As the result of the lymphangitis and blocking of the channels the embryos cannot reach the peripheral circulation; hence when obstruction does occur and symptoms of lymph stasis appear, there may be an absence of embryos in the circulation.
It is now well established that patients with elephantiasis very rarely show embryos in the peripheral circulation, and this fact should be better understood because there is a tendency to negative a filarial diagnosis when embryos are absent from the peripheral circulation.
These lymph channel obstructions may at one time cause dilatations or varices and at another bring about solid oedemas of the tributary parts. The treatment will be considered under each special form of the disease. It may be stated however that salvarsan, arsenophenylglycin and other similar remedies have been without special effect in destroying the filarial worms.
Clinical Manifestations
Not only is it important to understand that elephantiasis and other manifestations of filarial infection may and usually do exist without there being embryos in the peripheral blood of the patient, but also, that a high percentage of a population may show filarial embryos in their blood and yet never or with extreme rarity show any of the signs of filarial disease. These people, with abundant embryos in their blood, usually show no disturbance of health. In the Philippines one may rarely see a case of chylocele but usually there is nothing clinical to note.
Johnson, in examining 400 people, in Charleston, S. C., found 19% with filarial embryos, yet only 5% showed any symptoms of filariasis. Croll states that 11.5% of 4000 Europeans admitted to the Brisbane Hospital (Australia) showed filarial infection but practically none had symptoms. In South Queensland cases of lymphangitis, chyluria and varicose groin glands are occasionally seen and rather frequently hydrocele and filarial abscesses. There is an absence of elephantiasis.
Elephantoid Fever
The febrile accessions that accompany the recurring attacks of lymphangitis in elephantiasis, lymph scrotum and other filarial manifestations, are very important because they may lead to errors in diagnosis.
Thus in Barbadoes, where there is no malaria, a condition in which there occurs a high fever of sudden onset with rigors and associated erysipelatous redness of leg or scrotum, accompanied by lymphangitis and painful lymphatic glands, has given a suggestion of a malarial paroxysm. The tense inflamed area, after several days, shows an exudation of lymph and the redness disappears, but with some resulting thickening of the affected tissues. Such attacks may terminate with profuse sweating.