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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. Causes It'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. In both cases, bacteria may subsequently invade rapidly, causing the appendix to become inflamed and filled with pus. If not treated promptly, your appendix eventually may rupture. Signs and symptoms Appendicitis can cause a variety of symptoms that may change over time. The most common early symptom is an aching pain around your 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. This point is about halfway between your navel and the top of your right pelvic bone. But the location of your pain may vary, depending on your 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 true if the inflamed appendix is touching the peritoneum. The pain may lessen somewhat if you lie on your side and pull your legs up beneath 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 and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-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 organs onto film. Treatment Specific 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 Medicines If the diagnosis is uncertain, people may be watched and sometimes treated with antibiotics. This approach is taken when the doctor suspects 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 with antibiotics 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 the area of the appendix. The surgeon enters the abdomen and looks for the appendix, which usually is located in the right lower part of the abdomen. After examining the area around the appendix to be certain that no additional problem is present, the appendix is removed. This is done by freeing the appendix from its attachment to the abdomen and to the colon. If present, abscesses can be drained 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 a video camera that allows the surgeon inspect the inside of the abdomen through a small puncture wound (instead of a much larger incision). If appendicitis is found, the appendix can be removed with special instruments that can be passed into the abdomen, just like the laparoscope, through small puncture wounds. The benefits of the laparoscopic technique include less post-surgery pain (since much of the post-surgery pain comes from incisions) and a speedier recovery. An additional advantage of laparoscopy is that it allows the surgeon to look inside the abdomen in cases in which the diagnosis of appendicitis is in doubt and to make a clear diagnosis of the problem. 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 which only 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 the stomach. In most instances, this condition resolves spontaneously. Occasionally, another operation may be needed to free the obstruction. 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 pain relief 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 or frequent 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 Shingles Herpes 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 syndrome Causes, incidence, and risk factors After you get chickenpox, the virus remains inactive (becomes dormant) in certain nerves in the body. Shingles occurs after the virus becomes 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 can develop 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 before any 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. The symptoms 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, prevent complications, 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 the blisters 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 drugs do 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 motor nerves), 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 outbreak of 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 provider Call your health care provider if you have symptoms of shingles, particularly if you have a weakened immune system or if your symptoms persist or worsen. Shingles that affects the eye may lead to permanent blindness if you do not receive emergency medical care.

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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 chickenpox vaccine. A herpes zoster vaccine is available. It is different than the chickenpox vaccine. Older adults who receive the herpes zoster vaccine are less likely to have complications from shingles. The United States Advisory Committee on Immunization Practices (ACIP) has recommended that adults older than 60 receive the herpes zoster vaccine as part of routine medical care. Definition By Mayo Clinic staff Lupus 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, heart and lungs. Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive sign of lupus 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 staff Lupus 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, and may be temporary or permanent. Most people with lupus have mild disease characterized by episodes called flares when signs and 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 most common 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 Causes By Mayo Clinic staff Lupus occurs when your immune system attacks healthy tissue in your body. It's likely that lupus results from a combination of your genetics and your environment. It appears that people with an inherited predisposition for lupus may develop the disease when they come 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. People who have drug-induced lupus usually see their symptoms go away when they stop taking the medication. Risk factors By Mayo Clinic staff Factors 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.

