anal fissure

A tear in the skin around the anus.

amyotrophic lateral sclerosis

A progressive degenerative disease of the motor neurons in the brain and spinal cord that control voluntary muscles; also known as Lou Gehrig's disease.

amniotomy

Artificial rupture of the amniotic sac (the sac that contains the amniotic fluid, which protects a fetus in the uterus) to induce labor.

amniotic sac

The sac that contains the amniotic fluid, which protects a fetus in the uterus.

amniotic fluid

The fluid that surrounds and protects a fetus in the womb.

amenorrhea

The absence of menstruation (a woman's monthly period).

Alzheimer's disease

A form of dementia marked by impaired memory, thinking and behavior. A person who has Alzheimer's disease loses the ability to perform vital mental and physical functions.

alternative medicine

Health care practices, such as homeopathy, chiropractic or herbal medicine, that do not conform to conventional medical methods, and may not have a scientific explanation for their effectiveness.

alopecia areata

A condition that produces nonscarring hair loss with smooth patches of skin. It has an unpredictable course that depends on the extent of hair loss. The condition tends to resolve without treatment.

allergist/immunologist

An allergist/immunologist is a physician who specializes in allergies and other conditions affecting the immune system. An allergist/immunologist may treat allergies caused by various substances or factors.

albumin

One of a group of simple proteins that helps maintain blood volume and blood pressure.

agranulocytosis

The lack of granulocytic white blood cells (those that help protect against infection).

agoraphobia

The overwhelming fear of being in a situation or place in which escape may be difficult or help may not be available. Agoraphobia is accompanied by panic disorder in nearly 95 percent of cases. This fear often causes a person to avoid public situations or activities.

adrenal glands

Glands that produce a range of hormones and are located on the surface of the kidneys. Also called the suprarenal glands.

adrenal cortex

The outer portion of the adrenal gland, which manufactures hormones crucial for the functioning of nearly all body systems.

adenosis

Any disease of a gland, especially a lymphatic gland.

adenoid

Lymph node tissue in the back of the nose and throat area that helps filter infections from the body.

Addison's disease

A rare disease in which the adrenal glands (glands that produce a range of hormones and maintain normal levels of hormones in the blood) fail to produce enough steroid hormones. In some cases, Addison's disease is related to a problem with the immune system. It may also be caused by an infection or tumor.

acute

Severe, occurring or appearing abruptly or suddenly, and lasting a short duration; opposite of chronic.

acromegaly

A chronic condition that results in excessive enlargement of the extremities of the skeleton due to thickening of bones and soft tissues. Acromegaly is caused by excessive secretion of growth hormone, usually due to a tumor of the pituitary gland (the gland at the base of the brain that secretes hormones to stimulate growth and controls other hormone-producing glands).

abscess

Localized collection of pus caused by an infection. An abscess is the result of the body's natural defense mechanism, which walls off an area of infection to keep it from spreading to the rest of the body.

abruptio placenta

Early separation of the placenta (a structure in the womb that develops during pregnancy to nourish the fetus and help it discard waste) from the uterus (the female reproductive organ that houses the embryo and fetus during pregnancy). When the placenta separates from the uterus early there is an increased risk of hemorrhaging (excessive bleeding) during pregnancy and childbirth. Abruptio placenta most commonly occurs in the third trimester (the last 3 months) of pregnancy. Symptoms of abruptio placenta include vaginal bleeding, constant abdominal pain or back pain.

abdomen

The part of the body that contains the:


lower part of the esophagus (the tube that connects the throat and stomach)
stomach (the organ that processes food and passes it to the small intestine)
small intestine (the organ that continues the digestion process started by the mouth and stomach)
liver (an organ that plays a key role in many important metabolic functions and also produces bile, a fluid released into the intestine to help the body digest fats)
gallbladder (the sac that stores bile excreted from the liver and sends it to the small intestine during digestion)
spleen (the organ that helps in body defenses; the spleen stores and sometimes produces blood cells)
pancreas (the gland that produces hormones such as insulin, as well as some of the enzymes needed to digest food)
large intestine (the organ that reabsorbs water and directs waste products or feces to the anus for excretion from body)
bladder (the sac that collects urine produced by the kidney before excretion from the body)

Workplace performance problems

Overview
Job performance is typically based on various factors, including employer expectations; results, such as quality, quantity and timeliness; attendance and promptness; and work style, including relationships with coworkers and control of emotions. Workplace performance problems are typically related to a decline in work performance or an inability to meet job expectations, as perceived by either the employee or employer.
External control measures, such as formal policies for attendance and time, can typically enhance employee performance. Internal self-management, such as seeking additional help when needed to complete a project on time, can have the same effect. Through self-management, you can control certain aspects of your decision making and behavior. Generally, self-management is a set of behavioral and cognitive strategies that help you structure your own environment, become self-motivated, and choose behaviors that lead to good job performance. Not everyone is a good self-manager, however. Some employees may need help enhancing their self-management skills.


Personality factors
Researchers have correlated five personality traits with favorable job performance.
Conscientious: People who are conscientious are responsible, dependable and persistent. Theytured, cooperative and trusting. Theyre extroverted are sociable, talkative and typically assertive.
Open attitude: People who are open tend to be imaginative, artistically sensitive and intellectual.
Perhaps surprisingly, researchers have found these personality traits (particularly conscientiousness) to be better predictors of favorable job performance than measures of job-specific skills or general intelligence.


Characteristics
Workplace performance problems may lead to physical issues, such as fatigue, queasiness the night before work (particularly if you've been off for a weekend or vacation) or sleep changes. Psychologically, you may feel anxious, inadequate, unappreciated, irritable, nervous or frustrated. You may also feel panicked or have fantasies about revenge. Socially, you may become passive-aggressive or engage in counterproductive behaviors. You may also lack assertiveness, withdraw from others, and experience increased conflict with coworkers, your supervisor or others outside of work.
Sometimes, workplace performance problems can be more than you're able to handle at the time. Symptoms such as sleep disturbances, decreased energy, changes in appetite, anxiety, depression, inability to concentrate and hopelessness may warrant further evaluation by a health care professional.

As with all physical symptoms, consult your medical doctor to rule out a medical condition. If these or any other symptoms cause you distress that doesn't seem to improve, seek additional help and support from a mental health care professional.


Coping strategies
Focusing on interpersonal skills such as communication and conflict resolution can often help you resolve or better cope with the performance issue at hand. Talking with a trusted mentor or superior may help with developing and implementing possible solutions to the problem. In some cases, personal life coaching may be helpful. You might also consider stress-management techniques, such as deep breathing exercises, medication, or relaxation to reduce and alleviate stress around workplace performance issues.
Consider your perception of your job expectations, as well as what your employer expects. Discuss performance issues with your supervisor to help understand the expectations. Also explore options for making changes and improvements. You may find you need more effective training to complete your work duties. Or, you may want to explore other training topics in order to expand your skills.

Workplace discrimination

Overview
Discrimination in the workplace is a controversial topic that has been highly debated in the courts. Discrimination in the workplace may include discrimination based on a person's race, color, religion, sex, parental status, marital status, political affiliation or national origin (referring to birthplace, ancestry, culture or certain linguistic characteristics). The most common discrimination charge made to the Equal Employment Opportunity Commission in 2002 (the most recent year for which statistics are available) was racial discrimination, followed by discrimination based on gender, national origin and religion. The Americans with Disabilities Act involves discrimination on the basis of physical or mental disability.
There are three categories of workplace discrimination:

Overt discrimination is characterized by outward statements of a discriminatory nature.
Systematic discrimination is found in systems in which certain "neutral" characteristics or requirements, such as height or weight, are actually discriminatory.
A hostile work environment may develop when an employee is subjected to derogatory comments, racist or sexist jokes, or otherwise hostile treatment.
Various factors impact workplace discrimination and an employee's response to the situation. For example, an employee may find certain behaviors acceptable or unacceptable based on his or her cultural beliefs or practices. A history of discrimination and the action taken may affect an employee's view of discrimination. Work history and past performance may be another factor. Organizational culture also plays a role. For example, does the company have written policies about discrimination? Are they posted or widely available? Is a human resources representative or personnel department available to respond to discrimination concerns?


Impact on health and well-being
Discrimination can take a serious toll on your health and well-being. Physically, you may experience sleep and appetite changes or fatigue.
Socially, you may withdraw from others and/or lack assertiveness with co-workers or supervisors. You may be quick to take offense or increasingly sensitive to criticism. You be over-reactive, fearful of reaching out for assistance or distrustful of the system.

Emotionally, you may feel guilty, ashamed, anxious or full of self-doubt. Others become angry or fearful. You may be preoccupied and feel scattered or unorganized. You may also have difficulty correctly perceiving your situation.

Sometimes workplace discrimination can be more than you're able to handle at the time. Symptoms such as sleep disturbances, decreased energy, changes in appetite, anxiety, depression, inability to concentrate and hopelessness may warrant further evaluation by a health care professional.

As with all physical symptoms, consult your medical doctor to rule out a medical condition. If these or any other symptoms cause you distress that doesn't seem to improve, seek additional help and support from a mental health care professional.


Coping strategies
Consult your human resources representative, personnel department, supervisor or company policy for information about how to make a discrimination report. Collaborate with your employer to reach the desired outcome. It's important to seek emotional support outside your work environment. Consider counseling or a support group if needed, and remember the importance of taking care of yourself.
If you're managing an employee who's involved in a workplace discrimination situation, seek assistance if you're unsure how to implement the investigation process. Consult with a human resources or personnel representative or your supervisor to review your company's policies and procedures about workplace discrimination. Consult your legal department or an attorney as necessary. Keep your own managers apprised of the situation, and respond in a timely fashion to any allegations directed to you. Also determine if ADA statutes may apply. If this is the case, encourage your employee to consult the human resources department or other appropriate company representative, as well as the company's legal department or an attorney.

