Podoconiosis: endemic nonfilarial elephantiasis

Podoconiosis is a noncommunicable disease producing lymphoedema of the lower limbs; it affects predominantly barefoot agricultural workers in the tropics. Why should this be of interest to a journal of infectious disease? For many years this disease has not been widely recognized as distinct from lymphatic filariasis and yet it may affect about 10% of populations in volcanic tropical highlands. It produces considerable morbidity associated with limb lymphoedema, impacting on economically productive age groups. As it does not fall into the briefs of infectious or chronic disease initiatives of the World Health Organization, it has been difficult to attract funds for research and for the development of community management approaches. The aim of this review is to describe details of the clinical features, management, epidemiological significance and evidence for the underlying aetiology of this poorly understood condition.

A recent comprehensive study in Ethiopia by Destas et al. identified a mean zonal prevalence of 5.46% of the population with 64% being in the economically productive age group. Otherwise there are no other contemporary epidemiological publications in this field.

Podoconiosis is thought to be a geochemical disease induced by the absorption of ultrafine silica particles from the soil (konia) through the skin of the feet (podos) in susceptible individuals, leading to a progressive obliterative endolymphangitis.