Premature ventricular contractions (PVCs)

Premature ventricular contractions (PVCs)

Definition:

Premature ventricular contractions (PVCs) are extra, abnormal heartbeats that begin in one of your heart's two lower pumping chambers (ventricles). These extra beats disrupt your regular heart rhythm, sometimes causing you to feel a flip-flop or skipped beat in your chest. Premature ventricular contractions are very common — they occur in most people at some point.
Premature ventricular contractions are also called:

• Premature ventricular complexes
• PVCs
• Ventricular premature beats
• Extrasystoles

If you have occasional premature ventricular contractions, but you're an otherwise healthy person, there's generally no reason for concern, and no treatment is needed. If you have frequent premature ventricular contractions or underlying heart disease, you may need treatment to help you feel better and treat underlying heart problems.

Symptoms:

Premature ventricular contractions often cause no symptoms. But you may feel an odd sensation in your chest, such as:

• Flip-flops
• Fluttering
• Pounding or jumping
• Skipped beats or missed beats
• Increased awareness of your heartbeat

When to see a doctor
If you feel flip-flops, a sensation of skipped heartbeats or odd feelings in your chest, talk to your doctor. You'll want to identify the source of these symptoms. Premature ventricular contractions may be the problem, but other conditions also may be to blame, including other rhythm problems, serious heart problems, anxiety, anemia or infections.

Causes:

Your heart is made up of four chambers — two upper chambers (atria) and two lower chambers (ventricles). The rhythm of your heart is normally controlled by the sinoatrial node (SA node) — or sinus node — an area of specialized cells located in the right atrium. This natural pacemaker produces the electrical impulses that trigger the normal heartbeat.

 From the sinus node, electrical impulses travel across the atria to the ventricles, causing them to contract and pump blood out to your lungs and body.
Premature ventricular contractions are abnormal contractions that begin in the ventricles. These extra contractions usually beat sooner than the next expected regular heartbeat. And they often interrupt the normal order of pumping, which is atria first, then ventricles. As a result, the extra, out-of-sync beats are usually less effective in pumping blood throughout the body.

Why do extra beats occur?
The reasons aren't always clear. Certain triggers, heart diseases or changes in the body can make cells in the ventricles electrically unstable. Underlying heart disease or scarring may also cause electrical impulses to be misrouted. Premature ventricular contractions may be associated with:

• Chemical changes or imbalances in the body
• Certain medications, including common asthma medications
• Alcohol or illegal drugs
• Increased levels of adrenaline in the body that may be caused by caffeine, exercise or anxiety
• Injury to the heart muscle from coronary artery disease, congenital heart disease, high blood pressure or infections (myocarditis)

Complications:

 If you have frequent premature ventricular contractions or certain patterns of premature ventricular contractions, you may be at increased risk of developing heart rhythm problems (arrhythmias). Rarely, when accompanied by underlying heart disease, frequent premature contractions can lead to chaotic, dangerous heart rhythms and possibly sudden cardiac death

Treatments and drugs:

Most people with premature ventricular contractions and an otherwise normal heart won't need treatment. Rarely, if you have frequent, bothersome symptoms, you may be offered treatment to help you feel better, but PVCs are typically not harmful.

In some cases, if you have underlying heart disease that could lead to more serious rhythm problems, you may need to make efforts to avoid triggers or perhaps take medications.

• Lifestyle changes. Eliminating common PVC triggers — such as caffeine or tobacco — can decrease the frequency and severity of your symptoms.
  
• Medications. Beta blockers — which are often used to treat high blood pressure and heart disease — can suppress premature contractions. Other medications, such as calcium channel blockers, or anti-arrhythmic drugs, such as amiodarone, also may be used if you have ventricular tachycardia or very frequent premature ventricular contractions that interfere with your heart's function, causing severe symptoms.

If you have very frequent PVCs associated with underlying heart disease and periods of ventricular tachycardia, your doctor might recommend treatment for the underlying condition.

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Pulmonary embolism

Pulmonary embolism

Definition:

Pulmonary embolism is blockage in one or more arteries in your lungs. In most cases, pulmonary embolism is caused by blood clots that travel to your lungs from another part of your body — most commonly, your legs. Pulmonary embolism is a complication of deep vein thrombosis (DVT), which is clotting in the veins farthest from the surface of the body.

Pulmonary embolism can occur in otherwise healthy people. Common signs and symptoms include sudden and unexplained shortness of breath, chest pain and a cough that may bring up blood-tinged sputum.

Pulmonary embolism can be life-threatening, but immediate treatment with anti-clotting medications can greatly reduce the risk of death. Taking measures to prevent blood clots in your legs also can help protect you against pulmonary embolism.

Symptoms:

Pulmonary embolism symptoms can vary greatly, depending on how much of your lung is involved, the size of the clot and your overall health — especially the presence or absence of underlying lung disease or heart disease.
Common signs and symptoms include:

• Shortness of breath. This symptom typically appears suddenly, and occurs whether you're active or at rest.
  
• Chest pain. You may feel like you're having a heart attack. The pain may become worse when you breathe deeply, cough, eat, bend or stoop. The pain will get worse with exertion but won't go away when you rest.
  
• Cough. The cough may produce bloody or blood-streaked sputum.

Other signs and symptoms that can occur with pulmonary embolism include:

• Wheezing
• Leg swelling, usually in only one leg
• Clammy or bluish-colored skin
• Excessive sweating
• Rapid or irregular heartbeat
• Weak pulse
• Lightheadedness or fainting

When to see a doctor
Pulmonary embolism can be life-threatening. Seek immediate medical attention if you experience unexplained shortness of breath, chest pain or a cough that produces bloody sputum.

Causes:

Pulmonary embolism occurs when a clump of material, most often a blood clot, gets wedged into an artery in your lungs. These blood clots most commonly originate in the deep veins of your legs, but they can also come from other parts of your body. This condition is known as deep vein thrombosis (DVT). Not all DVT blood clots result in pulmonary embolism.
Occasionally, other substances can form blockages within the blood vessels inside your lungs. Examples include:

• Fat from within the marrow of a broken bone
• Part of a tumor
• Air bubbles

It's rare to experience a solitary pulmonary embolism. In most cases, multiple clots are involved. The lung tissue served by each blocked artery is robbed of fuel and may die. This makes it more difficult for your lungs to provide oxygen to the rest of your body.
Because pulmonary embolism almost always occurs in conjunction with deep vein thrombosis, most doctors refer to the two conditions together as venous thromboembolism (VTE).

Treatments and drugs:


Prompt treatment of pulmonary embolism is essential to prevent serious complications or death.
Medications
Medications to treat pulmonary embolism include:

• Anticoagulants. The drugs heparin and warfarin (Coumadin) prevent new clots from forming. Heparin works quickly and is usually delivered with a needle. Warfarin (Coumadin) comes in pill form and doesn't start working until a few days after your first dose. Risks include bleeding and easy bruising.
  