Complications By Mayo Clinic staff Inflammation 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 e ven strokes 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 can also 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 make breathing painful. Heart. Lupus can cause inflammation of your heart muscle, your arteries or heart membrane (pericarditis). The risk of cardi ovascular disease and heart attacks increases greatly as well. Other types of complications Having lupus also increase your risk of: Infection. People with lupus are more vulnerable to infection because both the disease and its treatments weaken the immune system. 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 the bone 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 th e risk of high blood pressure during pregnancy (preeclampsia) and preterm birth. To reduce the risk of these complications, doctors recommend delaying pregnancy until your disease has been under control for at least 6 months. ests and diagnosis By Mayo Clinic staff Diagnosing lupus is difficult because signs and symptoms vary considerably from person to person. Signs and symptoms of lupus may vary over time and overlap with those of many other disorders. No one test can diagnose lupus. The combination of blood and urine tests, signs and symptoms, and physical examination findings leads to the diagnosis. Laboratory tests Blood 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 of hemoglobin, a protein in red blood cells. Results may indicate you have anemia, which commonly occurs in lupus. A low white blood cell 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. It may 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 may occur if lupus has affected your kidneys. Antinuclear antibody (ANA) test. A positive test for the presence of these antibodies produced by your immune system indicates a stimulated immune system. While most people with lupus have a positive ANA test, most people with a positive ANA do not have lupus. If you test positive for ANA, your doctor may advise more-specific antibody testing. Imaging tests If 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 your valves and other portions of your heart. Biopsy Lupus can harm your kidneys in many different ways and treatments can vary, depending on the type of damage that occurs. In some cases, 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 drugs By Mayo Clinic staff Treatment for lupus depends on your signs and symptoms. Determining whether your signs and symptoms should be treated and what medications to use requires a careful discussion of the benefits and risks with your doctor. As your signs and symptoms flare and subside, you and your doctor may find that you'll need to change medications or dosages. The medications most commonly used to control 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 effects of 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-term side effects including weight gain, easy bruising, thinning bones (osteoporosis), high blood pressure, diabetes and increased risk of infection. 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 include cyclophosphamide (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 of cancer. A newer medication, belimumab (Benlysta) also reduces lupus symptoms in some people. Side effects include nausea, diarrhea and fever. Lifestyle and home remedies By Mayo Clinic staff Take steps to care for your body if you have lupus. Simple measures can help you prevent lupus flares and, should they occur, better cope 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 is n't necessarily 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 naps or 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 a nd promote general well-being. Don't smoke. Smoking increases your risk of cardiovascular disease and can worsen the effects of lupus on your heart and blood vessels. Eat a healthy diet. A healthy diet emphasizes fruits, vegetables and whole grains. Sometimes you may have dietary restricti ons, especially if you have high blood pressure, kidney damage or gastrointestinal problems. Alternative medicine By Mayo Clinic staff Sometimes alternative or complementary medicine may benefit people with lupus. However, these therapies are usually used with conventional medications. Discuss these treatments with your doctor before initiating them on your own. He or she can help you weigh the 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 to stabilize 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 have found 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 found some promise, though more study is needed. Side effects of fish oil supplements can include nausea, belching and a fishy taste in the mouth. Vitamin D. There is some evidence to suggest that people with lupus may benefit from supplemental vitamin D. Coping and support By Mayo Clinic staff If you have lupus, you're likely to have a range of painful feelings about your condition, from fear to extreme frustration. The challenges of living with lupus increase your risk of depression and related mental health problems, such as anxiety, stress and low self-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. Ask your doctor or nurse for reputable sources of further information. The more you know about lupus, the more confident you'll feel in your treatment choices. Gather support among your friends and family. Talk about lupus with your friends and family and explain ways they can help out when 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 friends and 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 or write 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 lupus through support groups in your community or through online message boards. Other people with lupus can offer unique support because they're facing many of the same obstacles and frustrations that you're facing. Definition By 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 an infection. The swelling associated with meningitis often triggers the "hallmark" signs and symptoms of this condition, including headache, 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 on the 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 staff It's easy to mistake the early signs and symptoms of meningitis for the flu (influenza). Meningitis signs and symptoms may develop over 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 newborns Newborns and infants may not have the classic signs and symptoms of headache and stiff neck. Instead, signs of meningitis in this age group 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 Seizures Infants with meningitis may be difficult to comfort, and may even cry harder when picked up. When to see a doctor Seek 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 neck There'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 o f a recovery without serious complications. Delaying treatment for bacterial meningitis increases the risk of permanent brain damage or death. 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 prevent getting sick. Causes By Mayo Clinic staff Meningitis Meningitis usually results from a viral infection, but the cause may also be a bacterial infection. Less commonly, a fungal infection may cause meningitis. Because bacterial infections are the most serious and can be life-threatening, identifying the source of the infection is an 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 also occur 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, young children 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 meni ngitis

