken into consideration regarding the Quality of Life (QoL) indicators of individuals. Lymphedema is not in itself a psychopathology, nor does it predispose individuals to poor mental health. The negative situation of non-treatment or under-treatment of lymphedema leads to increased disease progression and, contributes to the cycle of disability, disfigurement, social stigmatization, poverty, suffering, and thus, the associated burden on the physical, economic, social, and psychological well-being of individuals. Read more information about psychological aspects surrounding non-treatment of lymphedema HERE.


REFERENCES

(Pinch on the texts to read the following Research Articles)

SCIENTIFIC SOCIETIES

DIAGNOSE AND TREATMENT









    • WHAT KIND OF DOCTOR TREATS LYMPHEDEMA/LYMPHOEDEMA - WHICH MEDICAL SPECIALITIES ARE RELATED TO LYMPHEDEMA












    LYMPHEDEMA INCIDENCE 
    AND PREVALENCE
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