• Clot dissolvers (thrombolytics). While clots usually dissolve on their own, certain medications can dissolve clots quickly. Because these clot-busting drugs can cause sudden and severe bleeding, they usually are reserved for life-threatening situations.

Surgical and other procedures
In some cases, your doctor might recommend a procedure to treat pulmonary embolism, such as:

• Clot removal. If you have a very large clot in your lung and you're in shock, your doctor may thread a thin flexible tube (catheter) through your blood vessels and suction out the clot. It can be difficult to remove a clot this way, and this procedure isn't always successful.
  
• Vein filter. A catheter can also be used to place a filter in the main vein — called the inferior vena cava — that leads from your legs to the right side of your heart. This filter catches and stops blood clots moving through the blood stream toward your lungs. Filter insertion is typically reserved for people who can't take anticoagulant drugs or when anticoagulant drugs don't work well enough.
  
• Surgery. If you're in shock and thrombolytic medication isn't working quickly enough, your doctor might attempt emergency surgery. This happens infrequently, and the goal is to remove as many blood clots as possible, especially if there's a large clot in your main (central) pulmonary artery.

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DiGeorge syndrome

DiGeorge syndrome

Definition  :

DiGeorge syndrome (22q11.2 deletion syndrome), a disorder caused by a defect in chromosome 22, results in the poor development of several body systems.
Medical problems commonly associated with DiGeorge syndrome include heart defects, poor immune system function, a cleft palate, complications related to low levels of calcium in the blood and behavioral disorders.

The number and severity of problems associated with DiGeorge syndrome vary greatly. Almost everyone with DiGeorge syndrome needs treatment from specialists in a variety of fields.
Before the discovery of the chromosome 22 defect, the disorder was known by several names — DiGeorge syndrome, velocardiofacial syndrome and others. Although the term "22q11.2 deletion syndrome" is frequently used today — and is generally a more accurate description — previous names for the disorder are still used.

Symptoms:

Signs and symptoms of DiGeorge syndrome can vary significantly in type and severity. This variation depends on what body systems are affected and how severe the defects are. Some signs and symptoms may be apparent at birth, but others may not appear until later in infancy or early childhood.
Signs and symptoms may include some combination of the following:

• Bluish skin due to poor circulation of oxygen-rich blood (cyanosis)
• Weakness or tiring easily
• Failure to thrive
• Failure to gain weight
• Poor muscle tone
• Shortness of breath
• Twitching or spasms around the mouth, hands, arms or throat (tetany)
• Frequent infections
• Difficulty feeding
• Delayed development, such as delays in rolling over, sitting up or other infant milestones
• Delayed speech development
• Learning delays or difficulties
• A gap in the roof of the mouth (cleft palate) or other problems with the palate
• Certain facial features, such as low-set ears, wide-set eyes or a narrow groove in the upper lip

When to see a doctor
Other conditions may cause the signs and symptoms of DiGeorge syndrome. So it's important to get an accurate and prompt diagnosis if your child exhibits any signs or symptoms of the disorder.
If your child has any of the following signs and symptoms, seek immediate medical care:

• Bluish skin
• Twitching or spasms around the mouth, hands, arms or throat
• Seizures

Causes:

DiGeorge syndrome is caused by the deletion of a portion of chromosome 22. Each person has two copies of chromosome 22, one inherited from each parent. This chromosome contains an estimated 500 to 800 genes.

If a person has DiGeorge syndrome, one copy of chromosome 22 is missing a segment that includes an estimated 30 to 40 genes. Many of these genes haven't been clearly identified and aren't well understood. The region of chromosome 22 that's deleted in DiGeorge syndrome is known as 22q11.2. A small number of people with DiGeorge syndrome have a shorter deletion in the same region of chromosome 22.

The deletion of genes from chromosome 22 usually occurs randomly in the father's sperm or in the mother's egg, or it may occur very early during fetal development. Therefore, the deletion is repeated in all or nearly all of the cells in the body as the fetus develops.

Complications:

The portions of chromosome 22 deleted in DiGeorge syndrome play a role in the development of a number of body systems. As a result, the disorder can cause several errors during fetal development. Common problems that occur with DiGeorge syndrome include:

• Heart defects. DiGeorge syndrome often causes heart defects that result in an insufficient supply of oxygen-rich blood for the body. These defects may include a hole between the lower chambers of the heart (ventricular septal defect); only one large vessel, rather than two vessels, leading out of the heart (truncus arteriosus); and a combination of four abnormal heart structures (tetralogy of Fallot).
  
• Hypoparathyroidism. The four parathyroid glands are oval, grain-of-rice-sized glands located in your neck. These glands maintain proper levels of calcium and phosphorus in your body by turning off or on the secretion of parathyroid hormone (PTH). DiGeorge syndrome can result in smaller than normal parathyroid glands that secrete too little PTH (hypoparathyroidism). Hypoparathyroidism results in low levels of calcium and high levels of phosphorus in the blood
  .
• Thymus gland dysfunction. The thymus gland in children, located beneath the breastbone, is where T cells — a type of white blood cell — mature. Mature T cells are needed to help fight infections. As you grow older, the thymus decreases in size, and other parts of your body take over the role of the thymus in the immune system. In children with DiGeorge syndrome, the thymus gland may be small or missing, resulting in poor immune function and frequent, severe infections.
  
• Cleft palate. A common condition of DiGeorge syndrome is a cleft palate — an opening (cleft) in the roof of the mouth (palate). Other, less visible abnormalities of the palate that may also be present can make it difficult to swallow or produce certain sounds in speech.
  
• Facial features. A number of particular facial features may be present in some people with DiGeorge syndrome. These may include small, low-set ears, wide-set eyes, hooded eyes, a relatively long face or a short or flattened groove in the upper lip.
  
• Learning, behavioral and mental health problems. The 22q11.2 deletion may cause problems with the development and function of the brain, resulting in learning, social, developmental or behavioral problems. Delays in toddler speech development and learning difficulties are common. A number of children with DiGeorge syndrome develop disorders, such as attention-deficit/hyperactivity disorder (ADHD), autism or autism-related disorders. Later in life people with DiGeorge syndrome are at increased risk of mental health problems, including depression, anxiety disorders, schizophrenia and other psychiatric disorders.
  
• Autoimmune disorders. People who had poor immune function as children, due to a small or missing thymus, may have an increased risk of autoimmune disorders, such as rheumatoid arthritis and Graves' disease.
  
• Other problems. A large number of medical conditions may be associated with DiGeorge syndrome. These include hearing impairment, poor vision, poor kidney function and relatively short stature for one's family.

