Appendicitis Menigitis Shingles (Mayo Clinic Def)

7/28/2019 Appendicitis Menigitis Shingles (Mayo Clinic Def)

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What is appendicitis?---- Inflammation of the vermiform appendix

What is an appendectomy?An appendectomy is the surgical removal of the appendix. Appendectomy usually is done for appendicitis.

CausesIt's not always clear why appendicitis occurs. Sometimes it's the result of an obstruction when food waste or a hard piece of stool

(fecal stone) becomes trapped in an orifice of the cavity that runs the length of your appendix.Appendicitis may also follow an infection, such as a gastrointestinal viral infection, or it may result from other types of inflammation. Inboth cases, bacteria may subsequently invade rapidly, causing the appendix to become inflamed and filled with pus. If not treatedpromptly, your appendix eventually may rupture.

Signs and symptomsAppendicitis can cause a variety of symptoms that may change over time. The most common early symptom is an aching pain aroundyour navel that often shifts later to your lower-right abdomen. As the inflammation in your appendix spreads to nearby tissues,especially the inner lining (peritoneum) of your abdomen, the pain may become sharper and more severe.Eventually, the pain tends to settle in your lower-right abdomen - just above your appendix at what's known as McBurney's point. Thispoint is about halfway between your navel and the top of your right pelvic bone. But the location of your pain may vary, depending onyour age and the position of your appendix. Young children, especially, may have appendicitis pain in different places.

If you apply gentle pressure to the area that hurts, it will feel tender. As you release the pressure, appendicitis pain often will feel

worse (rebound tenderness). It will also tend to get worse if you cough, walk or make other jarring movements. This is particularly trueif the inflamed appendix is touching the peritoneum. The pain may lessen somewhat if you lie on your side and pull your legs upbeneath you.

In addition to pain, you may have one or more of the following signs and symptoms:> Nausea and sometimes vomiting> Loss of appetite> A low-grade fever that starts after other signs and symptoms appear> Constipation> An inability to pass gas> Diarrhea> Abdominal swelling

How is appendicitis diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for appendicitis may include the following:> blood tests (to check for signs of infection such as elevated white blood cell count)> urine tests (to rule out a urinary tract infection)> imaging procedures (to determine if the appendix is inflamed), including the following:

Computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays andcomputer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scanshows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than generalx-rays.Ultrasound - a diagnostic technique which uses high-frequency sound waves to create an image of the internal organs.X-Ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organsonto film.

TreatmentSpecific treatment for appendicitis will be determined by your physician based on:> your age, overall health, and medical history> extent of the condition> your tolerance of specific medicines, procedures, or therapies> expectations for the course of the condition> your opinion or preference

MedicinesIf the diagnosis is uncertain, people may be watched and sometimes treated with antibiotics. This approach is taken when the doctorsuspects that the patient's symptoms may have a nonsurgical or medically treatable cause. If the cause of the pain is infectious,symptoms resolve with intravenous antibiotics and intravenous fluids. In general, however, appendicitis cannot be treated withantibiotics alone and will require surgery.


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How is appendicitis managed surgically?During an appendectomy, an incision two to three inches in length is made through the skin and the layers of the abdominal wall in thearea of the appendix. The surgeon enters the abdomen and looks for the appendix, which usually is located in the right lower part ofthe abdomen. After examining the area around the appendix to be certain that no additional problem is present, the appendix isremoved. This is done by freeing the appendix from its attachment to the abdomen and to the colon. If present, abscesses can bedrained with drains (rubber tubes) that go from the abscess and out through the skin to allow the pus from the abscess to drain out.The abdominal incision then is closed.

Newer techniques for removing the appendix involve the use of the laparoscope. The laparoscope is a thin telescope attached to avideo camera that allows the surgeon inspect the inside of the abdomen through a small puncture wound (instead of a much largerincision). If appendicitis is found, the appendix can be removed with special instruments that can be passed into the abdomen, just likethe laparoscope, through small puncture wounds. The benefits of the laparoscopic technique include less post-surgery pain (since muchof the post-surgery pain comes from incisions) and a speedier recovery. An additional advantage of laparoscopy is that it allows thesurgeon to look inside the abdomen in cases in which the diagnosis of appendicitis is in doubt and to make a clear diagnosis of theproblem. For example, laparoscopy is especially helpful in menstruating women in whom bursting ovarian cysts may mimic appendicitis

What are the risks of an appendicectomy?As with any operation, the risks associated with an appendicectomy include:> bleeding> infection> reaction to medications

What are the complications of an appendicectomy?The most common complication of an appendicectomy is infection of the wound. Such infections vary from a superficial infection whichonly requires daily dressing of the wound; to a deeper infection which may require surgery.

