Podoconiosis

Podo is a disease of the poor mainly in rural areas of Ethiopia. People, who walk barefooted and come in contact with volcanic soil in the Highlands, are at risk. About a million of the worldwide four million affected are Ethiopians. Dust, that penetrates in the feet, cloggs the lymph vessels. The legs swell and develop a strong smell. Painful inflammation, immobility, stigmatization, as well as exclusion from the job market and all social contacts are the results.

What is Podoconiosis?

Podokoniose comes from the Greek (Ποδοϛ ' foot’ and κονιον ' dust) and is a non-infectious type of elephantiasis. It is also called endemic, non-filarial Elephantiasis, “Mossy foot” disease, Elephant foot disease, or “Price's”/”Morbus price” disease.

For more than 1000 years the clinical picture has been known to mankind. However, it took until the 19th century 19. to be recognized as , a geochemical, non-filarial Elephantiasis, which is associated with walking barefooted. Only when Podoconiosis got depicted as a separate diseases, the WHO recognized the disease in 2011 and officially registered it as one of the most neglected tropical diseases (NTD) of the world.

Cause

What is the cause?

Micro particles are the cause of Podokoniose, that occur in soils with a high content of red laterite of volcanic origin. These particles penetrate in humans, the running barefoot, through the intact skin in the subcutaneous tissue, where they lead to an inflammatory process. Edema and subsequent fibrosis * the lymphatics and lymph nodes shrink or. closing the lumen of the lymphatic channels, Thus there is a drain build-up of lymph. Over the years developed the image of a bilateral asymmetric Lymphoedema of the lower extremities, most of the time up to below the knee.
* Process of transforming specialized organ parenchyma in connective tissue

Geological and climatic factors

  • Regions with red soil of volcanic origin
  • silicate-rich earth (Aluminium, Quartz, Magnesium, Iron, alkaline metals such as sodium and potash)
  • Highland regions with a height of 1000 Meters above sea level
  • Adequate seasonal rainfall (more than 1000 mm per year)

Genetic factor
Not everyone, He goes barefoot, developed also Podokoniose. Also a genetic factor plays a role. The minority of barefoot running people with a genetic predisposition, developed the inflammatory reaction, which results in Podokoniose.

Poverty factor
Mostly the rural poor is affected, primarily farmers, but mineworkers and mine workers, that their work must go barefoot for poverty reasons. Also, the disease often occurs in weavers and Webern, sitting barefoot on the floor. Shoes are a priceless luxury for most of the rural population. Also, robust and durable and fully-enclosed shoes are z.B. in the rural regions of Ethiopia a market gap.

Clinical picture

What are the symptoms?

Podokoniose is a disease, characterized by massive swelling of the feet and legs. Usually the disease occurs regardless of the gender in the first and second decade of a human life. Then the prevalence keeps growing and reached its peak in the sixth decade of life.

Prodromal symptoms
The clinical picture of Podokoniose begins with the stage of pre elephantiasis with some prodromal symptoms:

  • burning feet and legs, usually at night
  • slight swelling of the Middle toes
  • itchy feet
  • throbbing big toe
  • Mushroom- and bacterial infections of the skin
  • rough, thick skin, sometimes with wart-like excrescences
  • greyish discolored skin
  • strong, unpleasant smell
  • Spreading of the forefoot
  • Edema on the sole of tissue fluid
  • Hyperkeratosis with MOSS-like shaping the Papillomas
  • stiff toes

Progressive symptoms
With progressive symptoms, one can distinguish two types of:

Water bag type: The water bag type (called also "water bag") the swellings are soft and yielding to pressure.

Leather type: The leathery type (called also "leathery type") the swellings are hard and fibrotisch with hardened tissue node.

Possible symptoms of both types:

  • strong, painful swelling of the feet to the knees
  • Convergence of the spaces between the toes
  • Fever in acute Adenolymphangitis Phases, very warm, painful skin (These phases seem to be with the water bag type in connection)
  • Inflammation
  • Skin ulcers
  • Mutilation of the feet

Due to the high tissue pressure of Lymphoedema, it comes to a thickening of DermIS and Epidermis with excessive keratin production within the meaning of Papillomatosis Cutis, which makes the affected skin a Podokoniose typical, MOSS-like consistency Gets. The sensitivity of peripheral nerves at the toe and the front of the foot is maintained. In the course of the disease, even the spaces between the toes can grow together, taking it to the Ankylosis comes the interphalangeal joints. Podokoniose is often an acute Adenolymphangitis (ALA) hand in hand: a painful infection of the feet and legs with swollen lymph nodes and fever. A common, the stench is very unpleasant symptom, It is driven by the inflammatory tissue.