Workplace culture

Overview
Workplace culture varies greatly depending on the type of industry or business, the style of leadership in the organization, and the diversity or uniformity of the workforce in terms of age, sex, ethnic and cultural background, and educational and socioeconomic status.
Various factors contribute to your perception of workplace culture. How your family shaped your attitude toward work and career is influential, as well as your ethnic or cultural background, particularly in regard to attitudes toward work and authority. Your ability to manage conflict and strive for "win-win" solutions also plays a role. Other factors include your age and stage of career development. For example, a young adult just starting a career is likely to have a different perception of work than an older person nearing the end of a career. Your need for challenge or stability can also affect your perceptions of the workplace.

Types of workplace cultures
According to Robert Blake and Jane Mouton, authors of Leadership Dilemmas -- Grid Solutions, there are five general types of workplace culture, each with a unique way of handling conflict among employees.

Low concern for tasks and productivity, as well as the social and emotional needs of employees: This type of culture is often prevalent in organizations experiencing change, such as when a leader retires, a plant faces closure, or layoffs are imminent. When conflict occurs, it does not seem to matter to participants.

High concern for tasks and productivity, but low concern for the social and emotional needs of employees: This type of culture is often prevalent in organizations with a rigid, hierarchical command structure. Dissent is not tolerated and forming meaningful relationships with other employees is discouraged.

Moderate concern for tasks and productivity, as well as the social and emotional needs of employees: With a "middle of the road" culture, conflict is often managed by manipulating the workload or the demands and rewards of work.

Low concern for tasks and productivity, but high concern for the social and emotional needs of employees: This type of culture focuses on relationships between employees. If there is significant focus on "in groups" and "out groups," the culture can be quite political. When conflict occurs, it's usually interpersonal in nature. Often, conflict is squelched because the emphasis is on employees getting along.

High concern for tasks and productivity, as well as the social and emotional needs of employees: With a team-focused culture, conflict is understood to be a part of the process. Conflict is handled by open discussion and attempting to develop "win-win" solutions.
Workplace culture can also influence how and to what extent an employee assistance program is utilized. For example, the extent to which employees are informed about their employee assistance services and general perceptions regarding program confidentiality have a direct impact on utilization.


Characteristics
Physically, a poor workplace culture may cause stress-related complaints such as headaches and tense muscles. Psychologically, you may feel angry, confused or hopeless. You may blame yourself or others for the feelings. Some unhappy employees develop low self-esteem or fantasize about revenge regarding certain co-workers or the workplace itself. Socially, you may exhibit aggressive or destructive behavior. You may experience increased absenteeism or workplace conflict, as well as begin to explore other job options. Lack of assertiveness and passive-aggressive behavior are also common. Eventually, you may notice increased tension in relationships outside of work.
Sometimes problems with your workplace culture can be more than you're able to handle at the time. Symptoms such as sleep disturbances, decreased energy, changes in appetite, anxiety, depression, inability to concentrate and hopelessness may warrant further evaluation by a health care professional.

As with all physical symptoms, consult your medical doctor to rule out a medical condition. If these or any other symptoms cause you distress that doesn't seem to improve, seek additional help and support from a mental health care professional.


Coping strategies
If your workplace culture significantly affects your ability to perform your job successfully or otherwise interferes with your health and well-being, you may want to consult your supervisor or human resources department. The role of human resources is to assist employees with work-related concerns and serve as a liaison between employees and the company. You may also want to consider your own skills for coping within your workplace's culture. For example, learning to improve your communication skills and problem-solving techniques, as well as conflict and anger management skills, may have a positive impact on your experience on the job.

Workplace conflict

Overview
As the name implies, workplace conflict is an angry, conflictual or confrontational relationship between co-workers or an employee and his or her supervisor. Workplace conflict may be caused by a personal, professional, physical, emotional, or psychological perception of threat or risk to yourself or someone else.
Generally, the perception of positive relationships between supervisors and employees is related to higher levels of work satisfaction. Conflict with a supervisor is usually related to organizationally relevant outcomes such as job dissatisfaction, lack of organizational commitment and turnover. Conflict with co-workers is usually related to personally relevant outcomes, such as depression and other physical symptoms that may have a psychological basis.


Characteristics
Physically, you may experience fatigue, a decreased energy level or sleep disturbances. You may also feel queasy the night before work. Psychologically, you may feel angry, irritable, powerless, worthless, defensive and frustrated. You may also experience low self-esteem and a loss of motivation. Socially, workplace conflict may impact your work performance and other work relationships. You may have a higher level of absenteeism and a fluctuating work pattern. You may also feel isolated, procrastinate or withdraw from work activities.
Sometimes, a conflict in the workplace can be more than you're able to handle at the time. Symptoms such as sleep disturbances, decreased energy, changes in appetite, anxiety, depression, inability to concentrate and hopelessness may warrant further evaluation by a health care professional.

As with all physical symptoms, consult a medical doctor to rule out a medical condition. If these or any other symptoms cause you distress that doesn't seem to improve, seek additional help and support from a mental health care professional.


Coping strategies
You may want to begin by assessing the problem. Document the nature of the conflict, how long it's lasted, and who is involved. Consider what you've done to resolve the conflict. Also, understand the nature of your job and the culture of the organization. If performance issues are a concern, what is the severity, frequency and duration? Be aware of the impact conflict can have on your personal life, physical health and emotional health, as well as that of the other people involved. Keep in mind the potential for violence in the workplace, as well as discrimination or bias issues. If you have any concerns about workplace conflict, consult your human resources representative or an appropriate member of the management team that's responsible for ensuring your company's policies and ethical guidelines.
If you're a supervisor, document any previous or current work performance issues for the employee, as well as any previous problems with other supervisors. Find out if the person has a history of anger management concerns, including angry outbursts in either a personal or work setting. Also find out if there has been any current or past human resources involvement.

To approach conflict negotiation and resolution in a positive manner, be direct and straightforward. Focus on the issues rather than the person involved. Use an appropriate problem-solving approach, and strive to achieve a win/win solution. Keep in mind that several outcomes to conflict negotiation are possible. In a win/win situation, an agreement that meets the needs of both people is reached. With a compromise, each person gives up part of his or her agenda. Or, you may agree to disagree. In this case, you will acknowledge that agreement is not essential to reaching mutual goals, and that disagreement does not damage your relationship. In a win/lose situation, one person prevails and the other loses. This outcome has a high potential to damage the relationship. If you don't reach a solution, the conflict or disagreement may simply continue.

If you find yourself working with a difficult person, having a strategy in mind may be helpful. Start by assessing the situation. Stop wishing the person were different, and distance yourself from the difficult behavior. Formulate a plan for interrupting interactions with the person, and implement your strategy. Monitor the progress or the effectiveness of your coping strategies and modify them when appropriate.

You may also want to consider seeking outside resources to help yourself cope with workplace conflict. For example, options may include individual or career counseling or training in stress management, assertiveness or anger management. Consulting peers and seeking support from human resources or an appropriate manager can be useful as well.

Wise use of medications

Medications are substances used to treat or prevent disease and illness. Some medications are available over the counter (OTC). Others require a prescription from your doctor.


Prescription medications
When your doctor prescribes a medication, make sure you understand exactly why you need to take it. Ask your doctor or pharmacist the following questions, as suggested by the U.S. Food and Drug Administration (FDA):
What are the brand and generic names of the medication?

How is the medication supposed to work?

When and how should I take the medication? For how long?

Can I take the medication on an empty stomach or should I eat first?

What should I do if I miss a dose of the medication?

What are the possible side effects of the medication?

How should I store the medication?

Is it safe to drink alcohol or take other medications while I take this one?
Always read the medication label carefully. Make sure the medication is what your doctor ordered. Also, talk to your doctor about any new medications or supplements you're taking to avoid possible problems with existing medical conditions, as well as interactions with other OTC medications, prescription medications or nutritional supplements.

If you receive a medication sample from your doctor, make sure you receive clear, understandable directions -- preferably in writing. Ideally, the medication should be labeled with your name and instructions regarding dosage and frequency.


Medication compliance
Take your medication as directed by your doctor or pharmacist. Prescription medications are most effective when taken at the same time every day. It can be easy to forget to take medication or become confused by multiple medication schedules. If you take medication several times a day or take many different medications, it may be helpful to set out the day's or week's supply in a divided pill box (available at most pharmacies). Some people prefer to keep a medication calendar in which they record the medication and time it was taken.
Always consult your doctor before you stop taking a particular medication. Although you may be tempted to stop taking your medication because you feel better or it causes an unpleasant side effect, this can do more harm than good. The ailment may recur, or you may experience withdrawal symptoms or complications.


Antibiotics
Many people request prescriptions for antibiotics for various symptoms or ailments, such as the common cold. Antibiotics are only effective for infections caused by bacteria, however. Improper or unnecessary use of antibiotics helps bacteria develop resistance, eventually rendering the antibiotic ineffective for the treatment of certain bacterial infections. Unnecessary use of antibiotics also leads to potential side effects, some of which may be serious or life-threatening.

Over-the-counter medications
Over-the-counter medications are available without a prescription. Common OTC medications include fever reducers, pain relievers, cough syrups, cold remedies and vitamins. Although these medications are available without a prescription, they can be harmful if taken incorrectly. They can also have side effects. Always read the label and consult your doctor or pharmacist if you have any questions. If you have a history of kidney or liver disease, are pregnant or breastfeeding, or already use prescription medications, consult your doctor before taking any nonprescription medications.

Side effects
It's important to take medications that are right for you based on your current health status and medical history. Any medication can potentially cause various side effects. If you have any concerns about a side effect you're experiencing, contact your doctor.
Common medication side effects may include:

rashes
nausea, upset stomach or vomiting
appetite loss
fatigue
If you experience any of the following side effects or new symptoms while taking any type of medication, consult your doctor immediately:

confusion
excessive sleepiness
accidental falls
bleeding that won't stop
increased bruising

Medication allergies
Medications can sometimes cause a severe, life-threatening allergic response called anaphylaxis. This is a medical emergency. The first symptom may be a feeling of impending doom. Other symptoms may include:
hives (a sudden bumpy or welt-like, itchy rash)
difficulty breathing
wheezing
swelling of the throat, tongue, lips or eyes
difficulty swallowing
nausea, vomiting, diarrhea or abdominal cramps
chest tightness
seizures
shock
Anaphylaxis is life-threatening. Call 911 immediately for medical assistance!