Another complication is abscess, a collection of pus in the area of the appendix. This will require drainage of the abscess.

A third complication is blockage of the intestines. This results in the intestines becoming filled with liquid and gas. When this happens,it may be necessary to drain the contents of the intestine through a tube passed through the nose and oesophagus, and into thestomach. In most instances, this condition resolves spontaneously. Occasionally, another operation may be needed to free theobstruction.

What happens if an inflamed appendix is not removed?Acute appendicitis may result in a rupture of the appendix (perforation) and the infection can spread to the entire abdominal space(peritonitis). Untreated acute appendicitis can result in death.

When can I drive a car?You may resume driving when you are able to step on the foot pedal without causing excessive pain or when you do not require painrelief medication that makes you drowsy.

When can I resume work?Most patients take up to 14 days off work to recuperate after an appendicectomy. Patients, whose jobs involve strenuous work orfrequent lifting, may be off work for a longer period. Consult your surgeon for specific instructions.

When do I need to see a doctor?Consult your doctor if any of the following occurs:> body temperature higher than 38C> drainage or fluid from incision> increased wound tenderness or soreness

> significant redness or swelling at the incision site, or> persistent nausea, vomiting, diarrhea

ShinglesHerpes zoster

Shingles (herpes zoster) is a painful, blistering skin rash due to the varicella-zoster virus, the virus that causes chickenpox.

See also: Ramsay Hunt syndromeCauses, incidence, and risk factors

After you get chickenpox, the virus remains inactive (becomes dormant) in certain nerves in the body. Shingles occurs after the virusbecomes active again in these nerves years later.


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The reason the virus suddenly becomes active again is not clear. Often only one attack occurs.

Shingles may develop in any age group, but you are more likely to develop the condition if:

You are older than 60

You had chickenpox before age 1

Your immune system is weakened by medications or disease

If an adult or child has direct contact with the shingles rash and did not have chickenpox as a child or a chickenpox vaccine, they candevelop chickenpox, not shingles.Symptoms

The first symptom is usually one-sided pain, tingling, or burning. The pain and burning may be severe and is usually present beforeany rash appears.

Red patches on the skin, followed by small blisters, form in most people.

The blisters break, forming small sores that begin to dry and form crusts. The crusts fall off in 2 to 3 weeks. Scarring is rare.

The rash usually involves a narrow area from the spine around to the front of the belly area or chest.

The rash may involve the face, eyes, mouth, and ears.

Other symptoms may include:

Abdominal pain

Fever and chills

General ill feeling

Genital sores

Headache

Joint pain

Swollen glands (lymph nodes)

You may also have pain, muscle weakness, and a rash involving different parts of your face if shingles affects a nerve in your face. Thesymptoms may include:

Difficulty moving some of the muscles in the face

Drooping eyelid (ptosis)

Hearing loss

Loss of eye motion

Taste problems

Vision problems

Signs and tests

Your health care provider can make the diagnosis by looking at your skin and asking questions about your medical history.

Tests are rarely needed, but may include taking a skin sample to see if the skin is infected with the virus that causes shingles.

Blood tests may show an increase in white blood cells and antibodies to the chickenpox virus, but they cannot confirm that the rash is


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due to shingles.Treatment

Your health care provider may prescribe a medicine that fights the virus, called an antiviral drug. This drug helps reduce pain, preventcomplications, and shorten the course of the disease. Acyclovir, famciclovir, and valacyclovir may be used.

The medications should be started within 72 hours of when you first feel pain or burning. It is best to start taking them before theblisters appear. The drugs are usually given in pill form, and in high doses. Some people may need to receive the medicine through a

vein (by IV).

Strong anti-inflammatory medicines called corticosteroids, such as prednisone, may be used to reduce swelling and pain. These drugsdo not work in all patients.