Treatments and drugs :
There is no cure for DiGeorge syndrome. Treatments can usually correct critical problems, such as a heart defect or low calcium levels. Care for developmental, mental health or behavioral problems are more challenging, and the outcomes are less predictable.
Treatments and therapy for a person with DiGeorge syndrome may include interventions for the following conditions:

• Hypoparathyroidism. Hypoparathyroidism can usually be managed with calcium supplements, vitamin D supplements and a low phosphorus diet. If enough of the parathyroid tissue is intact, it's possible your child's parathyroid glands will eventually regulate calcium and phosphorus levels without a specialized diet.
  
• Limited thymus gland function. If your child has some thymic function, infections may be frequent, but not necessarily severe. These infections — usually frequent colds and ear infections — are generally treated as they would be in any child. Most children with limited thymic function follow the normal schedule of vaccines. For most children with moderate thymus impairment, immune system function will improve as they grow older.
  
• Severe thymus dysfunction. If the impairment of the thymus is severe or there's no thymus, your child is vulnerable to a number of severe infections. Treatment requires a transplant of thymus tissue, specialized cells from bone marrow or specialized disease-fighting blood cells.
  
• Cleft palate. A cleft palate or other abnormalities of the palate can usually be surgically repaired.
• Heart defects. Most heart defects associated with DiGeorge syndrome require surgery to repair the heart and correct blood circulation.
  
• Overall development. Your child will likely benefit from a range of therapies, including speech therapy to improve verbal skills and articulation, occupational therapy to learn everyday skills and developmental therapy to learn age-appropriate behaviors, social skills and interpersonal skills. In the United States, early intervention programs providing these types of therapy are usually available through a state's health department.
  
• Mental health care. Psychotherapy and psychiatric medications may be recommended if your child is later diagnosed with attention-deficit/hyperactivity disorder (ADHD), depression, schizophrenia, or other mental health or behavioral disorders.

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Vasovagal syncope

Vasovagal syncope

Definition  :

Vasovagal syncope (vay-zo-VAY-gul SING-cuh-pee) is the most common cause of fainting. Vasovagal syncope occurs when your body overreacts to triggers, such as the sight of blood or extreme emotional distress. The trigger results in vasovagal syncope — a brief loss of consciousness caused by a sudden drop in your heart rate and blood pressure, which reduces blood flow to your brain.

Vasovagal syncope is usually harmless and requires no treatment. However, you can injure yourself during a vasovagal syncope episode. Also, your doctor may recommend tests to rule out more serious causes of fainting, such as heart disorders.

Symptoms:

Before a faint due to vasovagal syncope, you may experience some of the following:

• Skin paleness
• Lightheadedness
• Tunnel vision — your field of vision is constricted so that you see only what's in front of you
• Nausea
• Feeling of warmth
• A cold, clammy sweat

When to see a doctor
Because fainting can be a sign of a more serious condition, such as heart or brain disorders, you may want to consult your doctor after a fainting spell, especially if you never had one before.

Causes:

Vasovagal syncope occurs when the part of your nervous system that regulates heart rate and blood pressure malfunctions in response to a trigger, such as the sight of blood. Your heart rate slows, and the blood vessels in your legs widen. This allows blood to pool in your legs, which lowers your blood pressure. This drop in blood pressure and slowed heart rate quickly diminish blood flow to your brain, and you faint.

Although vasovagal syncope can occur at any age, it's being recognized as an increasingly important cause of fainting in the elderly.
Common triggers for vasovagal syncope include:

• Standing for long periods of time
• Heat exposure
• The sight of blood
• Having blood drawn
• Fear of bodily injury
• Straining, such as to have a bowel movement

Treatments and drugs:

In most cases of vasovagal syncope, treatment is unnecessary. Your doctor may help you identify your fainting triggers and discuss ways you can avoid them. However, if you experience vasovagal syncope often enough to interfere with your quality of life, your doctor may suggest trying one or more of the following remedies.

Medications
Drugs that might help prevent vasovagal syncope include:

• Blood pressure drugs. Beta blockers such as metoprolol (Lopressor) are designed to treat high blood pressure. They are also the type of drug used most often to prevent vasovagal syncope because they block some of the signals that can lead to fainting.
  
• Antidepressants. Selective serotonin reuptake inhibitors, such as paroxetine (Paxil), fluoxetine (Prozac) and sertraline (Zoloft), also have been successful in preventing vasovagal syncope.
  
• Blood vessel constrictors. Drugs to treat low blood pressure or asthma are sometimes helpful in preventing vasovagal syncope.

Therapies
Your doctor may recommend specific techniques to decrease the pooling of blood in your legs. These may include foot exercises, wearing elastic stockings or tensing your leg muscles when standing and increasing salt in your diet if you don't have high blood pressure. Avoid prolonged standing — especially in hot, crowded places — and drink plenty of fluids.

Surgery
The insertion of an electrical pacemaker, which helps regulate the heartbeat, helps some people with vasovagal syncope.

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Nonallergic rhinitis

Nonallergic rhinitis

Definition  :

Nonallergic rhinitis involves chronic sneezing or having a congested, drippy nose with no apparent cause. The symptoms of nonallergic rhinitis are similar to those of hay fever (allergic rhinitis), but there's no allergic reaction involved. Nonallergic rhinitis can affect children and adults, but is more common after age 20.

Although nonallergic rhinitis is more annoying than harmful, it can make you miserable. Triggers of nonallergic rhinitis symptoms vary from person to person and can include certain odors or irritants in the air, changes in the weather, some medications, certain foods, and chronic health conditions. A diagnosis of nonallergic rhinitis is made after an allergy is ruled out. This may require allergy skin or blood tests.

Symptoms:

If you have nonallergic rhinitis, you probably have symptoms that come and go year-round. You may have constant symptoms, symptoms that last for hours or symptoms that last for days. Signs and symptoms of nonallergic rhinitis may include:

• Stuffy nose
• Runny nose
• Mucus (phlegm) in the throat (postnasal drip)

Nonallergic rhinitis doesn't usually cause itchy nose, eyes or throat — symptoms associated with allergies such as hay fever.

When to see a doctor
See your doctor if:

• Your symptoms are severe
• You have signs and symptoms of nonallergic rhinitis that aren't relieved by over-the-counter medications or self-care
• You have bothersome side effects from over-the-counter or prescription medications for rhinitis

Causes:

Nonallergic rhinitis occurs when blood vessels in your nose expand (dilate), filling the nasal lining with blood and fluid. There are several possible causes of this abnormal expansion of the blood vessels or inflammation in the nose. But, whatever the trigger, the result is the same — swollen nasal membranes and congestion.