Precautions for women of childbearing age
If your last period was more than 30 days ago or there's any possibility of being pregnant, contact your doctor before taking any prescription or nonprescription medications.
If you're taking birth control pills, beware that other medications may reduce the effectiveness of the pill. Mention the type of birth control pill you take to any doctor who prescribes a new medication for you. Consult your doctor with any questions or concerns.


Pregnancy-specific information
If you're pregnant or breastfeeding, ask your doctor about the safety of any prescription or nonprescription medication you're considering taking. Remember, some medications can travel to a developing baby through the placenta. Likewise, certain medications can be transmitted to a nursing baby through breast milk.

Considerations
Keep a current list of all medications you take. Remember to include OTC and prescription medications, vitamins, and dietary and herbal supplements. Also include any medication allergies you may have. Bring this list with you to all doctor appointments or if you go to the hospital for any reason.
Periodic checkups are important to evaluate your health, re-evaluate your medication needs, and address any problems or any adverse effects you may have.

Never take anyone else's medication, even if you have the same symptoms.


Purchasing medication outside the United States
You may be familiar with people going to Canada or Mexico to purchase medications at a lower cost or without a prescription from a doctor. You may also have heard about people purchasing medication from other countries through the Internet. As debate about this practice continues on state and national levels, keep in mind that these medications may be unsafe, ineffective or even illegal.
For example, labeling and instructions may be in a language you don't understand or may not include all the information you need to safely take the medication. Also, these medications may not go through the same quality assurance procedures required in the United States. If you're considering purchasing medications outside the United States or through the Internet, especially prescription medications, discuss it with your doctor.

Whooping cough

Whooping cough, also known as pertussis, is a highly contagious bacterial respiratory infection that causes violent coughing spells that end in a characteristic "whoop" as the person tries to fill his or her lungs.


Causes/associated factors
Whooping cough is caused by the bacterium Bordetella pertussis. The infection typically spreads by inhaling infected respiratory droplets that were coughed or sneezed into the air. Then, the bacteria grow in the nasal passages and move down to the breathing tubes and lungs. There, the bacteria cause inflammation, resulting in the production of thick secretions that may block the airways and cause coughing, a lack of oxygen or pneumonia (a lung infection).
Whooping cough is most common in children younger than age 5, but it can affect older children and adults as well. The condition is most serious for infants. Whooping cough occurs at any time of the year, but may be more likely in the summer and fall. If you contract whooping cough once, you're unlikely to get it again. Reinfection years later is possible, however. Adolescents and adults who were immunized long ago or didn't receive the full series of immunizations can become infected. Although these adults often have mild symptoms, they can still spread the infection.

Although the incidence of whooping cough in the United States has increased recently, vaccination has greatly reduced the prevalence of whooping cough. Infants don't receive protective antibodies from their mothers at birth, so immunization must begin early.


Transmission
The incubation period (time from exposure until symptoms appear) for whooping cough is usually seven to 10 days, but may range from four to 21 days. Again, the bacteria usually enter your body when you inhale infected respiratory droplets in the air. It's quite common for members of the same household to infect each other. And the infection doesn't spread from children alone. Infected adults can transmit whooping cough to infants and susceptible children who haven't completed the vaccination series.
Whooping cough is highly contagious. You can spread the infection to others as early as seven days after you're exposed to the bacteria. You're the most contagious during the first stage of illness, before severe coughing begins. Without antibiotic treatment, you'll be contagious up to three weeks after the coughing stage begins. Antibiotics reduce this contagious period to just five days after beginning treatment.


Signs/symptoms
Whooping cough can last up to six to 10 weeks. The infection has three stages: early, cough and convalescent. The classic symptoms of whooping cough are most common in children between ages 6 months and 5 years. For this age group:
During the early stage, which lasts one to two weeks, symptoms often include a mild, dry cough; a runny nose; sneezing; lack of appetite; red, watery eyes; and possibly a slight fever.

During the cough stage, which usually lasts one to six weeks, the dry cough gets progressively worse as thicker secretions accumulate in the lungs. These secretions make it hard for the lungs to get oxygen into the body. The cough is the body's attempt to clear these secretions. When coughing attacks come one after the other, the lack of oxygen can be severe. Severe coughing attacks may last up to a minute and deprive the child of air, causing his or her face to turn red or blue. At the end of the coughing spell, there's a "whooping" sound as the child gasps for air. The child may then cough up thick, clear secretions and eventually vomit

During the convalescent stage, which lasts two to three weeks, the cough diminishes and gradually goes away. The cough may return if the child develops a cold or other respiratory infection in the months following the illness.
For infants younger than age 6 months, the early stage of the illness usually lasts only a few days. Sometimes, it's so mild it may go unnoticed. Then, there's choking and a gasping cough. Some infants actually have episodes of stopped breathing. The coughing may be induced by feedings.

Children older than age 5 and adults often have milder symptoms with a persistent dry cough, but no "whooping."


Diagnosis
The doctor will ask questions about your medical history and do a physical exam. Lab studies of nasal secretions or, in some locations, blood tests for antibody screening can confirm the presence of whooping cough, particularly early in the infection. Once the cough stage has begun, blood tests may indicate an extremely high white blood cell count.

Treatment
Infants who have whooping cough are usually hospitalized. Treatment may include suctioning the secretions, oxygen therapy and intravenous fluids (if it's hard for your baby to drink). Antibiotics or steroids may also be given. At home, make sure your baby gets plenty of rest, stays calm, avoids respiratory irritants, and eats and drinks often in small amounts.
For both children and adults, the antibiotic erythromycin is typically prescribed to treat whooping cough. It'll shorten the amount of time you're contagious, but won't ease the symptoms of the infection unless it's taken at the beginning of the cough stage or even earlier. For those who can't tolerate erythromycin, the medication trimethoprim-sulfamethoxazole may be prescribed.

If you think you've developed whooping cough, contact your doctor right away. Prompt treatment can reduce the chance that you'll spread the infection to your family or others. In some cases, the doctor may recommend isolation or antibiotic treatment for the entire family.


Complications
Infants younger than age 6 months have the highest risk for complications. Children in preschool who haven't completed the entire whooping cough vaccination series are also at risk for complications.
Although coughing usually helps clear the lungs, the characteristic cough of whooping cough is so violent that it actually causes problems. For example, forceful coughing may lead to:

ruptured blood vessels in the whites of the eyes
fine bruises on the upper body
nosebleeds
collapsed lung
broken ribs
retinal detachment (a separation of the retina from the back of the eye that can cause loss of vision or blindness without proper treatment)
hernia (protrusion of a loop of the intestine through the abdominal wall)
ruptured disc in the spinal column
angina (chest pain caused by inadequate circulation of blood to the heart muscle)
brain damage due to ruptured blood vessels in the brain
The most common complication of whooping cough is pneumonia. Other complications may include:

dehydration and weight loss from recurrent vomiting
ear infections
seizures
In extreme cases, pneumonia may become so severe that the body can't get enough oxygen to survive.


Pregnancy-specific information
Whooping cough appears to have no harmful effects on a developing baby.

Senior-specific information
Adults older than age 65 may be susceptible to whooping cough due to waning immunity, especially if booster doses haven't been given. In fact, whooping cough outbreaks have been reported among older adults.

Prevention
Before exposure
Vaccination is the best defense against whooping cough and its complications. The combination diphtheria, tetanus, pertussis vaccine (DTP) has been used for many years. However, the Centers for Disease Control and Prevention (CDC) now recommends a more sophisticated form of the vaccine called DTaP (for diphtheria, tetanus and acellular pertussis) to reduce the likelihood of side effects. Five injections of the vaccine are recommended before age 7 (at ages 2 months, 4 months, 6 months, 15 to 18 months, and 4 to 6 years), with a booster shot between ages 11 and 12.

After a whooping cough diagnosis
If you have whooping cough, early antibiotic treatment is important. Isolate yourself from anyone who may be susceptible to the infection -- especially young children and infants -- until your doctor says you're no longer contagious. Without antibiotic treatment, you'll be contagious up to three weeks after the coughing stage begins. If you're on antibiotics, you'll be contagious for the first five days of treatment.

Household and other close contacts
A 14-day course of the antibiotic erythromycin or trimethoprim-sulfamethoxazole is usually prescribed for anyone who lives with or has close contact with a person who's been diagnosed with whooping cough. For children younger than age 7 who haven't received four doses of the DTP or DTaP vaccine or who completed the primary series but haven't had a dose in the last three years, the vaccine is given as soon as possible.

Whipworm infection (trichuriasis)

Trichuriasis (also known as whipworm) is an intestinal worm infection. Intestinal worms are a type of parasite -- an organism that survives by feeding on other organisms or hosts. Parasites can inhabit the human body or live in soil, water, food or insects. Some parasites exist naturally in the human body, but are usually controlled by the immune system.


Causes/associated factors
Infection with the intestinal worm Trichuris trichiura causes trichuriasis, a common worldwide worm infection. Whipworm is most prevalent in warm moist regions of the world, especially where soil is contaminated by human feces. The infection is less common in the United States. When it does occur, it's most common in the southeastern states due to the favorable climate. Trichuriasis is more common in children than adults.

Transmission
Whipworm infections are more common with inadequate hygiene and sanitation or when human feces are used for fertilizer. Whipworm is not spread from person to person. Instead, infection occurs after ingesting infective whipworm eggs, which may be found in contaminated soil or on contaminated produce that has not been washed. The eggs hatch in the small intestine. Eventually, the larvae (immature worms) develop into mature whipworms about 4 centimeters long which attach themselves to the walls of the colon (the part of the large intestine that extends from the small intestine to the anus). The mature female whipworm produces up to 20,000 eggs a day, which pass out of the body in the feces. After at least 10 days, these eggs become capable of causing infection in someone else. An infected person will begin passing the eggs in his or her stool about two to three months after ingesting the infective eggs.

Signs/symptoms
Most often, whipworm infections cause no symptoms. A heavy infection may cause abdominal discomfort, diarrhea or bloody stools containing mucus. Symptoms are more frequent in children.