Other medicines may include:

Antihistamines to reduce itching (taken by mouth or applied to the skin)

Pain medicines

Zostrix, a cream containing capsaicin (an extract of pepper) that may reduce the risk of postherpetic neuralgia

Cool wet compresses can be used to reduce pain. Soothing baths and lotions, such as colloidal oatmeal bath, starch baths, or calamine

lotion, may help to relieve itching and discomfort.

Resting in bed until the fever goes down is recommended.

Keep the skin clean.

Do not reuse contaminated items.

Wash nondisposable items in boiling water or disinfect them before using them again

You may need to stay away from people while the sores are oozing to avoid infecting those who have never had chickenpox --especially pregnant women.Expectations (prognosis)

Herpes zoster usually clears up in 2 to 3 weeks and rarely returns. If the virus affects the nerves that control movement (the motornerves), you may have temporary or permanent weakness or paralysis.

Sometimes, the pain in the area where the shingles occurred may last from months to years. This pain is called postherpetic neuralgia.

Postherpetic neuralgia is more likely to occur in people over age 60. It occurs when the nerves have been damaged after an outbreakof shingles. Pain ranges from mild to very severe.Complications

Complications may include:

Another attack of shingles

Bacterial skin infections

Blindness (if shingles occurs in the eye)

Deafness

Infection, including encephalitis or sepsis (blood infection) in persons with a weakened immune system

Ramsay Hunt syndrome if shingles affects the nerves in the face

Calling your health care providerCall your health care provider if you have symptoms of shingles, particularly if you have a weakened immune system or if yoursymptoms persist or worsen. Shingles that affects the eye may lead to permanent blindness if you do not receive emergency medicalcare.


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Prevention

Avoid touching the rash and blisters on persons with shingles or chickenpox if you have never had chickenpox or the chickenpoxvaccine.

A herpes zoster vaccine is available. It is different than the chickenpox vaccine. Older adults who receive the herpes zoster vaccine areless likely to have complications from shingles.

The United States Advisory Committee on Immunization Practices (ACIP) has recommended that adults older than 60 receive theherpes zoster vaccine as part of routine medical care.

DefinitionBy Mayo Clinic staffLupus is a chronic inflammatory disease that occurs when your body's immune system attacks your own tissues and organs.Inflammation caused by lupus can affect many different body systems including your joints, skin, kidneys, blood cells, brain, heartand lungs.Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive sign oflupus a facial rash that resembles the wings of a butterfly unfolding across both cheeks occurs in many but not all cases of lupus.Some people are born with a tendency toward developing lupus, which may be triggered by infections, certain drugs or even sunlight.While there's no cure for lupus, treatments can help control symptoms.

Symptoms

By Mayo Clinic staffLupus facial rash

No two cases of lupus are exactly alike. Signs and symptoms may come on suddenly or develop slowly, may be mild or severe, andmay be temporary or permanent. Most people with lupus have mild disease characterized by episodes called flares when signsand symptoms get worse for a while, then improve or even disappear completely for a time.The signs and symptoms of lupus that you experience will depend on which body systems are affected by the disease. The mostcommon signs and symptoms include: Fatigue and fever Joint pain, stiffness and swelling Butterfly-shaped rash on the face that covers the cheeks and bridge of the nose Skin lesions that appear or worsen with sun exposure Fingers and toes that turn white or blue when exposed to cold or during stressful periods (Raynaud's phenomenon) Shortness of breath

Chest pain Dry eyes Headaches, confusion, memory loss

CausesBy Mayo Clinic staffLupus occurs when your immune system attacks healthy tissue in your body. It's likely that lupus results from a combination of yourgenetics and your environment. It appears that people with an inherited predisposition for lupus may develop the disease when theycome into contact with something in the environment that can trigger lupus. The cause for lupus in most cases, however, is unknown.Some potential triggers include: Sunlight. Exposure to the sun may bring on lupus skin lesions or trigger an internal response in susceptible people. Medications. Lupus can be triggered by certain types of anti-seizure medications, blood pressure medications and antibiotics. Peoplewho have drug-induced lupus usually see their symptoms go away when they stop taking the medication.

Risk factorsBy Mayo Clinic staffFactors that may increase your risk of lupus include: Your sex. Lupus is more common in women. Age. Although lupus affects people of all ages, it's most often diagnosed between the ages of 15 and 40. Race. Lupus is more common in African Americans, Hispanics and Asians.

ComplicationsBy Mayo Clinic staffInflammation caused by lupus can affect many areas of your body, including your: Kidneys. Lupus can cause serious kidney damage, and kidney failure is one of the leading causes of death among people with lupus.


