title: The diagnostic challenge of mapping elephantiasis in the Tigray region of northern Ethiopia.
abstract: BACKGROUND
  In Ethiopia, lymphatic filariasis and podoconiosis are the two neglected tropical diseases planned to be mapped together within the recently launched Ethiopian neglected tropical diseases master plan (2013-2015). However, other disorders cause tropical lymphedema, and this report aims to identify clinical epidemiological aspects of limb swelling in northern Ethiopia and to provide an algorithm orienting the clinical diagnosis.
  
  
  METHODS
  Medical records of patients with lower limb elephantiasis attending the Italian Dermatological Centre of Mekele, Tigray capital city, over a 4-year period (2005-2009) were retrospectively analyzed. Nine variables were collected from the charts comprising demographic data, job, origin, literacy, clinical, histopathologic, microscopic, and cultural findings.
  
  
  RESULTS
  Over a total of 511 patients, lymphedema resulted from trauma (40.7%), chronic venous insufficiency (12.5%), deep mycoses (10.8%), lymphatic filariasis (9.2%), elephantiasis nostras verrucosa (7.0%), tropical ulcer (6.3%), leprosy (4.9%), recurrent infections (3.1%), podoconiosis (1.8%), tuberculosis (1.0%), malignancy (1.3%), Kaposi's sarcoma (1.0%), leishmaniasis (0.2%), and neurofibromatosis (0.2%).
  
  
  CONCLUSIONS
  Advanced-stage elephantiasis, chronic osteomyelitis, and podoconiosis not previously reported in Tigray were observed. Further epidemiological investigation and training programs addressed to healthcare providers at the peripheral level are needed to detect elephantiasis early, prevent disabilities, and improve patients' quality of life.
authors.affiliation: National Institute for Health, Migration and Poverty (NIHMP), Rome, Italy.
authors.forename: Valeska
authors.initials: V
authors.lastname: Padovese
authors.affiliation: National Institute for Health, Migration and Poverty (NIHMP), Rome, Italy.
authors.forename: Rosalia
authors.initials: R
authors.lastname: Marrone
authors.affiliation: National Institute for Health, Migration and Poverty (NIHMP), Rome, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Dassoni
authors.affiliation: National Institute for Health, Migration and Poverty (NIHMP), Rome, Italy.
authors.forename: Pascal
authors.initials: P
authors.lastname: Vignally
authors.affiliation: Tigray Regional Health Bureau, Mekele, Ethiopia.
authors.forename: Gebre A
authors.initials: GA
authors.lastname: Barnabas
authors.affiliation: Fondazione IME, Istituto Mediterraneo di Ematologia.
authors.forename: Aldo
authors.initials: A
authors.lastname: Morrone
mesh_terms: D000293:Adolescent; D000328:Adult; D004522:Educational Status; D004604:Elephantiasis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D004605:Elephantiasis, Filarial / Q000175:diagnosis / Q000453:epidemiology; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006801:Humans; D007896:Leishmaniasis / Q000150:complications; D007918:Leprosy / Q000150:complications; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications; D058069:Neglected Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D017253:Neurofibromatoses / Q000150:complications; D009790:Occupations / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012514:Sarcoma, Kaposi / Q000150:complications; D014376:Tuberculosis / Q000150:complications; D014689:Venous Insufficiency / Q000150:complications; D014947:Wounds and Injuries / Q000150:complications; D055815:Young Adult