Diagnosis
Diagnosis is based on the presence of eggs in a stool sample.

Treatment
Trichuriasis may be treated with the drugs mebendazole or albendazole. The doctor may recommend a repeat stool sample test later.

Complications
Heavy intestinal infections in children can cause rectal prolapse (protrusion of the rectal mucous membranes through the anus), anemia and slowed growth.

Pregnancy-specific information
A variety of medications may be prescribed for various intestinal worm infections, but certain standard medications should not be taken if you're pregnant. Thoroughly discuss your health history with your doctor and review the risks and benefits of any treatment. If you don't have significant symptoms, your doctor may recommend postponing treatment until after delivery.
If you are or may be pregnant, you may want to avoid traveling to areas with poor sanitation, where you're more likely to develop parasitic infection(s). If you do travel to these areas, be sure to follow the preventive measures outlined below.


Senior-specific information
Growing older is not a risk factor for this condition.

Prevention
To prevent intestinal worms of any type, follow these general guidelines:
Practice sanitary hygiene habits, especially when disposing of human waste. Never wipe feces on the ground, and dispose of diapers properly.

Wear shoes in areas where the soil or sand may be contaminated with feces or parasites. Don't sit directly on the ground or handle the soil or sand with your bare hands.

Wash your hands thoroughly with soap and water or an antibacterial handwashing solution before handling food or water and after using the toilet or changing diapers.

Wash, peel or cook raw fruits and vegetables before eating.

Cook meat thoroughly, to at least 160°F. It should no longer be pink in the center. Measure the internal temperature to assure doneness. Keep in mind that curing, smoking, drying or microwaving meat may not kill all worms.

Slabs of pork less than 6 inches thick can be frozen at 5°F (-15°C) for 20 days to kill any worms. Freezing may not be effective for wild game.

If you're traveling abroad, it's wise to avoid uncooked fruits and vegetables, unless you've peeled them yourself; raw or undercooked meat, poultry, fish and eggs; foods prepared in advance that haven't been kept cold or very hot; and foods purchased from street vendors. If you have any doubts about a food's safety, follow this simple rule: Boil it, cook it, peel it or forget it.

If you're unsure of the safety of drinking water (such as in areas where the water isn't chlorinated or hygiene and sanitation are poor), ensure water safety by boiling your water vigorously for one minute, filtering it or treating it with iodine or chlorine. Drink only this water, beverages made from it, canned or bottled carbonated beverages (including water and soft drinks), beer or wine. Wash uncooked fruits or vegatables using treated or filtered water. Avoid using ice cubes and drinking from unclean glasses and wet or dirty cans or bottles. (It's best to drink straight from the can or bottle after wiping it clean and dry.) Don't brush your teeth in tap water, and avoid swallowing water while swimming or bathing.

When to call your child's doctor

From the first few months with your newborn through the toddler years and beyond, you're likely to have many questions for your child's doctor. Although some of the following advice applies especially to newborns and their parents, the information can be helpful at any stage of parenting.

Before calling the doctor, be prepared to describe your child's symptoms. You may want to have paper and pencil handy to write down any instructions the doctor gives you. It's also helpful to have the name and phone number of a local pharmacy ready, in case the doctor wants to call in a prescription for your child. If you're expecting the doctor to call you back, it's best to keep the phone line open. You may be given a time frame for when to expect the return call. To be prepared for future calls, find out from your child's doctor what to do when you need advice after business hours.


Questions to consider
General questions

When did the symptoms first appear?

How long have the symptoms been present?

Could anything have triggered the symptoms or made them worse?

Have you tried any treatments at home, such as over-the-counter medications or home remedies? What did you try (including medication dosages if applicable), when was the treatment given, and did it help?

Is your child taking any prescription medications?

Has your child been exposed to any contagious diseases, such as chickenpox or strep throat?

Is your child cared for in a child care setting? Are any of the other children there ill?

Is anyone else in the family ill?

Has your child had any recent injuries or falls?

Is your child able to move his or her arms and legs normally?

What is your child's temperature? Keep in mind air temperature, your child's level of activity and the time of day -- temperatures tend to be higher later in the day. Your child's doctor may not be concerned about a rectal temperature below 100.4°F, but an ongoing fever with rectal temperature over 102°F may require medical evaluation. Rather than relying on how warm your child feels, be sure to take his or her temperature. Don't wory about conversions. Simply tell the doctor what the thermometer reads and where the temperature was taken: oral, axillary, rectal, ear or skin.

Symptoms of infection require medical evaluation. Is the area red or streaked with red? Is there any swelling? Is the area warm to the touch? Is there any pus discharge? Is your child in discomfort?
Specific ear-related questions

Is your child pulling or poking at one or both ears?

Is there any discharge from the ears?
Specific respiratory questions

Is your child's nose stuffed up? Describe any congestion problems.

If your child's nose is runny, is the discharge clear and watery or thick and green or yellow in color?

Is your child coughing? Is the cough dry or loose? Does your child cough up any phlegm? If so, is it clear or colored?

Is your child's breathing labored, rapid or noisy? Is there any difference when your child is at rest? Is there any wheezing? Can you count your child's breathing rate? Can you describe how your child's chest, neck and abdomen look when your child breathes?

Does your child's coloring look healthy, or is there paleness around the mouth or in the nail beds? As your child breathes, what does his or her facial expression look like?

Does your child have a history of asthma?
Specific vomiting/diarrhea questions

How many times has your child vomited?

If your child has diarrhea, how many stools has he or she had? What is the consistency and volume of the stools?

If your child is older, when did he or she last urinate? For infants, how many wet diapers have you changed? Also, does your baby's fontanel (soft spot) appear sunken?

How frequent is the vomiting or diarrhea? When did it start? What color is it?
Specific skin-related questions

Does your child have a rash? When did it start? What does it look like? Be prepared to describe any rash as accurately as possible.

Where is the rash located? Is it widespread or only in one area?

Does the rash appear to be itchy?

What color is the affected area?

Is the rash flat or raised?

If spots are present, how many are there and how big are they?

Does the skin feel warm or cool to the touch?

Is your child's skin moist or dry?

Is your child's skin yellow in color? Jaundice (yellowing of the skin) is common from two or three days after birth through the first week of life. It's especially important to ask the doctor about jaundice that exists at birth, develops within the first 24 hours of life or develops or continues after two weeks. The doctor will want to know if your baby is nursing or receiving formula.
Specific throat- and teeth-related questions

Do your child's gums appear swollen where teeth might soon break through?

Are there any white patches on your child's gums, tongue or palate?

Does your child have a sore throat or difficulty swallowing?

Is your child eating fewer solids or drinking less fluids?
Specific behavior-related questions

Has there been any change in your child's routine or normal behavior?

Does your child's cry seem intense or high pitched? How long does it last? Is your child consolable? Be especially aware of sudden crying episodes. For an older infant or toddler, is there intermittent and inconsolable crying?

Is your child less active than usual?

Is your child alert and responsive or too sleepy to arouse?

Is your child more tired than usual or limp and suddenly uninterested?

Is your child more fussy or irritable than usual?

Has your child had a change in sleeping habits?

Has your child had a change in appetite? Let the doctor know if your baby is refusing to breastfeed or take a bottle.
Specific medical history questions

How old is your child?

What is your child's medical history? For example, has your child developed frequent ear infections or been diagnosed with asthma or another chronic disease?

Has your child had a recent immunization?

Has your child developed any medication allergies?

Considerations
If your baby is younger than 3 months old, contact the doctor immediately for symptoms such as fever (100.4°F or higher taken rectally), diarrhea, vomiting, cough, poor feeding or unusual irritability. At this age, what appear to be minor symptoms may actually be the warning signs of a serious illness.
It's typical for children younger than age 5 to develop six to eight colds or other respiratory infections a year, along with two or more bouts of vomiting or diarrhea. The rate of infection often decreases with age, depending on how often the child is exposed to cold viruses or other viruses.

Keep in mind that your child's developmental stage has a significant influence on symptom assessment. For example, an infant who's 1 month old is fairly nearsighted and would be expected to focus only on objects within 1 to 2 feet of his or her eyes. It would be typical to ignore objects in the peripheral (side) vision fields.

When appropriate, allow your child to describe his or her symptoms to the doctor directly. This information can help the doctor assess your child's needs.

West Nile virus

The West Nile virus is a mosquito-borne virus that can cause mild to severe illness.


Causes/associated factors
Birds are the major carrier of the West Nile virus. Mosquitoes that bite and feed on these birds may become infected and, in turn, transmit the virus to other birds, animals and people. Viruses that spread through the bite of a mosquito or other arthropod are known as arboviruses.
The West Nile virus was first identified in the United States in New York in 1999. Since then, it's been found in mosquitoes, birds, animals or people in all states except Hawaii, Alaska and Oregon.

Even if you live in an infected area, the risk of becoming ill with a West Nile infection is small. Less than 1 percent of mosquitoes are infected with the virus. About 20 percent of people infected with the virus develop a mild illness. An estimated one in 150 people who become infected become seriously ill. West Nile infections are most common in people older than age 50, who are also at greater risk of severe or even fatal complications.


Transmission
The West Nile virus has been found in more than 130 species of birds in the United States. The virus is most deadly for crows and blue jays. Mosquitoes become infected when they bite an infected bird. The virus may then spread to people and other animals -- including birds, horses, cats, bats, chipmunks, skunks, squirrels and domestic rabbits -- through the bite of an infected mosquito.
The West Nile virus doesn't appear to spread through contact with an infected animal. It doesn't spread from person to person, except rarely from mother to baby during pregnancy or breastfeeding.

Transmission to recent organ transplant and blood transfusion recipients has been reported. New screening methods are now in place to reduce the risk of spreading the virus through transfusions. Screening methods for organ donation are being evaluated.

The incubation period (time from the mosquito bite to the appearance of symptoms) ranges from three to 14 days.

In the temperate climate of the United States, West Nile infections are most common in late summer and early fall, when mosquitoes are more active. In tropical climates, the virus can spread at any time.