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Signs and symptoms of kidney problems may include generalized itching, chest pain, nausea, vomiting and leg swelling (edema). Brain. If your brain is affected by lupus, you may experience headaches, dizziness, behavior changes, hallucinations, and evenstrokes or seizures. Many people with lupus experience memory problems and may have difficulty expressing their thoughts. Blood and blood vessels. Lupus may lead to blood problems, including anemia and increased risk of bleeding or blood clotting. It canalso cause inflammation of the blood vessels (vasculitis). Lungs. Having lupus increases your chances of developing an inflammation of the chest cavity lining (pleurisy), which can makebreathing painful. Heart. Lupus can cause inflammation of your heart muscle, your arteries or heart membrane (pericarditis). The risk of cardiovascular

disease and heart attacks increases greatly as well.Other types of complicationsHaving lupus also increase your risk of: Infection. People with lupus are more vulnerable to infection because both the disease and its treatments weaken the immunesystem. Infections that most commonly affect people with lupus include urinary tract infections, respiratory infections, yeast infections,salmonella, herpes and shingles. Cancer. Having lupus appears to increase your risk of cancer. Bone tissue death (avascular necrosis). This occurs when the blood supply to a bone diminishes, often leading to tiny breaks in thebone and eventually to the bone's collapse. The hip joint is most commonly affected. Pregnancy complications. Women with lupus have an increased risk of miscarriage. Lupus increases the risk of high blood pressureduring pregnancy (preeclampsia) and preterm birth. To reduce the risk of these complications, doctors recommend delaying pregnancyuntil your disease has been under control for at least 6 months.ests and diagnosisBy Mayo Clinic staff

Diagnosing lupus is difficult because signs and symptoms vary considerably from person to person. Signs and symptoms of lupus mayvary over time and overlap with those of many other disorders. No one test can diagnose lupus. The combination of blood and urinetests, signs and symptoms, and physical examination findings leads to the diagnosis.

Laboratory testsBlood and urine tests may include: Complete blood count. This test measures the number of red blood cells, white blood cells and platelets as well as the amount ofhemoglobin, a protein in red blood cells. Results may indicate you have anemia, which commonly occurs in lupus. A low white bloodcell or platelet count may occur in lupus as well. Erythrocyte sedimentation rate. This blood test determines the rate at which red blood cells settle to the bottom of a tube in an hour.

A faster than normal rate may indicate a systemic disease, such as lupus. The sedimentation rate isn't specific for any one disease. Itmay be elevated if you have lupus, another inflammatory condition, cancer or an infection. Kidney and liver assessment. Blood tests can assess how well your kidneys and liver are functioning. Lupus can affect these organs. Urinalysis. An examination of a sample of your urine may show an increased protein level or red blood cells in the urine, which mayoccur if lupus has affected your kidneys. Antinuclear antibody (ANA) test. A positive test for the presence of these antibodies produced by your immune system indicatesa stimulated immune system. While most people with lupus have a positive ANA test, most people with a positive ANA do not havelupus. If you test positive for ANA, your doctor may advise more-specific antibody testing.

Imaging testsIf your doctor suspects that lupus is affecting your lungs or heart, he or she may suggest: Chest X-ray. An image of your chest may reveal abnormal shadows that suggest fluid or inflammation in your lungs. Echocardiogram. This test uses sound waves to produce real-time images of your beating heart. It can check for problems with yourvalves and other portions of your heart.BiopsyLupus can harm your kidneys in many different ways and treatments can vary, depending on the type of damage that occurs. In somecases, it's necessary to test a small sample of kidney tissue to determine what the best treatment might be. The sample can be

obtained with a needle, or through a small incision.

Treatments and drugsBy Mayo Clinic staffTreatment for lupus depends on your signs and symptoms. Determining whether your signs and symptoms should be treated and whatmedications to use requires a careful discussion of the benefits and risks with your doctor. As your signs and symptoms flare andsubside, you and your doctor may find that you'll need to change medications or dosages. The medications most commonly used tocontrol lupus include: Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs, such as naproxen (Aleve) and ibuprofen (Advil, Motrin,others), may be used to treat pain, swelling and fever associated with lupus. Stronger NSAIDs are available by prescription. Side effectsof NSAIDs include stomach bleeding, kidney problems and an increased risk of heart problems. Antimalarial drugs. Medications commonly used to treat malaria, such as hydroxychloroquine (Plaquenil), also can help control lupus.Side effects can include stomach upset and, very rarely, damage to the retina of the eye.