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commonly occurs when bacteria from an upper respiratory infection enter your bloodstream. This infection is highly contagious. It affects 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 of bacterial meningitis in children. But new Hib vaccines available as part of the routine childhood immunization schedule in the United States have greatly reduced the number of cases of this type of meningitis. When it occurs, it tends to follow an upper respiratory infection, 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 become contaminated. 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 and older adults tend to be more susceptible. Listeria can cross the placental barrier, and infections in late pregnancy may cause a baby to be stillborn or die shortly after birth. People with weakened immune systems, due to disease or medication effect, are most vulnerable. Viral meningitis Each year, viruses cause a greater number of cases of meningitis than do bacteria. Viral meningitis is usually mild and often clears on its own within two weeks. A group of viruses known as enteroviruses are responsible for about 30 percent of viral meningitis cases in the 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. These viruses tend to circulate in late summer and early fall. Viruses such as herpes simplex virus, La Crosse virus, West Nile virus and others also can cause viral meningitis. Chronic meningitis Chronic forms of meningitis occur when slow-growing organisms invade the membranes and fluid surrounding your brain. Although acute meningitis strikes suddenly, chronic meningitis develops over two weeks or more. Nevertheless, the signs and symptoms of chronic meningitis headaches, fever, vomiting and mental cloudiness are similar to those of acute meningitis. This type of meningitis is rare. Fungal meningitis Fungal 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 lifethreatening if not treated with an antifungal medication. Other meningitis causes Meningitis can also result from noninfectious causes, such as drug allergies, some types of cancer and inflammatory diseases such as lupus. Risk factors By Mayo Clinic staff Not 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 af fected young children. But since the mid-1980s, as a result of the protection offered by current childhood vaccines, the median age at which bacterial 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 boardin g schools and child care facilities are at increased risk of meningococcal meningitis, probably because the bacterium is spread by the respiratory route 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 also cause 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 of contracting listeria, which can lead to meningitis. Compromised immune system. Factors that may compromise your immune system including AIDS, diabetes and use of immunosuppressant drugs also make you more susceptible to meningitis. Removal of your spleen, an important part of your immune system, also may increase your risk. Complications By Mayo Clinic staff The complications of meningitis can be severe. The longer you or your child has the disease without treatment, the greater the risk of seizures and permanent neurological damage, including: Hearing loss Blindness Memory difficulty Loss of speech Learning disabilities Behavior problems Brain damage

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Paralysis Other complications may include: Kidney failure Adrenal gland failure Shock Death Tests and diagnosis By Mayo Clinic staff Your 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 your child 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 a microscope for bacteria. Imaging. X-rays and computerized tomography (CT) scans of the head, chest or sinuses may reveal swelling or inflammation. These tests 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 identify the exact bacterium that's causing the illness. It can take up to a week to get these test results, If your doctor suspects meningitis, he or she may order a DNA-based test known as a polymerase chain reaction (PCR) amplification to check for the presence of viral causes of meningitis. This may provide results about your meningitis in as little as four hours and help to determine proper treatment. Treatments and drugs By Mayo Clinic staff The 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, to ensure recovery and reduce the risk of complications. The antibiotic or combination of antibiotics that your doctor may choose depends on the type of bacteria causing the infection. Your doctor may recommend a broad-spectrum antibiotic until he or she can determine the 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. Infected fluid that has accumulated between the skull and the membranes that surround the brain also may need to be drained surgically. Viral meningitis Antibiotics can't cure viral meningitis, and most cases improve on their own in a week or two without therapy. Treatment of mild cases of viral meningitis usually includes: Bed rest Plenty of fluids Over-the-counter pain medications to help reduce fever and relieve body aches If 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 the cause is fungal. Non-infectious meningitis due to allergic reaction or autoimmune disease may be treated with cortisonelike medications. In some cases, no treatment may be required, because the condition can resolve on its own. Cancer related meningitis requires therapy for the individual cancer. Prevention By Mayo Clinic staff Meningitis typically results from contagious infections. Common bacteria or viruses that can cause meningitis can spread through coughing, sneezing, kissing, or sharing eating utensils, a toothbrush or a cigarette. You're also at increased risk if you live or work with someone 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 t heir hands often, especially before they eat and after using the toilet, spending time in a crowded public place or petting animals. Show them how to wash their hands vigorously, covering both the front and back of each hand with soap and rinsing thoroughly under running water. Stay healthy. Maintain your immune system by getting enough rest, exercising regularly, and eating a healthy diet with plenty of fresh 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 avoiding cheeses made from unpasteurized milk. Immunizations Some 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 recommended schedule of vaccines, starting at about 2 months of age. The vaccine is also recommended for some adults, including those who have sickle 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 2 years in the United States. In addition, it's recommended for children between the ages of 2 and 5 who are at high risk of pneumococcal 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 may receive this vaccine. The Centers for Disease Control and Prevention recommends the PPSV vaccine for all adults older than 65, for younger 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 MCV 4 be 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 be given to younger children who are at high risk of bacterial meningitis or who have been exposed to someone with the disease. It's approved for use in children as young as 9 months old. It's also used to vaccinate healthy people who have been exposed in outbreaks but have not been previously vaccinated.