Signs/symptoms
About 80 percent of people who are infected with the West Nile virus develop no symptoms. When symptoms do appear, they're often mild and flu-like, including fever, headache, body aches, nausea and vomiting. Occasionally there are swollen glands or a rash on the trunk of the body. This infection, referred to as West Nile fever, generally lasts three to six days.
In more severe cases -- affecting less than 1 percent of infected people -- the virus may cause:

West Nile encephalitis (inflammation of the brain)
meningitis (inflammation of the membrane surrounding the brain and spinal cord)
meningoencephalitis (inflammation of the brain and the surrounding membrane)
Symptoms of more severe disease may include high fever, severe headache, stiff neck, confusion, tremors, seizures, muscle weakness, paralysis or coma. In some cases, West Nile encephalitis may be fatal.


Diagnosis
Diagnosis is initially based on your medical history, current symptoms and a physical exam. If you live in an area with West Nile virus activity and have symptoms of possible infection, your doctor may test your blood for virus antibodies (compounds that help neutralize or destroy foreign substances in the blood).

Treatment
There's no specific treatment for a West Nile virus infection. The U.S. Food and Drug Administration (FDA) has approved a clinical trial to test alpha interferon as a possible treatment, however. In addition, the National Institute of Allergy and Infectious Diseases (NIAID) is currently enrolling patients in a clinical trial to test the effectiveness of an intravenous immunoglobulin that contains antibodies to the West Nile virus in preventing death or disability from West Nile encephalitis.
Meanwhile, treatment focuses on supportive care and easing the symptoms. If the infection is severe, hospitalization may be needed. In the hospital, treatment may include intravenous fluids, breathing support and medication to control symptoms such as pain, fever, brain swelling and seizures. Medication to treat or prevent associated infections, such as pneumonia, may also be needed.


Complications
Complications of West Nile encephalitis may include mental deterioration, seizures and coma. Permanent neurological damage can occur, and a few cases of polio-type paralysis have been reported. In some cases, encephalitis is fatal.

Pregnancy-specific information
To protect yourself from the West Nile virus, do your best to avoid mosquitoes. When you must be outdoors, wear protective clothing and use insect repellent as directed by your doctor. Follow the product instructions carefully.
Rarely, West Nile virus may spread from mother to baby during pregnancy or breastfeeding. The potential effect on the baby is being studied. If you develop a West Nile infection during pregnancy, your doctor will report it to the state or local health department or the Centers for Disease Control and Prevention.


Senior-specific information
Adults older than age 50 have the highest risk of developing serious and sometimes fatal illness from the West Nile virus. People who have diabetes or weak immune systems also have an increased risk of serious illness.

Prevention
A vaccine to prevent West Nile infections is being developed. In the meantime, consider these tips to prevent the spread of the virus:
Decrease the number of mosquitoes around your home by keeping plants trimmed and removing all plant debris from the area.

Eliminate mosquito breeding grounds by emptying any standing water from containers such as pots, cans and tires.

Keep wading pools and other containers turned over when not in use.

Change the water in birdbaths at least every three to four days.

Keep your roof gutters cleaned and draining properly.

Keep mosquitoes out of your home with intact screens on all doors and windows.
To avoid contact with mosquitoes, keep the following considerations in mind:

Stay indoors or in screened-in areas as much as possible when mosquitoes may be present, especially at dawn, dusk and in the early evening.

When outdoors during periods of mosquito activity, use insect repellent and wear long-sleeved shirts, long pants, shoes and socks. Avoid bright colors and scented products such as perfume, soap, lotion and aftershave. Avoid scented hair spray and deodorant.

When applying any insect repellent, carefully follow the directions on the product label. Diethyltoluamide (DEET) is a common ingredient in insect repellents that deter mosquitoes. If you're using a topical prescription medication, check with your doctor before using DEET.
Depending on the product, concentrations of DEET range from 4 to 100 percent. Products containing higher concentrations of DEET generally provide longer-lasting protection. This protection seems to peak at concentrations of about 30 to 50 percent. Higher concentrations are sometimes used in special situations, such as in areas where there's a high risk of infection spread through biting insects. Extended-release formulas reduce the concentration while extending the duration of protection. Most of the commercial products available contain 40 percent or less DEET.

Although there haven't been any adverse effects to insect repellent reported from women who are pregnant or breastfeeding, check with your doctor before using any medications or products such as insect repellent while you're pregnant or breastfeeding.

The best approach is to use the lowest concentration of DEET effective for the amount of time spent outside:


30-percent DEET protects for six hours
24-percent protects for five hours
20-percent protects for four hours
6.65-percent protects for two hours
4.75-percent protects for an hour and a half

Even for children, products containing DEET are the most effective insect repellents. The safety of DEET doesn't appear to be related to the concentration in the repellent. There are no studies on skin absorption of DEET in children, but studies of similar substances suggest that absorption through the skin wouldn't differ after age 2 months. Currently, 30-percent DEET is the maximum concentration recommended for infants and children older than age 2 months. Again, the concentration of DEET used is based on the time the child is expected to be outside. Keep insect repellent out of reach of children at all times.
Don't let your child touch the repellent or apply it himself or herself. Discourage children from licking areas of their skin treated with DEET. Kids often have a tendency to put their hands in their eyes and mouths, so discourage them from touching any skin treated with DEET as much as possible.


Only apply the repellent to exposed areas of the skin, using as little as possible. Heavy applications don't provide increased protection. Apply sparingly to exposed skin folds, and don't apply under clothing. Don't use products containing DEET under diapers or in areas of skin-to-skin contact, such as the groin area, the front of the elbows or the backs of the knees. Using DEET in these areas may cause the skin to become red, painful or blistered.

Don't inhale or ingest DEET products. Don't spray it in enclosed areas or apply it near food. Wash your hands before eating.

Use caution when applying the repellent to your face. Keep the product out of your eyes, nose and mouth area. Don't spray aerosol products directly onto your face. Instead, spray the repellent on your hands and apply it gently to your face. Don't apply repellent to the hands or faces of children of any age.

Don't apply products containing DEET to injured, irritated or sunburned skin. This increases the risk of absorption through the skin.

Generally, DEET shouldn't be applied more than once a day. If you're outside for longer than expected and are being bitten, however, you can reapply repellent. Also, sweating, perspiration or getting wet may require reapplying repellent, but do so only if you're being bitten.

Read product labels before applying anything containing DEET to surfaces such as fabrics or upholstery. DEET doesn't typically damage natural fibers, but it may harm leather, synthetics, plastics, eyeglass frames, watch crystals, and painted or varnished surfaces (including automobiles).

Follow fire safety measures if the product contains alcohol, which is flammable.

When protection is no longer needed, remove the product from your skin with soap and water. Do the same for your children. Wash any clothing that's been sprayed with DEET before wearing again.

You can also apply Permethrin, an EPA-approved insecticide that works to kill insects rather than repel them. Permethrin isn't applied to your skin. Instead, it's applied to your clothing and shoes to kill ticks. The product retains its effectiveness for up to two weeks, despite as many as five launderings. The risk of adverse effects is low because Permethrin isn't readily absorbed by the skin. Check with your doctor before using any insecticides if you're pregnant or breastfeeding.

If you live in an area where the West Nile virus has been documented, report any dead birds to the local health department.

Consider contacting your local mosquito control program for assistance or questions regarding control of mosquito populations, especially if treatment of ponds and other wetlands may be needed.

Warts

Definition
Warts are benign (noncancerous) skin growths.

Causes/associated factors
Warts are caused by a virus called the human papillomavirus (HPV). There are more than 60 types of HPV, but only a few of them cause warts. The warts may last for weeks, years or even a lifetime, but often go away on their own without treatment. Warts typically appear on the hands, fingers and face. Although they may appear at any age, they're most common in children and young adults.
There are various types of warts. The common wart (verruca vulgaris) usually appears on the hands. The plantar wart (verruca plantaris), also known as the foot wart, develops on the sole of the foot. The flat wart (verruca plana) is often seen on the face and the back of the hands.


Transmission
The papillomavirus often enters the body through small breaks in the skin after direct contact with an infected person or through a process called autoinoculation, in which an existing wart spreads the virus to other parts of your body. Warts can also spread through contact with any object contaminated with living viral particles, such as the floors of public showers. The odds of developing warts depends on how often you're exposed to the virus, your immune system and your skin's vulnerability.
Although warts are contagious, they're not easy to catch. You may face a higher risk of developing warts if you:

go barefoot in public showers
experience trauma to the skin
have a weak immune system

Signs/symptoms
Warts may develop alone or in clusters. They often start small and grow larger. Most warts have rough surfaces and clearly defined edges. They're generally the same color as your skin, but can be darker or sprinkled with dark flecks. Most warts are painless and don't itch. Plantar warts, however, tend to grow inward and can hurt quite a bit. These warts typically develop on the plantar surface (sole) of the foot. They often grow in single clusters that can be the size of a quarter or larger.

Diagnosis
Diagnosis is based on your symptoms, medical history and a physical exam. Lab tests are typically unnecessary to confirm the diagnosis.

Treatment
For most people with healthy immune systems, warts disappear within weeks to a few years without treatment. Early treatment is often recommended, however, to help limit the spread of warts to surrounding skin or other people, as well as decrease the risk of complications.
Because there is currently no permanent cure for the virus, treatment aims to destroy the outer layer of skin where the wart grows or cause immune reactions in the affected area (a process known as immunotherapy, described below). At first, your doctor will probably suggest conservative treatment methods to minimize scarring and restore your skin to its usual pattern. The location, type and number of warts, as well as previous treatments and personal preferences, also affect treatment choices.

Over-the-counter treatments
Some warts may be removed with repeated applications of over-the-counter (OTC) preparations, such as salicylic acid, a keratolytic (medication that causes the skin to shed). Because these medications can damage normal skin, they should only be applied to the wart itself. Daily applications may be needed for up to 12 weeks. If you have a plantar wart, wearing an adhesive pad with a hole in the center over the wart can help eliminate pain when you walk.

Remember to consult your doctor before trying an OTC remedy, especially if you have diabetes or impaired circulation. When using the medication, follow the label instructions carefully.