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Corticosteroids. Prednisone and other types of corticosteroids can counter the inflammation of lupus, but often produce long-termside effects including weight gain, easy bruising, thinning bones (osteoporosis), high blood pressure, diabetes and increased risk ofinfection. The risk of side effects increases with higher doses and longer term therapy. Immune suppressants. Drugs that suppress the immune system may be helpful in serious cases of lupus. Examples includecyclophosphamide (Cytoxan), azathioprine (Imuran, Azasan), mycophenolate (Cellcept), leflunomide (Arava) and methotrexate(Trexall). Potential side effects may include an increased risk of infection, liver damage, decreased fertility and an increased risk ofcancer. A newer medication, belimumab (Benlysta) also reduces lupus symptoms in some people. Side effects include nausea, diarrheaand fever.

Lifestyle and home remediesBy Mayo Clinic staffTake steps to care for your body if you have lupus. Simple measures can help you prevent lupus flares and, should they occur, bettercope with the signs and symptoms you experience. Try to: Get adequate rest. People with lupus often experience persistent fatigue that's different from normal tiredness and that isn'tnecessarily relieved by rest. For that reason, it can be hard to judge when you need to slow down. Get plenty of sleep a night and napsor breaks during the day as needed. Be sun smart. Because ultraviolet light can trigger a flare, wear protective clothing, such as a hat, long-sleeved shirt and long pants,and use sunscreens with a sun protection factor (SPF) of at least 55 every time you go outside. Get regular exercise. Exercise can help you recover from a flare, reduce your risk of heart attack, help fight depression and promotegeneral well-being. Don't smoke. Smoking increases your risk of cardiovascular disease and can worsen the effects of lupus on your heart and bloodvessels. Eat a healthy diet. A healthy diet emphasizes fruits, vegetables and whole grains. Sometimes you may have dietary restrictions,especially if you have high blood pressure, kidney damage or gastrointestinal problems.

Alternative medicineBy Mayo Clinic staffSometimes alternative or complementary medicine may benefit people with lupus. However, these therapies are usually used withconventional medications. Discuss these treatments with your doctor before initiating them on your own. He or she can help you weighthe benefits and risks and tell you if the treatments will interfere with your current lupus medications.Complementary and alternative treatments for lupus include: Dehydroepiandrosterone (DHEA). Supplements containing this hormone have been shown to reduce the dose of steroids needed tostabilize symptoms in some people who have lupus. Flaxseed. Flaxseed contains a fatty acid called alpha-linolenic acid, which may decrease inflammation in the body. Some studies havefound that flaxseed may improve kidney function in people who have lupus that affects the kidneys. Side effects of flaxseed include

bloating and abdominal pain. Fish oil. Fish oil supplements contain omega-3 fatty acids that may be beneficial for people with lupus. Preliminary studies have foundsome promise, though more study is needed. Side effects of fish oil supplements can include nausea, belching and a fishy taste in themouth. Vitamin D. There is some evidence to suggest that people with lupus may benefit from supplemental vitamin D.

Coping and supportBy Mayo Clinic staffIf you have lupus, you're likely to have a range of painful feelings about your condition, from fear to extreme frustration. Thechallenges of living with lupus increase your risk of depression and related mental health problems, such as anxiety, stress and lowself-esteem. To help you cope with lupus, try to: Learn all you can about lupus. Write down all the questions you have about lupus and ask them at your next appointment. Askyourdoctor or nurse for reputable sources of further information. The more you know about lupus, the more confident you'll feel in yourtreatment choices.

Gather support among your friends and family. Talk about lupus with your friends and family and explain ways they can help outwhen you're having flares. Lupus can be frustrating for your loved ones because they usually can't see it and you may not appear sick.They can't tell if you're having a good day or a bad day unless you tell them. Be open about what you're feeling so that your friendsand family know what to expect. Take time for yourself. Cope with stress in your life by taking time for yourself. Use that time to read, meditate, listen to music orwrite in a journal. Find activities that calm and renew you. Connect with others who have lupus. Talk to other people who have lupus. You can connect with other people who have lupusthrough support groups in your community or through online message boards. Other people with lupus can offer unique supportbecause they're facing many of the same obstacles and frustrations that you're facing.