Distinction to the filariösen elephantiasis
Podokoniose belongs to the tropical Lymphedema, is the lymphatic filariasis (LF) distinguished by the usually two-sided appearance in contrast to the asymmetric. Podokoniose begins in the feet and spreads to the legs up to the knees, but rarely up to the bar; Vice versa LF is visible usually first at the bar. Other than in the Podokoniose, the filariöse elephantiasis is caused by parasites, which are transmitted by mosquitoes.

ConsequencesWhat are the consequences?

Economic consequences
Podokoniose has a large negative impact on social and economic aspects of life of the persons concerned. It is often impossible to run them or to carry out everyday work and tasks in the family. Fear of contamination, because, for example, employers have, Many sufferers lose also their jobs and poor. Studies show an average loss of labour caused by the disease to 45 Percent per year.

2005 resulted in estimates, that the disease in the Wolaita zone in the South of Ethiopia (1,5 Millions of inhabitants) 16 Millions of dollars per year are lost. Consequently, losses will be from 200 Million dollars per year in all over Ethiopia. The parties concerned were, less (21.9%) and rare (44.9%) to work or to have completely stopped (8%). 96.4% have noticed a reduction/deterioration of their income.

stigmatization
Those affected live as outcasts. Reasons are the smell of inflamed skin, but also the lack of information about the cause of the disease. Stigmatized by the Podokoniose, discriminate against individuals, mainly from fear of contamination. Some attribute the disease to "Witchcraft" or a curse, others believe, you put on to, by using the same washing vessels. Such ignorance not infrequently leads to, to treat the sick like lepers: Affected are from the Church, the mosque and excluded from community meetings; Children and young people must no longer go to school; It is impossible to get a training them; Nobody wants to marry into families. Therefore insisting that sufferers often live as beggars, Some people starve even. Podokoniose is often a "hidden disease", because keep hidden the affected families, in order to escape the shame in the community. Because of healthcare of the Government learn rejection, are they trapped in their dilemma, without any prospect of a way out. Without help, they are predestined for, to be the poorest of the poor.

Geographical distributionWhere can I find Podokoniose?

Podokoniose is in the Highlands of tropical Africa, Central America, and Northern India spreading. 1 have a high prevalence: Uganda, Tanzania, Kenya, Rwanda, Burundi, Sudan and Ethiopia. Podokoniose is much more common than HIV in Ethiopia in one-fifth of the land area of endemic and endemic areas. Various studies have shown prevalence up to 9,1%. Probably is in Ethiopia to a million Podokoniose ill, 64% in a working-age.
For this geochemical illness incurred red clay soil is volcanic decisively, as well as some climatic factors such as an amount of 1000 m and enough seasonal rainfall.

Who is affected?

Especially farmers, miners and farmers in rural areas and Weber_innen are affected, you work on the ground and sit. Podokoniose occurs already in the first and second decade of life in appearance, then the prevalence of an ever-increasing, to achieve the maximum in the sixth decade of life. More and more women are affected (2.6:1) and people with very poor educational attainment. Before it comes to the development of the symptoms, the people live for years mostly in the endemic area. In addition to the disease causative micro-particles in volcanic soil, seems an autosomal-co dominating major gene for the outbreak of the disease play a role.

TreatmentHow can I prevent Podokoniose?

The primary prevention (= Avoidance of disease) All progress is wearing socks and protective, solid footwear, which is the best made sturdy leather.

How do you handle Podokoniose?

Secondary prevention (= Prevention of the progression of the disease) includes:
1) the training of the persons concerned in simple, but strict hygiene measures
2) daily foot washing with SOAP and water
3) the use of antiseptics and Emollienzien

Compression associations also lead to a continuous improvement of the symptoms. These measures require a lifelong patient compliance.

Tertiary prevention is the surgical therapy (Shaving surgery) equivalent and is rarely used.