Cryotherapy
Some warts can be removed with cryotherapy (freezing the tissue). To eliminate the wart completely, the treatment may need to be repeated within one to three weeks. The treatment may be painful. Rarely, permanent discoloration of the skin, scarring or nerve damage may occur.

Electrosurgery
With electrosurgery, the doctor uses an electric current to remove the wart. A single treatment may be all that's needed, but it may lead to scarring.

Laser therapy
Laser therapy may be used to dissolve certain warts. You may need local anesthesia, however. The plume that results with the use of the laser may cause the virus to spread, so the doctor will decide when this therapy is appropriate. Cost may also be a factor when deciding to use this treatment.

Bleomycin
Bleomycin is a cancer drug that can be injected into wart tissue. Bleomycin is very effective, but you may need local anesthesia. It should not be used on the fingers or toes due to possible nail loss or impaired circulation.

Surgery
For most warts, surgical removal is not typically recommended. Surgery may be used for very large warts that have not responded to other treatments, however. Surgery poses an increased risk of scarring, and the warts may return.

Immunotherapy
Immunotherapy can help boost the immune system by causing mild allergic reactions around the wart area. With a stronger immune system, you may be able to effectively fight off the virus causing the wart. Dinitrochlorobenzene (DNCB) is one medication in this category that's useful for stubborn warts.

Duct tape
A recent study showed that treating warts with duct tape was more successful for children than treating warts with cryotherapy using liquid nitrogen. Duct tape is placed over the wart for six days, then removed. Next, the area is soaked in water and rubbed with a pumice stone or emery board. After 12 hours, a new piece of duct tape is placed over the wart, and the cycle is repeated for two months or until the wart disappears. It's important to note that this small study involved only healthy children and that a doctor first identified the lesion as a wart before recommending duct tape therapy.


When to call the doctor
Contact your doctor if you have any questions or concerns about warts, or if:
warts develop on your feet, genitals or face
you suspect a wart is infected
a new wart develops after two weeks of treatment
warts still exist after 12 weeks of treatment

Complications
Warts may spread to other parts of your body, cause secondary infections or recur after treatment.

Pregnancy-specific information
If you develop a wart while you're pregnant, discuss the safety of any medications (including those available over the counter) with your doctor before beginning treatment.

Senior-specific information
With age, the immune system usually becomes less effective. You may become more vulnerable to infections, including warts. You may notice stronger or more frequent adverse effects of medication. If you develop warts, remember to tell your doctor about any medications you're taking or other health conditions you may have.

Prevention
Avoid touching another person's warts or wearing anyone else's shoes. Keep your feet clean and dry, and wear proper footwear when using public locker rooms or showers. Avoid using towels that have been used by a person who has warts. Finally, avoid skin trauma by protecting your skin and practicing good hygiene.
To prevent warts from spreading, avoid scratching any warts you may have and keep them covered while they're being treated. To help prevent spreading warts to others, cover any warts with a waterproof bandage while you're swimming or engaging in contact sports.

Vitamins for adults

Vitamins are substances that help regulate important body cell functions. Vitamins help change food into energy, and they're also needed for the formation of red blood cells, good vision, strong bones and teeth, and to ensure proper heart and nervous system function. Since your body doesn't produce most vitamins, you need to get them from food.


General information
There are two kinds of vitamins: water-soluble and fat-soluble. Water-soluble vitamins dissolve in water and are carried in the bloodstream throughout the body. Vitamin C and the B complex vitamins are all water-soluble. Since these vitamins dissolve in water, they're not stored well in the body. Because water is lost through your breath, urine and sweat, you must replace water-soluble vitamins daily. However, megadoses of even water-soluble vitamins can be harmful. For example, repeatedly taking supplements of vitamin B6 that greatly exceed the recommended daily allowance can cause nerve damage.
The fat-soluble vitamins -- A, D, E and K -- dissolve in fats. They are carried through the body attached to substances that are attached to fats in the bloodstream. Since the body stores fat better than water, you don't have to replace these vitamins as often. In fact, if you take large doses of these vitamins over a long period of time, you can store up so much that it harms your health. For example, high levels of vitamins A and D can become toxic.

Vitamins A (beta carotene), C and E are antioxidants. They help protect the body from the damaging effects of free radicals.

Fruits and vegetables are good sources of vitamins. If they're improperly handled or cooked, however, the vitamins can be easily destroyed. To avoid this, it's best to refrigerate fresh fruits and vegetables and use them within three to four days of purchase. To cook vegetables with minimum vitamin loss, steam them in a small amount of water or use a microwave. When fresh produce isn't available, frozen or canned varieties can also be a good source of vitamins.


Nutrition terminology
Trying to make sense of your nutrition requirements can be confusing and sometimes even overwhelming. Here are definitions of some of the most common nutrition terms you may encounter:
Recommended dietary allowance (RDA) is the recommended daily amount of a nutrient most people need to stay healthy. These recommendations were developed by the Food and Nutrition Board of the National Academy of Sciences. They were last revised in 1989.

Adequate intake (AI) is the recommended daily amount of a nutrient needed when an RDA cannot be determined.

Tolerable upper intake level (UL) is the maximum daily amount of a nutrient that is not likely to have harmful health effects for people in the general population.

Dietary reference intake (DRI) is the term used for a set of nutrient reference values. These values include the RDA, AI and UL nutrient recommendations. Many nutrient requirements have been updated since the RDAs were originally set. The DRIs were developed in 2000 based on current nutrition research.

Many conditions can affect your daily nutritional requirements, including your age, health status, weight and sex. Elderly adults and women who are pregnant or nursing may have enhanced nutritional needs. Your lifestyle habits, such as smoking or drinking excessive amounts of alcohol, can also have an impact on your nutritional needs. Consult your doctor about health factors that may affect your nutritional needs. Discuss your child's nutritional needs with his or her doctor.


Water-soluble vitamins
Vitamin C
Vitamin C (ascorbic acid) promotes healthy gums, teeth, connective tissue and bones. It also helps maintain your immune system and aids wound healing. A prolonged vitamin C deficiency can cause scurvy (a condition characterized by joint pain, bleeding gums and weakness), delayed wound healing and poor immune system response. On the other end of the spectrum, long-term excessive consumption of vitamin C may lead to side effects such as facial flushing, stomach cramps, diarrhea, nausea, vomiting, kidney stones and headaches.

Fruits and vegetables are often good sources of vitamin C, including:

citrus fruits and juices
strawberries, kiwi, guava and papaya
broccoli, cabbage, red peppers and brussels sprouts
tomatoes
potatoes
DRIs for vitamin C are:

90 milligrams for men
75 milligrams for women
Smokers need to add an additional 35 milligrams per day to their total intake of vitamin C because smoking depletes this important vitamin.

Vitamin B1
Vitamin B1 (thiamine) helps convert carbohydrates into energy. It's vital for normal growth and development, the health of mucus membranes and proper muscle performance. Vitamin B1 also helps maintain a healthy nervous system and heart. A prolonged vitamin B1 deficiency can result in fatigue, weak muscles, nerve damage or beriberi (a condition that causes nerve and heart failure). Alcohol impairs thiamine absorption, so alcoholics are often thiamine-deficient.

Good sources of vitamin B1 include:

whole grains, nuts and dried sunflower seeds
navy beans, kidney beans and soybeans
pork, red meat and organ meats
brewer's yeast, wheat germ and rice bran
RDAs for vitamin B1 are:

1.2 milligrams per day for men
1.1 milligrams per day for women
Vitamin B2
Vitamin B2 (riboflavin) helps protect the nervous system, mucus membranes, skin and eyes. A vitamin B2 deficiency can cause cataracts (a cloudy area in the lens of the eye, the clear structure that focuses light rays onto the retina), dry skin and a sore tongue. Side effects of taking large doses of riboflavin are unknown.

Good sources of vitamin B2 include:

milk, cheese and yogurt
chicken and beef liver
leafy green vegetables
cereal
bread
wheat germ
almonds
RDAs for vitamin B2 are:

1.3 milligrams per day for men
1.1 milligrams per day for women
Vitamin B3
Vitamin B3 (niacin) helps convert food into energy and make genetic DNA (a substance found in the center of cells that carries hereditary information). It helps keep the skin, nerves and digestive system healthy. A niacin deficiency can cause pellagra (a condition which can cause diarrhea, mental disorders and skin problems). Too much niacin can cause flushing of the skin, rashes, liver damage, nausea, vomiting or abdominal pain.

Good sources of vitamin B3 include:

poultry
pork
beef
veal
salmon, swordfish, halibut, and other types of fish and tuna
peanuts and sunflower seeds
fortified cereal
RDAs for vitamin B3 are:

16 milligrams NE (niacin equivalents) per day for men
14 milligrams NE (niacin equivalents) per day for women
Vitamin B6
Vitamin B6 (pyridoxine) helps your body use dietary protein, fats and carbohydrates. Vitamin B6 helps maintain brain function, form red blood cells, and keep your immune system working. A prolonged lack of vitamin B6 can cause convulsions, anemia (a condition marked by a decreased number of red blood cells or hemoglobin, a protein in red blood cells that contains iron), nausea or flaky skin. For infants, a lack of vitamin B6 can cause seizures. Too much of this vitamin can produce nerve damage and depression.

Good sources of vitamin B6 include:

meat
salmon, other types of fish, shrimp and tuna
bananas, avocados and watermelon
lentils, sunflower seeds and whole grains
peanut butter
almonds
RDAs for vitamin B6 are:

1.3 milligrams per day for adults
Vitamin B12
Vitamin B12 (cyanocobalamin) helps the body form red blood cells, use fats and carbohydrates, and maintain normal nervous system function. A prolonged vitamin B12 deficiency can result in anemia, fatigue or nerve damage.

Good sources of vitamin B12 are animal products, including:

clams, flounder, herring, mackerel, sardines, salmon and snapper
dairy foods, including milk, blue cheese, Swiss cheese, cottage cheese, yogurt and mozzarella cheese
beef, chicken and pork
eggs
fortified skim milk
Since vitamin B12 is not found in any plant foods, strict vegetarians should consume B12-fortified cereals and soy milk to prevent a vitamin B12 deficiency.

