MBP 603: PARASITIC INFECTIONS

TOPIC: PODOCONIOSIS

PRESENTED BY:
ESENDEGE LUKE FOTABE.
 OUTLINE
 Causative agent
Morphology
Epidemiology
Pathogenesis and Pathology of disease
 Diagnosis and Treatment
Prevention and Control
 Challenges faced in disease control
 Perspectives
 INTRODUCTION
 Podoconiosis is an endemic non-filarial elephantiasis
of the lower extremities.

 It is the second most common cause of tropical

lymphedema after filariasis.

 It is thought to be caused by prolonged exposure of

the feet to irritant soils of volcanic origin, generated
by environmental conditions of high altitude.

 It is a non-communicable disease now found

exclusively in the tropics.
 Disease Morphology
 The disease is characterized by; Bilateral lower
extremity swelling and "mossy“ hyperkeratotic
papillomata
 It can either appear as rough and bumpy like the
moss or soft and fluid.
 Podoconiosis is also called ‘mossy foot disease’
Soft ‘water-bag’ swelling in a 20-year-old man
 Signs and symptoms
 The primary symptom of podoconiosis is swelling
and disfigurement of the lower extremities.

 Swelling may be one of two types: soft and fluid, or

hard and fibrotic, often associated with multiple
hard skin nodules.

 The edema of podoconiosis is usually bilateral and

asymmetric.
 Epidemiology
 It is estimated that 4 million people are affected
by podoconiosis worldwide,

 Population-based surveys suggest a prevalence of

5-10% in barefoot populations living on irritant
soil.

 Podoconiosis is most frequently seen in the

highland areas of Africa, India, and Central
America.
 High prevalence has been documented in Ethiopia,
Tanzania, Kenya, Uganda, Rwanda, Burundi, Sudan,
Cameroon and Equatorial Guinea. (Tekola, 2008)

 The incidence of podoconiosis increases with age,

likely due to cumulative exposure to irritant soil.

 Podoconiosis is rarely seen from the 0–5 year old

age group, and the incidence rapidly rises from 6 to
20 years of age, with the highest prevalence after
45 years of age. (Davey et al, 2007)
 Pathology
 Podoconiosis is characterized by a prodromal
phase before elephantiasis sets in.

 Early symptoms commonly include itching of the

skin of the forefoot and a burning sensation in
the foot and lower leg.

 Early changes that may be observed are splaying

of the forefoot, plantar edema with lymph ooze
and increased skin markings.
 Diagnosis
 The differential diagnosis for podoconiosis includes
other causes of tropical lymphedema, such as
filariasis or leprosy, and mycetoma pedis.

 Podoconiosis begins almost exclusively in the foot,

as opposed to filariasis, where the initial edema can
appear anywhere in the lower extremities.

 Podoconiosis is usually asymmetrically bilateral

without groin involvement, whereas filariasis and
mycetoma are usually unilateral.
 Radiology can help distinguish between podoconiosis
and mycetoma if the diagnosis is questionable.

 Local epidemiology can also be a clue to diagnosis, as

podoconiosis is typically found in higher altitude
areas with volcanic soils. If a clinical distinction
between podoconiosis and filariasis cannot be made
based on history and examination alone, blood
smears and ELISA antigen testing can be useful to
screen for filariasis.
 Prevention, Treatment and Control
There are primary, secondary and tertiary control.
 Primary prevention should consist of education
on the etiology and how to avoid prolonged
exposure to irritant soils, most importantly by
using appropriate and protective footwear,
covering floor surfaces and applying skincare.
 Secondary prevention consists, again, of
encouraging shoe wearing and daily foot-washing
with soap, water and, if possible, antiseptics in
order to prevent bacterial infection. Wound care
is important and infections should be treated
with antibiotics.
 Relocation from an area of irritant soil (Price,
1983) or adoption of a non-agricultural
occupation are also effective, but may not be
feasible for the patient

 The tertiary prevention of podoconiosis is an

extension of the secondary preventive
measures and also includes elevation of the
limb above hip level.
 Challenges

 Bad cultural and behavioral habits.

 Poor sensitization on the disease

 Stigmatization
 Perspectives

 There are still many unresolved questions

surrounding the pathogenesis of podoconiosis,
in particular the pathways through which
inorganic particles provoke inflammation and
obliteration of the lymphatic lumen.

 The case management of podoconiosis in

countries of high prevalence is poor and as
such, the creation of health facilities or centers
and trained personnel will be helpful.
•THANKS FOR YOUR
ATTENTION