DefinitionBy Mayo Clinic staff


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Meningitis is an inflammation of the membranes (meninges) surrounding your brain and spinal cord, usually due to the spread of aninfection. The swelling associated with meningitis often triggers the "hallmark" signs and symptoms of this condition, includingheadache, fever and a stiff neck in anyone over the age of 2.Most cases of meningitis are caused by a viral infection, but bacterial and fungal infections also can lead to meningitis. Depending onthe cause of the infection, meningitis can resolve on its own in a couple of weeks or it can be a life-threatening emergency.

Symptoms

By Mayo Clinic staffIt's easy to mistake the early signs and symptoms of meningitis for the flu (influenza). Meningitis signs and symptoms may developover several hours or over one or two days and, in anyone over the age of 2, typically include: High fever Severe headache that isn't easily confused with other types of headache Stiff neck Vomiting or nausea with headache Confusion or difficulty concentrating in the very young, this may appear as inability to maintain eye contact Seizures Sleepiness or difficulty waking up Sensitivity to light Lack of interest in drinking and eating Skin rash in some cases, such as in viral or meningococcal meningitis

Signs in newbornsNewborns and infants may not have the classic signs and symptoms of headache and stiff neck. Instead, signs of meningitis in this agegroup may include: High fever Constant crying Excessive sleepiness or irritability Inactivity or sluggishness Poor feeding A bulge in the soft spot on top of a baby's head (fontanel) Stiffness in a baby's body and neck SeizuresInfants with meningitis may be difficult to comfort, and may even cry harder when picked up.When to see a doctorSeek medical care right away if you or someone in your family has signs or symptoms of meningitis, such as:

Fever Severe, unrelenting headache Confusion Vomiting Stiff neckThere's no way to know what kind of meningitis you or your child has without seeing your doctor and undergoing spinal fluid testing. Viral meningitis may improve without treatment in a few days. Bacterial meningitis is serious, can come on very quickly and requires prompt antibiotic treatment to improve the chances of arecovery without serious complications. Delaying treatment for bacterial meningitis increases the risk of permanent brain damage ordeath. In addition, bacterial meningitis can prove fatal in a matter of days.

Also talk to your doctor if a family member or someone you work with has meningitis. You may need to take medications to preventgetting sick.

Causes

By Mayo Clinic staffMeningitis

Meningitis usually results from a viral infection, but the cause may also be a bacterial infection. Less commonly, a fungal infection maycause meningitis. Because bacterial infections are the most serious and can be life-threatening, identifying the source of the infection isan important part of developing a treatment plan.Bacterial meningitis

Acute bacterial meningitis usually occurs when bacteria enter the bloodstream and migrate to the brain and spinal cord. But it can alsooccur when bacteria directly invade the meninges, as a result of an ear or sinus infection or a skull fracture.

A number of strains of bacteria can cause acute bacterial meningitis. The most common include: Streptococcus pneumoniae (pneumococcus). This bacterium is the most common cause of bacterial meningitis in infants, youngchildren and adults in the United States. It more commonly causes pneumonia or ear or sinus infections. Neisseria meningitidis (meningococcus). This bacterium is another leading cause of bacterial meningitis. Meningococcal meningitis


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commonly occurs when bacteria from an upper respiratory infection enter your bloodstream. This infection is highly contagious. Itaffects mainly teenagers and young adults, and may cause local epidemics in college dormitories, boarding schools and military bases. Haemophilus influenzae (haemophilus). Before the 1990s, Haemophilus influenzae type b (Hib) bacterium was the leading cause ofbacterial meningitis in children. But new Hib vaccines available as part of the routine childhood immunization schedule in the UnitedStates have greatly reduced the number of cases of this type of meningitis. When it occurs, it tends to follow an upper respiratoryinfection, ear infection (otitis media) or sinusitis. Listeria monocytogenes (listeria). These bacteria can be found almost anywhere in soil, in dust and in foods that have becomecontaminated. Contaminated foods have included soft cheeses, hot dogs and luncheon meats. Many wild and domestic animals also

carry the bacteria. Fortunately, most healthy people exposed to listeria don't become ill, although pregnant women, newborns andolder adults tend to be more susceptible. Listeria can cross the placental barrier, and infections in late pregnancy may cause a baby tobe stillborn or die shortly after birth. People with weakened immune systems, due to disease or medication effect, are mostvulnerable.