Many things can trigger the nasal swelling in nonallergic rhinitis — some resulting in short-lived symptoms while others cause chronic problems. Nonallergic rhinitis triggers include:

• Environmental or occupational irritants. Dust, smog, secondhand smoke or strong odors, such as perfumes, can trigger nonallergic rhinitis. Chemical fumes, such as those you might be exposed to in certain occupations, also may be to blame.
  
• Weather changes. Temperature or humidity changes can trigger the membranes inside your nose to swell and cause a runny or stuffy nose.
  
• Infections. A common cause of nonallergic rhinitis is a viral infection — a cold or the flu, for example. This type of nonallergic rhinitis usually clears up after a few weeks but can cause lingering mucus in the throat (postnasal drip). Sometimes, this type of rhinitis can become chronic, causing ongoing discolored nasal discharge, facial pain and pressure (sinusitis).
  
• Foods and beverages. Nonallergic rhinitis may occur when you eat, especially when eating hot or spicy foods. Drinking alcoholic beverages, such as beer and wine, also may cause the membranes inside your nose to swell, leading to nasal congestion.
  
• Certain medications. Some medications can cause nonallergic rhinitis. These include nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin, others), and high blood pressure (hypertension) medications, such as beta blockers. Nonallergic rhinitis can also be triggered in some people by sedatives, antidepressants, oral contraceptives or drugs used to treat erectile dysfunction. Overuse of decongestant nasal sprays can cause a type of nonallergic rhinitis called rhinitis medicamentosa.
  
• Hormone changes. Changes in hormones due to pregnancy, menstruation, oral contraceptive use or a hormonal condition such as hypothyroidism can cause nonallergic rhinitis.
  
• Stress. Emotional or physical stress can trigger nonallergic rhinitis in some people.

Complications:

Complications from nonallergic rhinitis include:

• Nasal polyps. These are soft, noncancerous (benign) growths that develop on the lining of your nose or sinuses due to chronic inflammation. Small polyps may not cause problems, but larger ones can block the airflow through your nose, making it difficult to breathe.
  
• Chronic sinusitis. Prolonged nasal congestion due to nonallergic rhinitis may increase your chances of developing sinusitis — an infection or inflammation of the membrane that lines the sinuses. When sinusitis lasts for longer than 12 consecutive weeks, it's referred to as chronic sinusitis. Sinusitis causes pain, tenderness and swelling around your eyes, cheeks, nose or forehead.
  
• Middle ear infections. Increased fluid and nasal congestion may lead to middle ear infections.
  
• Interrupted daily activities. Nonallergic rhinitis can be disruptive. You may be less productive at work or school, and you may need to take time off because of symptom flares or doctor visits.

Treatments and drugs:

Treatment of nonallergic rhinitis depends on how much it bothers you. For mild cases, home treatment and avoiding triggers may be enough. For more bothersome symptoms, certain medications may provide relief, including:

• Saline nasal sprays. Use an over-the-counter nasal saline spray or homemade saltwater solution to flush the nose of irritants and help thin the mucus and soothe the membranes in your nose.
  
• Corticosteroid nasal sprays. If your symptoms aren't easily controlled by decongestants or antihistamines, your doctor may suggest a prescription corticosteroid nasal spray, such as fluticasone (Flonase) or mometasone (Nasonex). Corticosteroid medications help prevent and treat inflammation associated with some types of nonallergic rhinitis. Possible side effects include indigestion, nausea, headache and bodily pains.
  
• Antihistamine nasal sprays. Try a prescription antihistamine spray such as azelastine (Astelin) and olopatadine hydrochloride (Patanase). While oral antihistamines don't seem to help nonallergic rhinitis, antihistamine in the form of a nasal spray may reduce symptoms of nonallergic rhinitis. Side effects may include a bitter taste in your mouth, headache and fatigue.
  
• Anti-drip anticholinergic nasal sprays. The prescription drug ipratropium (Atrovent) is often used as an asthma inhaler medication. But it's now available as a nasal spray and can be helpful if a runny, drippy nose is your main symptom. Side effects may include a bitter taste in your mouth and drying of the inside of your nose.
  
• Oral decongestants. Available over-the-counter or by prescription, examples include pseudoephedrine-containing drugs (Actifed, Sudafed, others) and phenylephrine (Neo-Synephrine, others). These medications help narrow the blood vessels, reducing congestion in the nose. Possible side effects include high blood pressure, insomnia, loss of appetite, heart pounding (palpitations), anxiety and restlessness.
  
• Decongestant nasal sprays. These include oxymetazoline (Afrin, others). Don't use these medications for more than three or four days, as they can cause congestion to come back with even worse symptoms when you stop using them. Other possible side effects include headache, insomnia and feeling nervous.

Over-the-counter oral antihistamines, such as diphenhydramine (Benadryl), clemastine (Tavist) and loratadine (Claritin), typically don't work nearly as well for nonallergic rhinitis as they do for allergic rhinitis.
In rare cases, surgical procedures may be an option to treat complicating problems, such as a deviated nasal septum or persistent nasal polyps.

Some studies have shown repeated applications to the inside of the nose of capsaicin, the ingredient responsible for the heat in hot peppers, to be effective. But the use of capsaicin to treat nonallergic rhinitis hasn't been approved.

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Vasculitis

Vasculitis

Definition  :

Vasculitis is an inflammation of your blood vessels. Vasculitis causes changes in the walls of your blood vessels, including thickening, weakening, narrowing and scarring.
There are many types of vasculitis. Some forms last only a short time (acute) while others are long lasting (chronic). Vasculitis, which is also known as angiitis and arteritis, can be so severe that the tissues and organs supplied by the affected vessels don't get enough blood. This shortage of blood can result in organ and tissue damage, even death.

Vasculitis can affect anyone, though some types of vasculitis are more common among certain groups. Some forms of vasculitis improve on their own, but others require treatment — often including taking medications for an extended period of time.

Symptoms:

General signs and symptoms common to most vasculitis types
The signs and symptoms of vasculitis vary depending on which blood vessels and, as a result, which organ systems are affected. However, general signs and symptoms that many people with vasculitis experience include:

• Fever
• Fatigue
• Weight loss
• Muscle and joint pain
• Loss of appetite
• Nerve problems, such as numbness or weakness

Signs and symptoms for some types of vasculitis

• Behcet's syndrome. This condition causes inflammation of your arteries and veins, and often appears in your 20s and 30s. Signs and symptoms include mouth and genital ulcers, eye inflammation, and acne-like lesions on your skin.
  
• Buerger's disease. Also called thromboangiitis obliterans, this condition causes inflammation and clots in the blood vessels in your extremities. Signs and symptoms can include pain in your hands, arms, feet and legs, and ulcers on your fingers and toes. This disorder is strongly associated with cigarette smoking.
  
