Egypt's efforts to halt elephantiasis get promising results

GARAWAN, Egypt - Mahmoud Said Kheder's sinewy body is honed by years of toil in the corn and wheat fields, but his long robe conceals a lower leg that is swollen to the size of a paint can.

Nineteen years ago, Kheder contracted "elephantiasis," named for inflaming the arms and legs so the folds of flesh resemble those of an elephant. His lower right leg is grotesquely disfigured, swollen to three times the size of his left one.

Elephantiasis, or lymphatic filariasis, has plagued Egypt at least since the days of a Pharaonic priest who lived 3,000 years ago. His mummy contained the parasite.

Now, the country is the first to undertake a nationwide campaign to eliminate the disease. This year it is distributing the final dosages of medication in a five-year program to halt its transmission.

Elephantiasis infects about 120-million people worldwide. As it is carried by mosquitoes, those living near an infected person are in danger of catching it. The World Health Organization estimates more than 1-billion people are at risk.

In areas where lymphatic filariasis is well-established, WHO says the prevalence of infection is on the rise. With the rapid growth of cities and the expansion of urban slums, breeding sites for mosquitoes are increasing. In the worst-hit areas, up to 50 percent of men and 10 percent of women are infected.

Despite its name and symptoms, elephantiasis is not the disease suffered by the "elephant man," 19th century Briton Joseph Merrick. He had Proteus syndrome, a rare genetic disorder.

Egypt's campaign targets about 2.7-million people in eight provinces and was timed to cover the five-year reproductive lifespan of the parasite. The idea is that over five years, any parasites in people's bodies will die off naturally, breaking the parasite's cycle of transmission.

The campaign is supported by WHO and the drug company GlaxoSmithKline, which has donated large quantities of required medicine, albendazole.

So far, the results are impressive. In 1999, researchers found that 8.8 percent of people in certain communities in Kafr el-Sheik, a province in the Nile Delta, and 4.2 percent of people in parts of Giza, Cairo's twin city, were carrying the parasite though they had not yet suffered inflammations.

Today the percentages in both places are zero, said Dr. Hala el Hennawy, an Egyptian working for WHO.

In the community where Kheder lives, the infection rate has fallen from 2.5 percent to 0.11 percent, according to Dr. Samia Habib, a Health Ministry official.

She credits the success to the fact that everyone in the community knows of a victim of elephantiasis, and to what she calls "good propaganda" - before distributing the drugs door-to-door, officials promote the medicine on television and imams lend their support in mosques.

There is a tremendous social stigma attached to elephantiasis - not only because of the swollen limbs, but because the disease often affects the genitals, especially in men.

The parasite inflicts even more damage internally, wrecking the kidneys and lymphatic system and weakening the immune system.

Kheder said he prefers that people don't know about his bloated leg, which he hides under a robe. But he posed for news photographers because he supports the campaign.

"I tell my children and others to take the medicine so they don't become like me," he said.

DISTRIBUTION: About 120-million people worldwide are infected with elephantiasis, or lymphatic filariasis. About a third live in Africa and a third in India. Egypt has about 1,500 people disfigured by the disease.

SYMPTOMS: The disease causes severe swelling of the legs, arms, genitals and breasts. It also damages the immune system, the kidneys and the lymphatic system. Microscopic parasites block the flow of lymphatic fluid, causing inflammation.

TRANSMISSION: The disease is transmitted by mosquitoes that pick up the parasite when biting an infected person and deposit larvae in the bloodstream of another person. Doctors think hundreds of bites are necessary to infect a person.

TREATMENT: The parasite can be killed by taking the drugs diethylcarbamazine and albendazole. In communities where the disease is endemic, diethylcarbamazine has been added to table salt. The inflammation can be reduced by measures such as rigorous hygiene and antibiotic creams to prevent the infection of new tissue.

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