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Lymphangitis and Filariasis in Porto Rico

A Report of 57 Cases

G. R. Burke
Presbyterian Hospital, San Juan, Porto Rico

1. Clinically lymphangitis and elephantiasis are very prevalent among both males and females in Porto Rico.

2. The lower limbs are much more commonly affected than other parts of the body.

3. The constitutional signs of inflammation and the early local signs are the same for lymphangitis and elephantoid fever.

4. In both lymphangitis and elephantoid fever pain, which is often definitely localized, is usually the first indication of the illness. The chill or rigor which marks the beginning of constitutional disturbance may come on from half an hour to several hours or one or two days after the pain.

5. The pain may be primary in the groin.

6. More frequently the pain is localized in the distal parts of the limb and most commonly in the foot and the neighborhood of the ankle.

7. While in typical attacks of lymphangitis or elephantoid fever there is a chill followed by fever, and then sweating, yet one or all of these symptoms may be absent.

8. The chills are usually short. Fever when present is most commonly of about three days' duration.

9. Headache, vomiting and nausea are more commonly associated with high fever.

10. Redness of the affected areas of skin generally lasts about two days longer than the fever.

11. When there is high fever the local symptoms are generally severe. But the converse is not always the case and there may be extensive swelling and redness of the limb, with very mild, or without, constitutional symptoms.

12. Elephantiasis is common among young people.

13. Elephantiasis may occur without local or constitutional signs of inflammation.

14. Elephantiasis may be primary, as first manifestation of infection, or it may develop secondarily during subsequent recurrences of lymphangitis.

15. Patients may experience local sensations instead of definite pain before typical attacks of either lymphangitis or elephantoid fever or enlargement.

16. Following a succession of attacks with pain, chills, fever, sweats, etc. all such serious symptoms may be discontinued and subsequent recurrences with or without enlargement of the limb be only accompanied by mild sensations.

17. There is much variation in the frequency of recurrences among different patients but for each patient there seems to be a more or less regular periodicity of his or her attacks.

18. Observation of 2 cases following Kondoleon operation for elephantiasis does not give the impression that this measure brings permanent relief to the condition.

19. Hydrocele is very common in Porto Rico. We failed to find microfilaria in the centrifuged sediment of 20 cases of the condition.

20. Abscess may occur several times in the same part of a limb in a patient suffering from filarial lymphangitis without interfering with subsequent recurrences of lymphangitis. Abscess may also develop without noticeable rise in the body temperature during or following an attack of lymphangitis.