• Churg-Strauss syndrome. This condition, also known as allergic granulomatosis and allergic angiitis, most commonly affects the blood vessels in your lungs. It's often associated with asthma.
  
• Cryoglobulinemia. This condition is often associated with hepatitis C infections. Signs and symptoms include a rash called purpura on your lower extremities, arthritis, weakness and nerve damage (neuropathy).
  
• Giant cell arteritis. This condition, which usually occurs in people older than 50, is an inflammation of the arteries in your head, especially your temples. Giant cell arteritis can cause headaches, scalp tenderness, jaw pain while chewing, blurred or double vision, and even blindness. Giant cell arteritis is often associated with another type of inflammatory condition called polymyalgia rheumatica (PMR). PMR causes pain in and inflammation of the large joints, such as your shoulders and hips. Signs and symptoms include pain and stiffness in the muscles of your hips, thighs, shoulders, upper arms and neck.
  
• Henoch-Schonlein purpura. This condition is caused by inflammation of the blood vessels of your skin, joints, bowel and kidneys. Signs and symptoms can include abdominal pain, blood in the urine, joint pain, and a rash called purpura on your buttocks, legs and feet. Henoch-Schonlein usually affects children, but it can occur at any age.
  
• Hypersensitivity vasculitis. The primary sign of hypersensitivity vasculitis is red spots on your skin. It can be triggered by an allergy, most often to a medication or an infection.
  
• Kawasaki disease. Also known as mucocutaneous lymph node syndrome, this condition most often affects children younger than 5 years of age. Signs and symptoms include fever, skin rash and eye inflammation.
  
• Microscopic polyangiitis. This form of vasculitis affects small-sized blood vessels in your kidneys, lungs and skin. Signs and symptoms include skin lesions, fever, unintentional weight loss, glomerulonephritis — inflammation of the small blood vessels in the kidneys — and nerve damage.
  
• Polyarteritis nodosa. This form of vasculitis affects medium-sized blood vessels in many different parts of the body, including your skin, heart, kidneys, peripheral nerves, muscles and intestines. Signs and symptoms include a rash called purpura, skin ulcers, muscle and joint pain, abdominal pain, and kidney problems.
  
• Takayasu's arteritis. This form of vasculitis includes the largest arteries in the body, including the aorta, and typically occurs in young women. Signs and symptoms include a feeling of numbness or cold in the extremities, decreased or absent pulses, high blood pressure, headaches, and visual disturbances.
  
• Granulomatosis with polyangiitis (Wegener's). Formerly known as Wegener's granulomatosis, granulomatosis with polyangiitis causes inflammation of the blood vessels in your nose, sinuses, throat, lungs and kidneys. Signs and symptoms can include nasal stuffiness, chronic sinus infections and nosebleeds. The kidneys are often affected, though most people won't have any noticeable symptoms until the damage is more advanced.

When to see a doctor
Make an appointment with your doctor if you have any signs or symptoms that worry you.

Causes:

Vasculitis occurs when your immune system mistakenly sees blood vessel cells as foreign. The immune system then attacks those cells as if they were an invader, such as a bacteria or virus. It's not always clear why this happens, but an infection, some cancers, certain immune system disorders or an allergic reaction may serve as the trigger.

Blood vessels affected by vasculitis become inflamed, which can cause the layers of the blood vessel wall to thicken. This narrows the blood vessels, reducing the amount of blood — and therefore oxygen and vital nutrients — that reaches your body's tissues. In some cases, a blood clot may form in an affected blood vessel, obstructing blood flow. Sometimes instead of becoming narrower, a blood vessel may weaken and form a bulge (aneurysm), a potentially life-threatening condition.

Vasculitis with no known cause (primary vasculitis)
For many of its forms, the cause of vasculitis is unknown. These forms of vasculitis are called primary vasculitis.

Vasculitis that occurs due to another disease (secondary vasculitis)
Forms of vasculitis for which an underlying disease is the cause are called secondary vasculitis. Examples of causes of secondary vasculitis include:

• Infections. Some vasculitis occurs in response to an infection. For instance, most cases of cryoglobulinemia are the result of the hepatitis C virus infection, and the hepatitis B virus infection causes some cases of polyarteritis nodosa.
  
• Immune system diseases. Vasculitis can also occur as the result of some diseases of the immune system, such as rheumatoid arthritis, lupus and scleroderma.
  
• Allergic reactions. Sometimes an allergic reaction to a medication may cause vasculitis.
  
• Blood cell cancers. Cancer that affects the blood cells, including leukemia and lymphoma, can cause vasculitis.

Complications:

Complications of vasculitis depend on the type of vasculitis you have. In general, complications that can occur include:

• Organ damage. Some types of vasculitis can be severe, causing damage to major organs.
• Recurring episodes of vasculitis. Even when treatment for vasculitis is initially successful, the condition may recur and require additional treatment. In other cases, vasculitis may never completely go away and requires ongoing treatment.

Treatments and drugs:

Specific treatment for vasculitis depends on what kind of vasculitis you have, how serious your condition is and your general health. Though some types of vasculitis are self-limiting and improve on their own, such as Henoch-Schonlein purpura, others require medications.
Medications used to treat vasculitis include:

• Steroids to control inflammation. Treatment for many types of vasculitis consists of doses of a corticosteroid drug, such as prednisone or methylprednisolone (Medrol), to control inflammation. Side effects of steroids can be severe, especially when taken over a long period of time. Side effects can include weight gain, diabetes and bone thinning (osteoporosis). You're likely to receive the lowest dose of steroids possible to control your disease.
  
• Medications to control the immune system. Severe cases of vasculitis or those that don't respond adequately to corticosteroids may need treatment with cytotoxic drugs that kill immune system cells responsible for causing inflammation. Cytotoxic drugs include azathioprine (Azasan, Imuran) and cyclophosphamide (Cytoxan). Another drug that helps dampen the immune system response is rituximab (Rituxan). This drug is approved for treating granulomatosis with polyangiitis (Wegener's) and microscopic polyangiitis along with corticosteroids. Researchers have also had some success using drugs that alter your body's immune response to treat certain types of vasculitis. Drugs that have been used, but are still being tested include mycophenolate (Cellcept), infliximab (Remicade), adalimumab (Humira) and anakinra (Kineret).

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Smallpox

Smallpox

Definition:

Smallpox is a contagious, disfiguring and often deadly disease that has affected humans for thousands of years. Naturally occurring smallpox was eradicated worldwide by 1980 — the result of an unprecedented global immunization campaign.

Stockpiles of smallpox virus have been kept for research purposes. This has led to concerns that smallpox could someday be used as a biological warfare agent.
There's no treatment or cure for smallpox. A vaccine can prevent smallpox, but the risk of the vaccine's side effects is too high to currently justify routine vaccination for people at low risk of exposure to the smallpox virus.

