Case Report and Literature Review: Podoconiosis in Southwestern Uganda

Dwek, Philip; Kong, Ling Yuan; Wafer, Meghan; Cherniak, William; Pace, Romina; Malhamé, Isabelle; Simonsky, Dean; Anguyo, Geoffrey; Silverman, Michael; Stern, E

doi:10.9734/ijtdh/2015/17672

Cited by 5 publications

(3 citation statements)

References 20 publications

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“…[22][23][24][25][26][27] In Uganda, the disease has been reported on the slopes of Mt Elgon in Kapchorwa in northeastern Uganda (areas rich in volcanic soils), and in the highlands of Kabale and Kisoro districts in southwestern Uganda. 1,22,28,29 However, podoconiosis had never before been recognized in western Uganda (Toro-Ankole region).…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Podoconiosis: Kamwenge District, Western Uganda, September 2015

Kihembo

Masiira

Lali

et al. 2017

The American Society of Tropical Medicine and Hygiene

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Podoconiosis, a noninfectious elephantiasis, is a disabling neglected tropical disease. In August 2015, an elephantiasis case-cluster was reported in Kamwenge District, western Uganda. We investigated to identify the disease's nature and risk factors. We defined a suspected podoconiosis case as onset in a Kamwenge resident of bilateral asymmetrical lower limb swelling lasting ≥ 1 month, plus ≥ 1 of the following associated symptoms: skin itching, burning sensation, plantar edema, lymph ooze, prominent skin markings, rigid toes, or mossy papillomata. A probable case was a suspected case with negative microfilaria antigen immunochromatographic card test (ruling out filarial elephantiasis). We conducted active case-finding. In a case-control investigation, we tested the hypothesis that the disease was caused by prolonged foot skin exposure to irritant soils, using 40 probable case-persons and 80 asymptomatic village control-persons, individually matched by age and sex. We collected soil samples to characterize irritants. We identified 52 suspected (including 40 probable) cases with onset from 1980 to 2015. Prevalence rates increased with age; annual incidence (by reported onset of disease) was stable over time at 2.9/100,000. We found that 93% (37/40) of cases and 68% (54/80) of controls never wore shoes at work (Mantel-Haenszel odds ratio [OR] = 7.7; 95% [confidence interval] CI = 2.0-30); 80% (32/40) of cases and 49% (39/80) of controls never wore shoes at home (OR = 5.2; 95% CI = 1.8-15); and 70% (27/39) of cases and 44% (35/79) of controls washed feet at day end (versus immediately after work) (OR = 11; 95% CI = 2.1-56). Soil samples were characterized as rich black-red volcanic clays. In conclusion, this reported elephantiasis is podoconiosis associated with prolonged foot exposure to volcanic soil. We recommended foot hygiene and universal use of protective shoes.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Podoconiosis: Kamwenge District, Western Uganda, September 2015

Kihembo

Masiira

Lali

et al. 2017

The American Society of Tropical Medicine and Hygiene

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“…A pathological study revealed amorphous and crystalline silicon compounds in macrophages of femoral lymph nodes [ 19 ]. In Uganda, podoconiosis cases were reported from highlands of >1500 m [ 9 , 10 ], while LF distribution was limited in areas lower than 1300 m [ 8 ]. In Ethiopia, however, potential distribution overlap of these two different types of elephantiasis is reported at an altitude of 1225−1698 m [ 20 ], and one report clearly mentions the co-endemicity in western Ethiopia [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…The disease is found in the high mountain area, where filariasis does not exist. Three cases of podoconiosis were also reported in the south-western highland in Uganda [ 10 ]. In the course of the study, we encountered several “unusual” elephantiasis cases among people walking barefoot.…”

Section: Introductionmentioning

confidence: 99%

Wuchereria bancrofti infection at four primary schools and surrounding communities with no previous blood surveys in northern Uganda: the prevalence after mass drug administrations and a report on suspected non-filarial endemic elephantiasis

et al. 2017

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BackgroundA prevalence study of Wuchereria bancrofti infection was carried out in 2014 at 4 study sites in northern Uganda using antigen and microfilaria tests. Each study site consists of a primary school and surrounding communities. These sites are inside the filariasis endemic area and have been covered by mass drug administration under the national elimination programme. However, no prevalence study had been conducted there before the present study. Without information on past and present endemicity levels, our study was meant to be an independent third-party investigation to know the latest filariasis situation.ResultsA total of 982 people including 570 schoolchildren (7–19 years) and 412 community people (7–25 years) were examined, all of them for filarial antigen and 695 for microfilariae. The study revealed that all subjects were negative by both methods.ConclusionsIt was considered that annual mass drug administrations together with anti-malarial activities such as indoor residual spraying had contributed to the reduction of the filarial infection. However, based on the past data obtained near our study sites, we cannot exclude the possibility that filarial prevalence rates in our study sites were very low or even zero originally. During the study, we encountered several patients with lower leg edema and pachydermic (elephant skin-like), mossy skin lesion of the foot. Judging from clinical features and bare-footed life-style of people in the area, non-filarial elephantiasis, possibly podoconiosis, was suspected. This elephantiasis has been reported in areas where filariasis is not endemic.

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