RDAs for vitamin B12 are:

2.4 micrograms per day for adults
Folic acid
Folic acid (folate) helps form red blood cells and genetic DNA. A folic acid deficiency can cause anemia and lead to weight loss, gastrointestinal problems and a burning sensation in the tongue. Too much folic acid can cause crystals to form in the urine, appetite loss, nausea, gas or possible nerve damage. Very early in pregnancy, folic acid helps develop the neural tube of the fetus. Without adequate amounts of this important vitamin, serious brain and spinal cord birth defects can occur. Therefore, it's important for all women who may become pregnant to get enough folic acid.

Good sources of folic acid include:

broccoli, spinach and romaine lettuce
oranges and orange juice
wheat germ
beans, peas and lentils
whole grains
fortified cereals and grain products
RDAs for folic acid are:

400 micrograms per day for adults
600 micrograms per day during pregnancy
Biotin
Biotin, to some extent, is made by the "good" bacteria in your intestines. Biotin helps your body use protein, fats and carbohydrates. It helps nerve tissue, blood cells, bone marrow, skin and hair to grow. It also helps male sex glands to function. No harmful side effects have been identified with excess biotin. However, an inadequate amount can result in scaly skin, appetite loss, fatigue or depression.

Good sources of biotin include:

nuts and sunflower seeds
vegetables
fish
egg yolk
whole grains
brewer's yeast
dairy products
meat, especially liver
Thirty micrograms per day for adults is considered an adequate intake of biotin.

Pantothenic acid
Pantothenic acid helps the body make energy and use protein, fats and carbohydrates. Deficiencies of this vitamin are rare, but include fatigue and gastrointestinal symptoms. Side effects of large amounts are unknown.

Good sources of pantothenic acid include:

broccoli
poultry
fish
whole grains
avocado
milk
vegetables
mushrooms
Five milligrams per day for adults is considered an adequate intake of pantothenic acid.


Fat-soluble vitamins
Vitamin A
Vitamin A (retinol) promotes good vision, especially at night. It also helps form and maintain skin, teeth, bones, hair and mucus membranes. Your body breaks down beta carotene into vitamin A, so you can eat foods high in either vitamin A or beta carotene to meet your recommended vitamin A needs. Prolonged vitamin A deficiency may cause infertility, dry skin, stunted growth and night blindness. Too much over a long period of time can cause hair loss, headaches, bone thickening, liver enlargement, menstrual problems, joint pain, weakness and dry skin. It may also lead to an increased risk of fractures.

Good sources of vitamin A and beta carotene include:

dark-green, leafy vegetables (such as broccoli, spinach and kale)
yellow and orange vegetables and fruits (such as carrots, sweet potatoes, winter squash, apricots, cantaloupe and mangoes)
eggs
beef or chicken liver
DRIs for vitamin A are:

900 micrograms (or retinol equivalents, the standard measurement for vitamin A activity in foods) per day for men or 4,500 IU (international units, often listed on food or supplement labels
700 micrograms (retinol equivalents) per day for women or 3,500 IU
Vitamin D
Vitamin D promotes strong bones, teeth and cartilage by helping your body absorb calcium and phosphorus. Your body manufactures vitamin D when you're exposed to sunlight, and it's in a small selection of food products. Insufficient vitamin D can cause rickets (a disease that produces brittle bones and teeth). In high doses, especially over long periods of time, vitamin D can hurt the kidneys, heart and interfere with normal growth in children.

In addition to sun exposure, good sources of vitamin D include:

sun exposure
fortified milk
fortified cereals
beef and veal
herring, mackerel, salmon and sardines
egg yolks
Adequate intake for vitamin D is considered:

5 micrograms per day for people ages 19 to 50 or 200 IU (international units, often listed on food or supplement labels)
10 micrograms per day for people ages 51 to 70 or 400 IU
15 micrograms per day for people older than age 70 or 600 IU
Vitamin E
Vitamin E (alpha-tocopherol) helps prevent cell breakdown and blood clots. It also helps your body produce red blood cells. Because of the amount of vitamin E present in foods, vitamin E deficiencies do not take place in the general population. Although it's a fat-soluble vitamin, it takes a lot of vitamin E to cause health problems. At very high doses, vitamin E may increase the effects of blood-thinning medications.

Good sources of vitamin E include:

vegetable oils
nuts and seeds
wheat germ and whole-wheat flour
margarine
spinach, lettuce and broccoli
sweet potato
shrimp
DRIs for vitamin E (alpha-tocopherol) are:

15 milligrams for adults or 22 IU (international units, often listed on food or supplement labels)
Vitamin K
Vitamin K helps blood clot -- if you don't have enough, serious clotting disorders occur. Very large doses seem tolerated by the body, but in rare cases too much can cause liver or brain damage for infants. Vitamin K is made by the "good" bacteria in your intestines.

Good sources of vitamin K include:

dark green leafy vegetables, including brussels sprouts and spinach
cabbage, broccoli and cauliflower
oats and soybeans
dairy products
egg yolks
Adequate intake (AIs) for vitamin K are:

120 micrograms per day for men
90 micrograms per day for women

Vitamin supplements
Most people who eat a well-balanced diet generally don't need a daily multivitamin supplement. Many researchers are now recommending a basic daily vitamin and mineral supplement, however. If you're considering taking a supplement, you may want to ask your doctor if it's necessary. If you choose to take a multivitamin supplement, select one that contains 100 percent of the RDA for a variety of vitamins and minerals.
Vitamin supplements are often recommended to meet the special needs of pregnant women. Folic acid supplements are recommended for all women in their childbearing years to prevent neural-tube birth defects. Others who may benefit from a vitamin supplement include:

elderly adults (especially if you're reducing food intake for any reason)
heavy drinkers
teenagers with poor dietary habits
smokers
chronic dieters
people with impaired immune systems
people who take certain long-term medication therapy
children
strict vegetarians

Vital signs

One way to keep tabs on your family's health is to understand what vital signs mean. So how do you know what's normal? The information here can help because it provides normal and, in certain instances, optimal parameters for blood pressure, pulse rate, temperature and respiration at different ages. Keep in mind these are guidelines. What may be average vital signs for you aren't necessarily average for your best friend. If you have any concerns about specific vital signs, contact your health care provider.


Blood pressure norms
Blood pressure is a measurement of the amount of force that blood exerts on the arteries (blood vessels that carry blood from the heart to the rest of the body) as it's pumped from the heart through the circulatory system. When you have your blood pressure taken, there are two different measurements: systolic and diastolic. Systolic (the top number in a blood pressure reading) measures the highest pressure within your arteries when the heart squeezes or pumps. Diastolic (the bottom number in a blood pressure reading) indicates the pressure in your arteries when the heart is at rest.
Blood pressure norms in children vary with gender, age and height. Rather than an absolute numeric cutoff, high blood pressure in children is defined as average systolic and diastolic blood pressure greater than or equal to the 95th percentile for age and sex. High-normal blood pressure is blood pressure greater than or equal to the 90th percentile, but less than the 95th percentile. The following numbers will give you an idea of what the National Institutes of Health (NIH) considers the upper limit of normal blood pressure for a child with average height (50th percentile) as determined by growth curves:


Age Systolic Diastolic
1 year 98 (boy)
100 (girl) 53 (boy)
54 (girl)
5 years 108 (boy)
106 (girl) 67 (boy)
67 (girl)
10 years 115 (boy)
115 (girl) 75 (boy)
74 (girl)
15 years 127 (boy)
124 (girl) 79 (boy)
79 (girl)

For adults, the following blood pressure numbers are listed as cutoffs for normal, prehypertension and hypertension:


Category Systolic Diastolic
Normal Less than 120 Less than 80
Prehypertension 120 to 139 80 to 89
Hypertension Greater than or equal to 140 Greater than or equal to 90

Note: Normal refers to the best blood pressure to reduce the risk of heart attack, stroke and other major complications related to blood pressure. Also, unusually low blood pressure readings warrant evaluation by a doctor to determine the clinical significance, if any, especially if low blood pressure situations are associated with symptoms.


Temperature
Body temperature normally varies according to time of day and place of measurement. In fact, it can vary as much as .9°F (.5°C) during the day in a healthy person. A normal oral temperature (a temperature taken by mouth) is 98.6°F (37°C). A normal rectal temperature is 99.5°F, and a normal armpit temperature is 98.1°F. A fever is defined as an oral temperature over 99.5°F (37.5°C), a rectal temperature over 100.4°F (38.0°C), or an armpit temperature over 99.0°F (37.2°C).
To convert a temperature from Fahrenheit to Celsius, subtract 32 from the Fahrenheit reading and multiply by 5/9. Or, subtract 32 from the Fahrenheit reading and divide by 1.8.

To convert a temperature from Celsius to Fahrenheit, multiply the Celsius reading by 9/5 and add 32. Or, multiply the Celsius reading by 1.8 and add 32.


Pulse rate
Pulse rate is a measurement of the number of times your heart beats in one minute. To count your pulse, place two fingers lightly underneath your jaw line on the side of your neck and count the number of beats you feel in one minute. While you're exercising, it may be more accurate to count the number of beats you feel in 10 seconds and multiply by six. It's important to remember that pulse rate varies according to your activity level and a variety of other factors. For example, exercise, fever and stress elevate your pulse rate in response to your body's increased need for oxygen and nutrients.
Average pulse rates for children vary by age, but remain higher until ages 6 to 8.

Age Beats per minute
birth to 11 months Average rates vary by age in weeks to age in months.
11 months to 2 years 80 to 160
2 to 4 years 80 to 130
4 to 6 years 80 to 120
6 to 8 years 75 to 115
8 years to adolescence 70 to 110
adolescence to adulthood (13 to 18 years) 60 to 110


The normal adult pulse range is 60 to 80 beats per minute, though up to 100 beats per minute is still within the average range. Well-conditioned athletes have a slower pulse range, often 40 to 60 beats per minute.


Respiration
Respiration is the process of inhaling and exhaling air. It's counted by the number of breaths in one minute. Like pulse rates, respiration rates can increase from factors such as exercise, stress and fever.
Average respiration rates for children vary by age.