Symptoms:

The first symptoms of smallpox usually appear 12 to 14 days after you're infected. During the incubation period of seven to 17 days, you look and feel healthy and can't infect others.
Following the incubation period, a sudden onset of flu-like signs and symptoms occurs. These include:

• Fever
• Overall discomfort
• Headache
• Severe fatigue
• Severe back pain
• Sometimes vomiting, diarrhea or both

A few days later, flat, red spots appear first on your face, hands and forearms, and later on your trunk. Within a day or two, many of these lesions turn into small blisters filled with clear fluid, which then turns into pus. Scabs begin to form eight to nine days later and eventually fall off, leaving deep, pitted scars.

The rash is usually most noticeable on the palms of your hands and the soles of your feet. Lesions also develop in the mucous membranes of your nose and mouth and quickly turn into sores that break open, spreading the virus into your saliva.

Smallpox:

 Smallpox usually requires fairly prolonged face-to-face contact to spread. It's most often transmitted through the air by droplets that escape when an infected person coughs, sneezes or talks. In rare instances, airborne virus may spread farther, possibly through the ventilation system in a building, infecting people in other rooms or on other floors. Smallpox can also spread through contact with contaminated clothing and bedding, although the risk of infection from these sources is slight.

Complications:
 
Most people who get smallpox survive. However, there are a few rare varieties of smallpox that are almost always fatal. These more severe forms of smallpox most commonly affect pregnant women and people with impaired immune systems.
People who recover from smallpox usually have severe scars, especially on the face, arms and legs. In some cases, smallpox may cause blindness.

Treatments and drugs:

 No cure for smallpox exists. Treatment would focus on relieving symptoms and keeping the person from becoming dehydrated. Antibiotics may be prescribed if the person also develops a bacterial infection in the lungs or on the skin.

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Esophageal varices

Esophageal varices

Definition:

Esophageal varices are abnormal, enlarged veins in the lower part of the esophagus — the tube that connects the throat and stomach. Esophageal varices occur most often in people with serious liver diseases.

Esophageal varices develop when normal blood flow to your liver is slowed. The blood then backs up into nearby smaller blood vessels, such as those in your esophagus, causing the vessels to swell. Sometimes, esophageal varices can rupture, causing life-threatening bleeding.
A number of drugs and medical procedures are available to stop bleeding from esophageal varices. These same treatments can help prevent bleeding in people diagnosed with esophageal varices.


Esophageal varices:

Esophageal varices usually don't cause signs and symptoms unless they bleed. Signs and symptoms of bleeding esophageal varices include:

• Vomiting blood
• Black, tarry or bloody stools
• Shock, in severe cases

When to see a doctor
Make an appointment with your doctor if you have any signs or symptoms that worry you. If you've been diagnosed with liver disease, ask your doctor about your risk of esophageal varices and how you may reduce your risk of these complications. Ask your doctor whether you should undergo an endoscopy procedure to check for esophageal varices.

If you've been diagnosed with esophageal varices, your doctor may instruct you to be vigilant for signs of bleeding. Bleeding esophageal varices are an emergency. Call 911 or your local emergency services right away if you experience bloody vomit or bloody stools.

Causes:

The enlarged veins of esophageal varices form when blood flow to your liver is slowed. Often the flow of blood is slowed by scar tissue in the liver caused by liver disease. When the blood to your liver is slowed, it begins to back up, leading to increased pressure within a major vein (portal vein) that carries blood to your liver. This pressure forces the blood into the nearby smaller veins, such as those in your esophagus. These fragile, thin-walled veins begin to balloon with the added blood. Sometimes the veins can rupture and bleed.

Liver diseases and other causes of esophageal varices
Esophageal varices are most often a complication of cirrhosis — irreversible scarring of the liver. Other diseases and conditions also can cause esophageal varices. Causes can include:

• Severe liver scarring (cirrhosis). A number of liver diseases can result in cirrhosis, such as hepatitis infection, alcoholic liver disease and a bile duct disorder called primary biliary cirrhosis.
  
• Blood clot (thrombosis). A blood clot in the portal vein or in a vein that feeds into the portal vein called the splenic vein can cause esophageal varices.
  
• A parasitic infection. Schistosomiasis is a parasitic infection found in parts of Africa, South America, the Caribbean, the Middle East and Southeast Asia. The parasite can damage the liver, as well as the lungs, intestine and bladder.
  
• A syndrome that causes blood to back up in your liver. Budd-Chiari syndrome is a rare condition that causes blood clots that can block the veins that carry blood out of your liver.

Complications:
 Bleeding
The most serious complication of esophageal varices is bleeding. Once you have had a bleeding episode, your risk of another is greatly increased. In some cases, bleeding can cause the loss of so much blood volume that you go into shock. This can lead to death.

Treatments and drugs:
The primary aim in treating esophageal varices is to prevent bleeding. Bleeding esophageal varices are life-threatening. If bleeding occurs, treatments are available to try to stop the bleeding.

Treatments to prevent bleeding
Treatments to lower blood pressure in the portal vein may reduce the risk of bleeding esophageal varices. Treatments may include:

• Medications to slow flow of blood in the portal vein. A type of blood pressure drug called a beta blocker may help reduce blood pressure in your portal vein, reducing the likelihood of bleeding. These medications include propranolol (Inderal, Innopran) and nadolol.
  
• Using a scope to access your esophagus and treat varices. If your esophageal varices appear to have a very high risk of bleeding, your doctor may recommend some of the same treatments that are used to stop active bleeding. Treatments may involve using an endoscope to see inside your esophagus and inject a medication or tie off veins with an elastic band.

Treatments to stop bleeding
Bleeding varices are life-threatening, and immediate treatment is essential. Treatments used to stop bleeding include:

• Using elastic bands to tie off bleeding veins. During variceal ligation, your doctor uses an endoscope to snare the varices and wrap them with an elastic band, which essentially "strangles" the veins so they can't bleed. Variceal ligation carries a small risk of complications, such as scarring of the esophagus.
  
• Injecting a solution into bleeding veins. In a procedure called endoscopic injection therapy, the bleeding varices are injected with a solution that shrinks them. Complications can include perforation of the esophagus and scarring of the esophagus that can lead to trouble swallowing (dysphagia).
  
• Medications to slow blood flow into the portal vein. Medications can slow the flow of blood from the internal organs to the portal vein, reducing the pressure in the vein. A drug called octreotide (Sandostatin) is often used in combination with endoscopic therapy to treat bleeding from esophageal varices. The drug is usually continued for five days after a bleeding episode.
  
