Concluded Case

65 Years old women c/o fever rigor and body pain.I/E temp 102°F,Anaemic, glossitis,thin build, malnourished ,socioeconomically poor,agricultural labourer,. leg swelling both legs up to middle 1/3 of leg. fever monthly occurrence periodicity bilateral inguinal gland enlargement . Similar patients in her village more than 5 of her ages having leg swellings are living there as per history. She reported to my clinic during this summer for body pain,exhausted feeling,poor appetite, losing weight. Inguinal glands bilaterally present enlarged. Leg swelling with warmth noticed .Dehydrated. Discuss this case.

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Concluded answer

Conclusion. This is the case of Elephantiasis ,Bilaterally presenting .Both leg elephantiasis is uncommon, but the lady is coming from high endemic area of elephantiasis. India still reporting filariasis ,presence of wuchuriria bancrafti in the peripheral blood is epidemiological important ,and such patient will harbour the disease through the female Culex mosquito in the Endemic Zones. National filarial control program , supervision ,over the vector,environment ,and the host and blood sample collection and DEC drug delivery is not effectively carried out in India . Govt concentration over public health is meagre than the vote based issues.

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Thanks Dr Elumalai subbarayan

History and the picture suggest that lady is suffering bilateral filariasis with lymphangitis. There are other people also suffering of similar sort ailment, that goes more in favour of filariasis. As there is secondary lymphangitis inguinal lymp node also palpable which is more prominent due to repeated attack of lymphangitis. There are blackish colouration due to stasis detmatitis Investigation. Blood examination eosiniphill count may be high Blood sugar Blood sample during sleep for microfilaria Colo Doppler may be done both legs to study the vascularity .

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Filariasis lymjphaedema withlymphagitis ttDEC antibiotic llegcare

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* filariasis Needs further investigations and evaluation to conclude diagnosis and line of treatment. Symptomatic treatment till reports complied.

Thanks Dr Dinesh Gupta
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Multi factorial ANEMIA, +hypoproteinemia, > bilateral lower limb EDEMA,> lymph stasis,> bacterial infection, >inguinal lymph nodes enlargement, > septecemia--- may be the sequence . Filarial infection has to be ruled out. If not possible administer DCC, Deworm, treat ANEMIA with oral iron, Protein supplements like egg in diet, treat lymphangitis with antibiotics, diuretics ,DCC

Multiple level approach is well taken ,but filarail treatment is main stay .
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Elephantiasis of legs with secondary infection.

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DD 1.Filariasis. 2. Chronic lympaedema 3.DVT.

Filariasis with Stesis dermatitis with Secondary infection CBC, ESR, Absolute Eosinophil count, BSL Colour doppler study of vascular system of both lower limbs Blood for microfilaria (midnight sample) Keep lower limbs raised upto 1/2 an hour 3-4 times daily Proper care of legs Wash with NS Betadine Soln Tab Bandy A stat & rept after 14days Tab Hetrazen forte tds×1month Rept every 6 months Cap Daflon 500mg tds Tab Augmentin 1gm bd×7days The areas have endemic topical eosinophilia, should refer to Govt hospital for epidomolological survey.

Good approach
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?Filariasis Lymphodema With stasis dermatitis More pts are there as mentioned Symptomatic treatment

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D/d r/o 1 filariasis 2 chr lymphoedema 3 Dvt Significant point in history you mentioned is few more people with same complaints are there i think municipal heath officer should be informed and he should take cognizance of it. Or you should screen them out so as to safegard the community

Lovely ,bilateral filarial leg ,uncommon. Mass ,DEC not reached her was the problem .
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