Age Breaths per minute
birth to 1 year 30 to 39
1 to 2 years 26 to 31
2 to 6 years 21 to 29
6 to 9 years 20 to 24
9 to 13 years 19 to 22
13 to 15 years 18 to 21
15 to 18 years 16 to 21

The normal adult respiration rate is 12 to 20 breaths per minute.

Viral encephalitis

Encephalitis is a severe inflammation of the brain. Encephalitis is often accompanied by meningitis (an inflammation of the membranes surrounding the brain and spinal cord). This condition is sometimes referred to as meningoencephalitis.


Causes/associated factors
Encephalitis is usually caused by a virus, as described below. The virus can enter your body through the bite of an arthropod (such as a mosquito or tick) or animal or through contact with an infected person. Less frequently, encephalitis is caused by fungi, parasites and bacteria. An infected mother can also pass the infection to her baby before or during birth.
When the virus enters the body, it often causes an infection somewhere other than the brain. When transported through the bloodstream, however, some viruses may travel to the brain. Some viruses can travel along the nerves to the brain.

You're at risk for encephalitis if you've been exposed to infected carriers (such as mosquitoes and ticks) or travel to areas where the disease is prevalent. Newborns, elderly adults and people infected with HIV (the virus that causes AIDS) are also at increased risk.


Types of encephalitis
Herpes simplex encephalitis (HSE)
The most common cause of viral encephalitis in the United States is the herpes simplex virus (HSV). Herpes simplex encephalitis (HSE) spreads through direct contact with drainage or discharge from the rash of someone who has herpes. HSE occurs year-round and affects people of all age groups. Left untreated (or ineffectively treated), it's often fatal.

Arboviral encephalitis
Arboviruses are viruses transmitted to humans and other animals through the bite of an infected arthropod (such as a mosquito or tick). The arthropod itself can become infected when it feeds on an infected bird or animal. In turn, female arthropods pass the virus in their eggs. These eggs develop into adult insects that are also capable of spreading the virus. Humans with arboviral encephalitis can't pass the infection to others through casual contact. Arboviral encephalitis is most common from June through September, the most active time of year for mosquitoes and ticks. In areas with mild weather, however, cases of encephalitis have been reported into the winter months. The main types of arboviral encephalitis in the United States include:

St. Louis encephalitis (SLE): The SLE virus is transmitted to humans through the bite of certain infected mosquitoes. The mosquitoes themselves become infected when they bite an infected bird. Outbreaks have occurred most recently in the Midwest and Southeast, but SLE can occur anywhere in the United States. Most people infected with the virus do not develop encephalitis. In fact, most develop no symptoms at all. An average of about 130 cases of SLE are reported in the United States each year. Most people survive the infection. Elderly adults are at the greatest risk of severe or fatal SLE. The infection is usually milder in children.

Lacrosse encephalitis (LAC): The LAC virus is transmitted to humans through the bite of certain daytime biting mosquitoes. The mosquitoes themselves become infected when they bite an infected animal, usually a chipmunk or tree squirrel. LAC occurs more often in the Midwest and mid-Atlantic states. There are about 75 cases reported each year in the United States. Most cases of LAC develop in children younger than age 16. Although the infection can be severe, it's not often fatal.

Western equine encephalitis (WEE): The WEE virus is transmitted to humans through the bite of certain infected mosquitoes. The mosquitoes themselves become infected when they bite an infected bird. Areas with irrigated agriculture provide a good habitat for this cycle. WEE occurs most often in the western United States. Children, especially those younger than age 1, are more often seriously affected by WEE. Most people survive the infection.

Eastern equine encephalitis (EEE): The EEE virus is transmitted to humans through the bite of certain infected mosquitoes. The mosquitoes themselves become infected when they bite an infected bird. Swampy areas provide a good habitat for this cycle. EEE occurs most often in the United States along the East Coast, the Gulf Coast and some inland Midwestern locations. Human outbreaks of EEE may be preceded by horse outbreaks. In fact, the infection is more common in horses than humans. EEE is a severe form of encephalitis for humans, however. About one-third of all people who are infected do not survive. Those who recover may experience permanent brain damage.

Powassan encephalitis (POW): POW virus is a rare cause of viral encephalitis. It's transmitted to humans through the bite of an infected deer tick. It is usually found in the upper United States and Canada. Only 20 cases have been reported in humans. It's considered to be a severe form of encephalitis and those who recover may have lasting neurological difficulties.

West Nile encephalitis (WNE): The WNE virus was previously thought to be present only in Africa, Asia and the Middle East. In 1999, however, it was identified in an outbreak of encephalitis in New York. Since then, virus activity has been identified in most of the continental United States. WNE spreads to humans through the bites of certain infected mosquitoes. The mosquitoes themselves become infected when they bite an infected bird. Most people survive the infection, but people older than age 50 are at the highest risk of developing a severe or even fatal infection.
Many other types of arborviral encephalitis occur throughout the world, including Venezuelan equine encephalitis, Japanese encephalitis and Murray Valley encephalitis. Most of these diseases are problematic only to the countries where the virus is found and for travelers to those countries.

Other types of encephalitis
Less common types of viral encephalitis are those caused by:

the varicella zoster virus, which spreads through contact with someone who has shingles or chickenpox
the Epstein-Barr virus, which spreads through contact with an infected person
the rabies virus, which most commonly spreads through the bite or saliva of an infected animal (often bats, wild animals or dogs)

Transmission
Again, viral encephalitis typically spreads through contact with an infected person or the bite of a mosquito, tick or animal. The method of transmission and incubation period (time from exposure until symptoms appear) depends on the type of virus. It's also important to remember that the arbovirus cannot be spread from human to human through casual contact, although suspected transmission to recent organ organ transplant and blood transfusion recipients has been reported. This is not true for other types of viral encephalitis, however.

Signs/symptoms
Although certain differences occur, most infections are characterized by nonspecific symptoms at first, which may progress slowly or rapidly. For all types of viral encephalitis, symptoms may include:
personality changes
impaired memory
confusion
hallucinations
trouble with speech
tremors
difficulty with movement
seizures
coma
If the infection involves the membranes surrounding the brain and spinal cord, symptoms may also include:

fever
headache
stiff neck and/or stiff back
muscle aches
aversion to bright light
nausea and vomiting

Diagnosis
Diagnosis is initially based on your medical history, current symptoms and a physical exam. Sporadic cases of encephalitis are often difficult to distinguish from other fever-producing illnesses. Your doctor will do a lumbar puncture or spinal tap (taking samples of cerebrospinal fluid, the fluid that surrounds the brain and spinal cord, through a needle placed in your lower back). In an attempt to isolate the disease-causing organism, the fluid will be studied for cell count and type, bacteria, glucose (sugar) level and protein count. Viral and fungal cultures and other studies may also be done. With all types of encephalitis, the pressure measured during the spinal tap will be elevated. White blood cells and protein levels may also be higher than normal. Another test called a polymerase chain reaction can be done to help diagnose herpes simplex virus, Epstein-Barr and enterovirus infections.
You'll also need blood tests, as well as possible studies of swabs or fluid samples from affected areas. Depending on the circumstances, you may also need one or more of the following tests:

electroencephalogram (a recording of the electrical activity of the brain) to identify abnormalities
computed tomography (CT scan, an imaging technique) to rule out the possibility of cerebral hematoma (a swelling or mass of blood in the brain) or sores in the temporal lobe (part of the brain)
magnetic resonance imaging (MRI, another imaging technique) to check for sores characteristic of herpes simplex encephalitis or signs that would indicate encephalitis caused by a parasite, such as toxoplasmosis
In severe cases, a brain biopsy (taking a tissue sample for further examination) may be recommended. Although an extremely invasive procedure, a brain biopsy is a highly sensitive and specific diagnostic tool for herpes simplex encephalitis.


Treatment
Early diagnosis and treatment are essential. Antiviral medications are effective for some infections. For example, herpes simplex and varicella zoster encephalitis are treated with the antiviral medication acyclovir for 14 to 21 days. Currently, although encephalitis treatment recommendations are constantly evolving, there are no effective antiviral medications for arboviral encephalitis. For any type of encephalitis, the doctor may recommend drinking fluids and replacing electrolytes (substances that transmit electrical impulses) to prevent dehydration. The doctor may prescribe medications to help prevent seizures, relieve pain, and reduce brain swelling and inflammation, as well as restlessness and fever. Antibiotics may also be prescribed for any associated infections.

Complications
Complications of encephalitis may include mental deterioration, seizures and coma. Long-term effects may include hearing loss, visual impairment, memory loss, seizures and behavioral changes. In some cases, encephalitis is fatal. Recently, there have been a few cases of polio-type paralysis associated with the West Nile virus.

Pregnancy-specific information
If you're infected with a virus that causes genital herpes, rubella, chickenpox or western equine encephalitis, the infection can spread to your baby before or during delivery and cause viral encephalitis.

Senior-specific information
Some types of viral encephalitis, such as St. Louis encephalitis and West Nile encephalitis, can be more serious for older adults.

Prevention
To prevent herpes simplex encephalitis, avoid contact with anyone who has active herpes sores, especially if there is any drainage or discharge. Seek prompt medical attention if you develop a lesion after contact with an infected person.
To prevent arboviral encephalitis, reduce the amount of time you spend outdoors, especially during the early evening hours. When you are outdoors, wear long pants and long-sleeved shirts, and apply mosquito repellent to exposed skin. Be sure that windows and doors are properly protected with intact screens.

Discourage the breeding of mosquitoes by emptying water out of any containers kept outside. Discarded tires that collect water are a good example. On the community level, chemicals can be sprayed to stop larvae from growing into infected adult mosquitoes, as well as kill adult mosquitoes. Any cases of encephalitis should be reported to the state or local health department.

If you're HIV-positive, discuss individual risk factors and additional precautions with your doctor.

In the United States, a human vaccine is available for Japanese encephalitis and a horse vaccine is available for eastern, western and Venezuelan equine encephalitis. Unfortunately, there are currently no approved vaccines for other types of encephalitis in the United States.