• Diverting blood flow away from the portal vein. A transjugular intrahepatic portosystemic shunt (TIPS) is a small tube that is placed between the portal vein and the hepatic vein, which carries blood from your liver back to your heart. By providing an additional path for blood, the shunt often can control bleeding from esophageal varices. But TIPS can cause a number of serious complications, including liver failure and mental confusion, which may develop when toxins that would normally be filtered by the liver are passed through the shunt directly into the bloodstream. TIPS is mainly used when all other treatments have failed or as a temporary measure in people awaiting a liver transplant.
  
• Replacing the diseased liver with a healthy one. Liver transplant is an option for people with severe liver disease or those who experience recurrent bleeding of esophageal varices. Although liver transplantation is often successful, the number of people awaiting transplants far outnumbers the available organs.

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Chickenpox

Chickenpox

Definition:

Chickenpox (varicella) was once considered a rite of passage for most children. Before routine chickenpox vaccination, virtually everyone had been infected by the time they reached adulthood, sometimes with serious complications. Today, the number of cases and hospitalizations is down dramatically.

However, when chickenpox does occur, it's highly contagious among people who aren't immune. Most people think of chickenpox as a mild disease — and, for most, it is. Unfortunately, there's no way to know who will develop a severe case.
The chickenpox vaccine is a safe, effective way to prevent chickenpox and its possible complications.

Symptoms:

The signs and symptoms of chickenpox are:

• A red, itchy rash, initially resembling insect bites, on your face, scalp, chest and back
• Small, liquid-filled blisters that break open and crust over
• Fever
• Abdominal pain or loss of appetite
• Mild headache
• General feeling of unease and discomfort (malaise) or irritability
• A dry cough
• Headache

The chickenpox rash goes through these three phases:

• Raised pink or red bumps (papules), which break out in different spots over several days
• Fluid-filled blisters (vesicles), forming from the raised bumps over about one day before breaking and leaking
• Crusts and scabs, which cover the broken blisters and take several more days to heal

New bumps continue to appear for several days. As a result, you may have all three stages of the rash — bumps, blisters, and scabbed lesions — at the same time on the second day of the rash. Once infected, you can spread the virus for up to 48 hours before the rash appears, and you remain contagious until all spots crust over.

The disease is generally mild in healthy children. In severe cases, the rash can spread to cover the entire body, and lesions may form in the throat, eyes and mucous membranes of the urethra, anus and vagina. New spots continue to appear for several days.

When to see a doctor
If you suspect that you or your child has chickenpox, consult your doctor. He or she usually can easily diagnose chickenpox by examining the rash and by noting the presence of accompanying symptoms. Your doctor can also prescribe medications to lessen the severity of chickenpox and treat complications, if necessary. Be sure to call ahead for an appointment, to avoid waiting and possibly infecting others in a crowded waiting room.
Also, be sure to let your doctor know if any of these complications occur:

• The rash spreads to one or both eyes.
• The rash gets very red, warm or tender, indicating a possible secondary bacterial skin infection.
• The rash is accompanied by dizziness, disorientation, rapid heartbeat, shortness of breath, tremors, loss of muscle coordination, worsening cough, vomiting, stiff neck or a fever higher than 103 F (39.4 C).
• Anyone in the household is immune deficient or younger than 6 months old.

Complications:

Chickenpox is normally a mild disease. But it can be serious and can lead to complications, especially in these high-risk groups:

• Newborns and infants whose mothers never had chickenpox or the vaccine
• Adults
• Pregnant women
• People whose immune systems are impaired by medication, such as chemotherapy, or another disease
• People who are taking steroid medications for another disease or condition, such as children with asthma
• People with the skin condition eczema

A common complication of chickenpox is a bacterial infection of the skin. Chickenpox may also lead to pneumonia or, rarely, an inflammation of the brain (encephalitis), both of which can be very serious.

Chickenpox and shingles
Anyone who had chickenpox is at risk of a latent illness called shingles. After a chickenpox infection, some of the varicella-zoster virus may remain in your nerve cells. Many years later, the virus can reactivate and resurface as shingles — a painful band of short-lived blisters. The virus is more likely to reappear in older adults and people with weakened immune systems.

Shingles can lead to its own complication — a condition in which the pain of shingles persists long after the blisters disappear. This complication, called postherpetic neuralgia, can be severe.
A shingles vaccine is available and is recommended for adults age 60 and older who have had chickenpox in the past.

Chickenpox and pregnancy
Other complications of chickenpox affect pregnant women. Chickenpox early in pregnancy can result in a variety of problems in a newborn, including low birth weight and birth defects, such as limb abnormalities. A greater threat to a baby occurs when the mother develops chickenpox in the week before birth. Then it can cause a serious, life-threatening infection in a newborn.
If you're pregnant and not immune to chickenpox, talk to your doctor about the risks to you and your unborn child.

Treatments and drugs:

In otherwise healthy children, chickenpox typically requires no medical treatment. Your doctor may prescribe an antihistamine to relieve itching. But for the most part, the disease is allowed to run its course.

For people who have a high risk of complications from chickenpox, doctors sometimes prescribe medications to shorten the duration of the infection and to help reduce the risk of complications.
If you or your child falls into a high-risk group, your doctor may suggest an antiviral drug such as acyclovir (Zovirax) or another drug called immune globulin intravenous (IGIV). These medications may lessen the severity of the disease when given within 24 hours after the rash first appears. Other antiviral drugs, such as valacyclovir (Valtrex) and famciclovir (Famvir), also may lessen the severity of the disease, but have been approved for use only in adults. In some cases, your doctor may recommend getting the chickenpox vaccine after exposure to the virus. This can prevent the disease or lessen its severity.

If complications do develop, your doctor will determine the appropriate treatment. Treatment for skin infections and pneumonia may be with antibiotics. Treatment for encephalitis is usually with antiviral drugs. Hospitalization may be necessary.
Don't give anyone with chickenpox — child or adult — any medicine containing aspirin because this combination has been associated with a condition called Reye's syndrome.

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Creutzfeldt-Jakob disease

Creutzfeldt-Jakob disease

Definition:

Creutzfeldt-Jakob (KROITS-felt YAH-kobe) disease is a degenerative brain disorder that leads to dementia and, ultimately, death. Symptoms of Creutzfeldt-Jakob disease (CJD) sometimes resemble those of other dementia-like brain disorders, such as Alzheimer's, but Creutzfeldt-Jakob disease usually progresses much more rapidly.

Creutzfeldt-Jakob disease captured public attention in the 1990s when some people in the United Kingdom developed a form of the disease — variant CJD (vCJD) — after eating meat from diseased cattle. However, "classic" Creutzfeldt-Jakob disease has not been linked to contaminated beef.
Although serious, CJD is rare, and vCJD is the least common form. Worldwide, there is an estimated one case of Creutzfeldt-Jakob disease diagnosed per million people each year, most commonly in older adults.