Viral meningitisEach year, viruses cause a greater number of cases of meningitis than do bacteria. Viral meningitis is usually mild and often clears onits own within two weeks. A group of viruses known as enteroviruses are responsible for about 30 percent of viral meningitis cases inthe United States. As many viral meningitis episodes never have a specific virus identified as the cause.The most common signs and symptoms of enteroviral infections are rash, sore throat, diarrhea, joint aches and headache. Theseviruses tend to circulate in late summer and early fall. Viruses such as herpes simplex virus, La Crosse virus, West Nile virus and othersalso can cause viral meningitis.

Chronic meningitisChronic forms of meningitis occur when slow-growing organisms invade the membranes and fluid surrounding your brain. Althoughacute meningitis strikes suddenly, chronic meningitis develops over two weeks or more. Nevertheless, the signs and symptoms ofchronic meningitis headaches, fever, vomiting and mental cloudiness are similar to those of acute meningitis. This type ofmeningitis is rare.Fungal meningitisFungal meningitis is relatively uncommon and causes chronic meningitis. Occasionally it can mimic acute bacterial meningitis.Cryptococcal meningitis is a common fungal form of the disease that affects people with immune deficiencies, such as AIDS. It's life-threatening if not treated with an antifungal medication.Other meningitis causesMeningitis can also result from noninfectious causes, such as drug allergies, some types of cancer and inflammatory diseases such aslupus.

Risk factors

By Mayo Clinic staffNot completing the childhood vaccine schedule increases your risk of meningitis. So do a few other risk factors: Age. Most cases of viral meningitis occur in children younger than age 5. In the past, bacterial meningitis also usually affected youngchildren. But since the mid-1980s, as a result of the protection offered by current childhood vaccines, the median age at whichbacterial meningitis is diagnosed has shifted from 15 months to 25 years. Living in a community setting. College students living in dormitories, personnel on military bases, and children in boarding schoolsand child care facilities are at increased risk of meningococcal meningitis, probably because the bacterium is spread by the respiratoryroute and tends to spread quickly wherever large groups of susceptible teenagers or young adults congregate. Pregnancy. If you're pregnant, you're at increased of contracting listeriosis an infection caused by listeria bacteria, which may alsocause meningitis. If you have listeriosis, your unborn baby is at risk, too. Working with animals. People who work with domestic animals, including dairy farmers and ranchers, have a higher risk ofcontracting listeria, which can lead to meningitis. Compromised immune system. Factors that may compromise your immune system including AIDS, diabetes and use ofimmunosuppressant drugs also make you more susceptible to meningitis. Removal of your spleen, an important part of your immune

system, also may increase your risk.

ComplicationsBy Mayo Clinic staffThe complications of meningitis can be severe. The longer you or your child has the disease without treatment, the greater the risk ofseizures and permanent neurological damage, including: Hearing loss Blindness Memory difficulty Loss of speech Learning disabilities Behavior problems Brain damage


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ParalysisOther complications may include: Kidney failure Adrenal gland failure Shock Death

Tests and diagnosisBy Mayo Clinic staffYour family doctor or pediatrician can diagnose meningitis based on a medical history, a physical exam and certain diagnostic tests.During the exam, your doctor may check for signs of infection around the head, ears, throat and the skin along the spine. You or yourchild may undergo the following diagnostic tests: Blood cultures. Blood drawn from a vein is sent to a laboratory and placed in a special dish to see if it grows microorganisms,particularly bacteria. A sample may also be placed on a slide to which stains are added (Gram's stain), then examined under amicroscope for bacteria. Imaging. X-rays and computerized tomography (CT) scans of the head, chest or sinuses may reveal swelling or inflammation. Thesetests can also help your doctor look for infection in other areas of the body that may be associated with meningitis. Spinal tap (lumbar puncture). The definitive diagnosis of meningitis is often made by analyzing a sample of your cerebrospinal fluid(CSF), which is collected during a procedure known as a spinal tap. In people with meningitis, the CSF fluid often shows a low sugar(glucose) level along with an increased white blood cell count and increased protein. CSF analysis may also help your doctor identifythe exact bacterium that's causing the illness. It can take up to a week to get these test results, If your doctor suspects meningitis, heor she may order a DNA-based test known as a polymerase chain reaction (PCR) amplification to check for the presence of viral causesof meningitis. This may provide results about your meningitis in as little as four hours and help to determine proper treatment.

Treatments and drugsBy Mayo Clinic staffThe treatment depends on the type of meningitis you or your child has.Bacterial meningitis

Acute bacterial meningitis requires prompt treatment with intravenous antibiotics and, more recently, cortisonelike medications, toensure recovery and reduce the risk of complications. The antibiotic or combination of antibiotics that your doctor may choose dependson the type of bacteria causing the infection. Your doctor may recommend a broad-spectrum antibiotic until he or she can determinethe exact cause of the meningitis.If you or your child has bacterial meningitis, your doctor may also recommend treatments for: Brain swelling Shock

Convulsions Dehydration

Infected sinuses or mastoids the bones behind the outer ear that connect to the middle ear may need to be drained. Infectedfluid that has accumulated between the skull and the membranes that surround the brain also may need to be drained surgically.

Viral meningitisAntibiotics can't cure viral meningitis, and most cases improve on their own in a week or two without therapy. Treatment of mild casesof viral meningitis usually includes: Bed rest Plenty of fluids Over-the-counter pain medications to help reduce fever and relieve body achesIf the cause of your meningitis is a herpes virus, there's an antiviral medication available.Other types of meningitis

If the cause of your meningitis is unclear, your doctor may start antiviral and antibiotic treatment while a cause is being determined.Fungal meningitis treatments are associated with harmful side effects, so treatment is often deferred until a laboratory can confirm thecause is fungal.Non-infectious meningitis due to allergic reaction or autoimmune disease may be treated with cortisonelike medications. In some casesno treatment may be required, because the condition can resolve on its own. Cancer related meningitis requires therapy for theindividual cancer.

PreventionBy Mayo Clinic staffMeningitis typically results from contagious infections. Common bacteria or viruses that can cause meningitis can spread throughcoughing, sneezing, kissing, or sharing eating utensils, a toothbrush or a cigarette. You're also at increased risk if you live or work withsomeone who has the disease.


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These steps can help prevent meningitis: Wash your hands. Careful hand washing is important to avoiding exposure to infectious agents. Teach your children to wash theirhands often, especially before they eat and after using the toilet, spending time in a crowded public place or petting animals. Showthem how to wash their hands vigorously, covering both the front and back of each hand with soap and rinsing thoroughly underrunning water. Stay healthy. Maintain your immune system by getting enough rest, exercising regularly, and eating a healthy diet with plenty offresh fruits, vegetables and whole grains.

Cover your mouth. When you need to cough or sneeze, be sure to cover your mouth and nose. If you're pregnant, take care with food. Reduce your risk of listeriosis if you're pregnant by cooking meat thoroughly and avoidingcheeses made from unpasteurized milk.ImmunizationsSome forms of bacterial meningitis are preventable with the following vaccinations: Haemophilus influenzae type b (Hib) vaccine. Children in the United States routinely receive this vaccine as part of the recommendedschedule of vaccines, starting at about 2 months of age. The vaccine is also recommended for some adults, including those who havesickle cell disease or AIDS and those who don't have a spleen. Pneumococcal conjugate vaccine (PCV7). This vaccine is also part of the regular immunization schedule for children younger than 2years in the United States. In addition, it's recommended for children between the ages of 2 and 5 who are at high risk ofpneumococcal disease, including children who have chronic heart or lung disease or cancer. Pneumococcal polysaccharide vaccine (PPSV). Older children and adults who need protection from pneumococcal bacteria mayreceive this vaccine. The Centers for Disease Control and Prevention recommends the PPSV vaccine for all adults older than 65, foryounger adults and children who have weak immune systems or chronic illnesses such as heart disease, diabetes or sickle cell anemia,

and for those who don't have a spleen. Meningococcal conjugate vaccine (MCV4). The Centers for Disease Control and Prevention recommends that a single dose of MCV4be given to children ages 11 to 12 or to any children ages 11 to 18 who haven't yet been vaccinated. However, this vaccine can begiven to younger children who are at high risk of bacterial meningitis or who have been exposed to someone with the disease. It'sapproved for use in children as young as 9 months old. It's also used to vaccinate healthy people who have been exposed in outbreaksbut have not been previously vaccinated.

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