Symptoms:

Creutzfeldt-Jakob disease is marked by rapid mental deterioration, usually within a few months. Initial signs and symptoms of CJD typically include:

• Personality changes
• Anxiety
• Depression
• Memory loss
• Impaired thinking
• Blurred vision
• Insomnia
• Difficulty speaking
• Difficulty swallowing
• Sudden, jerky movements

As the disease progresses, mental symptoms worsen. Most people eventually lapse into a coma. Heart failure, respiratory failure, pneumonia or other infections are generally the cause of death. The disease usually runs its course in about seven months, although a few people may live up to one or two years after diagnosis.

In people with the rarer vCJD, psychiatric symptoms may be more prominent in the beginning, with dementia — the loss of the ability to think, reason and remember — developing later in the course of the illness. In addition, this variant affects people at a younger age than classic CJD does, and appears to have a slightly longer duration — 12 to 14 months.

Causes:

Creutzfeldt-Jakob disease and its variants belong to a broad group of human and animal diseases known as transmissible spongiform encephalopathies (TSEs). The name derives from the spongy holes, visible under a microscope, that develop in affected brain tissue.

The cause of Creutzfeldt-Jakob disease and other TSEs appears to be abnormal versions of a kind of protein called a prion. Normally, these proteins are harmless, but when they're misshapen they become infectious and can wreak havoc on normal biological processes.

How CJD is transmitted
The risk of CJD is low. The disease can't be transmitted through coughing or sneezing, touching, or sexual contact. The three ways it develops are:

• Sporadically. Most people with classic CJD develop the disease for no apparent reason. CJD that occurs without explanation is termed spontaneous CJD or sporadic CJD and accounts for the majority of cases.
  
• By inheritance. In the United States, about 5 to 10 percent of people with CJD have a family history of the disease or test positive for a genetic mutation associated with CJD. This type is referred to as familial CJD.
  
• By contamination. A small number of people have developed CJD after being exposed to infected human tissue during a medical procedure, such as a cornea or skin transplant. Also, because standard sterilization methods do not destroy abnormal prions, a few people have developed CJD after undergoing brain surgery with contaminated instruments. Cases of CJD related to medical procedures are referred to as iatrogenic CJD. Variant CJD is linked primarily to eating beef infected with bovine spongiform encephalopathy (BSE), the medical term for mad cow disease.

Complications:

As with other causes of dementia, Creutzfeldt-Jakob disease profoundly affects the brain as well as the body, although CJD and its variants usually progress much more rapidly. People with CJD usually withdraw from friends and family and eventually lose the ability to recognize or relate to them in any meaningful way. They also lose the ability to care for themselves, and many eventually slip into a coma. The disease ultimately is fatal.
Physical complications, all of which may become life-threatening, include:

• Infection
• Heart failure
• Respiratory failure

Treatments and drugs:

 No effective treatment exists for Creutzfeldt-Jakob disease or any of its variants. A number of drugs have been tested — including steroids, antibiotics and antiviral agents — and have not shown benefits. For that reason, doctors focus on alleviating pain and other symptoms and on making people with these diseases as comfortable as possible.

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Plague

Plague

Definition:

Plague was known as the Black Death during medieval times, when it killed up to a third of the population of Europe. Currently, plague occurs in fewer than 3,000 people per year worldwide. It can be deadly if not treated promptly with antibiotics.

The organism that causes plague, Yersinia pestis, lives in a variety of small rodents on every continent except Australia. The organism is transmitted to humans when they are bitten by fleas that have previously fed on infected rodents.

The most common form of plague results in swollen and tender lymph nodes — called buboes — in the groin, armpits or neck. The rarest and deadliest form of plague affects the lungs, and it can be spread from person to person.

Symptoms:

Plague is divided into three main types — bubonic, septicemic and pneumonic — depending on which part of your body is involved. Signs and symptoms vary depending on the type of plague.

Bubonic plague
Bubonic plague is the most common variety of the disease. It's named after the buboes — swollen lymph nodes — which typically develop within a week after an infected flea bites you. Buboes may be:

• Located in the groin, armpit or neck
• About the size of a chicken egg
• Tender and warm to the touch

Other signs and symptoms may include:

• Sudden onset of fever and chills
• Headache
• Fatigue or malaise
• Muscle aches

Septicemic plague
Septicemic plague occurs when plague bacteria multiply in your bloodstream. Signs and symptoms include:

• Fever and chills
• Abdominal pain, diarrhea and vomiting
• Bleeding from your mouth, nose or rectum, or under your skin
• Shock
• Blackening and death of tissue (gangrene) in your extremities, most commonly your fingers, toes and nose

Pneumonic plague
Pneumonic plague affects the lungs. It's the least common variety of plague but the most dangerous, because it can be spread from person to person via cough droplets. Signs and symptoms can begin within a few hours after infection, and may include:

• Cough, with bloody sputum
• Difficulty breathing
• High fever
• Nausea and vomiting
• Weakness

Pneumonic plague progresses rapidly and may cause respiratory failure and shock within two days of infection. If antibiotic treatment isn't initiated within a day after signs and symptoms first appear, the infection is likely to be fatal.

When to see a doctor
Seek immediate medical attention if you begin to feel ill and have been in an area where plague has been known to occur. This includes parts of several states in the western portion of the United States — primarily New Mexico, Arizona and Colorado.

Causes:

The plague bacteria, Yersinia pestis, is transmitted to humans when they are bitten by fleas that have previously fed on infected animals, such as:

• Rats
• Squirrels
• Rabbits
• Prairie dogs
• Chipmunks

The bacteria can also enter your body if you have a break in your skin that comes into contact with an infected animal's blood. Domestic cats can become infected with plague from flea bites or from eating infected rodents.
Pneumonic plague, which affects the lungs, is spread by inhaling infectious droplets coughed into the air by a sick animal or person.

Complications:

Complications of plague may include:

• Death. Most people who receive prompt antibiotic treatment survive plague. Untreated plague has a fatality rate over 50 percent.
• Gangrene. Blood clots in the tiny blood vessels of your fingers and toes can disrupt the flow of blood and cause that tissue to die. The portions of your fingers and toes that have died may need to be amputated.
• Meningitis. Rarely, plague may cause meningitis, an inflammation of the membranes surrounding your brain and spinal cord. 

Treatments and drugs:

Medications
As soon as your doctor suspects that you have plague, you'll need to be admitted to an isolation room in a hospital. There, you'll receive powerful antibiotics, such as:

• Streptomycin
• Gentamicin
• Doxycycline (Vibramycin)
• Ciprofloxacin (Cipro)
• Chloramphenicol

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