Pneumonia Disease Information

Pneumonia is a serious infection and/or inflammation of your lungs. The air sacs in the lungs fill with pus and other liquid. Oxygen has trouble reaching your blood. If there is too little oxygen in your blood, your body cells can't work properly. Because of this and spreading infection through the body pneumonia can cause death.
Pneumonia can have over 30 different causes.


Until 1936, pneumonia was the No.1 cause of death in the U.S. Since then, the use of antibiotics brought it under control. In 2003, pneumonia and influenza combined ranked as the seventh leading cause of death.1

Pneumonia affects your lungs in two ways. Lobar pneumonia affects a section (lobe) of a lung. Bronchial pneumonia (or bronchopneumonia) affects patches throughout both lungs.

CAUSES OF PNEUMONIA

Pneumonia is not a single disease. It can have over 30 different causes. There are five main causes of pneumonia:

• Bacteria

• Viruses

• Mycoplasmas

• Other infectious agents, such as fungi -- including pneumocystis

• Various chemicals

BACTERIAL PNEUMONIA

Bacterial pneumonia can attack anyone from infants through the elderly. Alcoholics, the debilitated, post-operative patients, people with respiratory diseases or viral infections and people who have weakened immune systems are at greater risk.

Pneumonia bacteria are present in some healthy throats. When body defenses are weakened in some way, by illness, old age, malnutrition, general debility or impaired immunity, the bacteria can multiply and cause serious damage. Usually, when a person's resistance is lowered, bacteria work their way into the lungs and inflame the air sacs.

The tissue of part of a lobe of the lung, an entire lobe, or even most of the lung's five lobes becomes completely filled with liquid (this is called "consolidation"). The infection quickly spreads through the bloodstream and the whole body is invaded.

The organism streptococcus pneumoniae is the most common cause of bacterial pneumonia. It is one form of pneumonia for which a vaccine is available.

Symptoms: The onset of bacterial pneumonia can vary from gradual to sudden. In the most severe cases, the patient may experience shaking chills, chattering teeth, severe chest pain, and a cough that produces rust-colored or greenish mucus.

A person's temperature may rise as high as 105 degrees F. The patient sweats profusely, and breathing and pulse rate increase rapidly. Lips and nailbeds may have a bluish color due to lack of oxygen in the blood. A patient's mental state may be confused or delirious.

VIRAL PNEUMONIA

Half of all pneumonias are believed to be caused by viruses. More and more viruses are being identified as the cause of respiratory infection, and though most attack the upper respiratory tract, some produce pneumonia, especially in children. Most of these pneumonias are not serious and last a short time but some may be.

Infection with the influenza virus may be severe and occasionally fatal. The virus invades the lungs and multiplies, but there are almost no physical signs of lung tissue becoming filled with fluid. It finds many of its victims among those who have pre-existing heart or lung disease or are pregnant.

Symptoms: The initial symptoms of viral pneumonia are the same as influenza symptoms: fever, a dry cough, headache, muscle pain, and weakness. Within 12 to 36 hours, there is increasing breathlessness; the cough becomes worse and produces a small amount of mucus. There is a high fever and there may be blueness of the lips.

In extreme cases, the patient has a desperate need for air and extreme breathlessness. Viral pneumonias may be complicated by an invasion of bacteria, with all the typical symptoms of bacterial pneumonia.

MYCOPLASMA PNEUMONIA

Because of its somewhat different symptoms and physical signs, and because the course of the illness differed from classical pneumococcal pneumonia, mycoplasma pneumonia was once believed to be caused by one or more undiscovered viruses and was called "primary atypical pneumonia."

Identified during World War II, mycoplasmas are the smallest free-living agents of disease in humankind, unclassified as to whether bacteria or viruses, but having characteristics of both. They generally cause a mild and widespread pneumonia. They affect all age groups, occurring most frequently in older children and young adults. The death rate is low, even in untreated cases.

Symptoms: The most prominent symptom of mycoplasma pneumonia is a cough that tends to come in violent attacks, but produces only sparse whitish mucus. Chills and fever are early symptoms, and some patients experience nausea or vomiting. Patients may experience profound weakness that lasts for a long time.

OTHER KINDS OF PNEUMONIA

Pneumocystis carinii pneumonia (PCP) is caused by an organism believed to be a fungus. PCP may be the first sign of illness in many persons with AIDS.

PCP can be successfully treated in many cases. It may recur a few months later, but treatment can help to prevent or delay its recurrence.

Other less common pneumonias may be quite serious and are occurring more often. Various special pneumonias are caused by the inhalation of food, liquid, gases or dust, and by fungi. Foreign bodies or a bronchial obstruction such as a tumor may promote the occurrence of pneumonia, although they are not causes of pneumonia.

Rickettsia (also considered an organism somewhere between viruses and bacteria) cause Rocky Mountain spotted fever, Q fever, typhus and psittacosis, diseases that may have mild or severe effects on the lungs. Tuberculosis pneumonia is a very serious lung infection and extremely dangerous unless treated early.


TREATING PNEUMONIA

If you develop pneumonia, your chances of a fast recovery are greatest under certain conditions: if you're young, if your pneumonia is caught early, if your defenses against disease are working well, if the infection hasn't spread, and if you're not suffering from other illnesses.

In the young and healthy, early treatment with antibiotics can cure bacterial pneumonia, speed recovery from mycoplasma pneumonia, and a certain percentage of rickettsia cases. There is not yet a general treatment for viral pneumonia, although antiviral drugs are used for certain kinds. Most people can be treated at home.

The drugs used to fight pneumonia are determined by the germ causing the pneumonia and the judgment of the doctor. After a patient's temperature returns to normal, medication must be continued according to the doctor's instructions, otherwise the pneumonia may recur. Relapses can be far more serious than the first attack.

Besides antibiotics, patients are given supportive treatment: proper diet and oxygen to increase oxygen in the blood when needed. In some patients, medication to ease chest pain and to provide relief from violent cough may be necessary.

The vigorous young person may lead a normal life within a week of recovery from pneumonia. For the middle-aged, however, weeks may elapse before they regain their accustomed strength, vigor, and feeling of well-being. A person recovering from mycoplasma pneumonia may be weak for an extended period of time.

Adequate rest is important to maintain progress toward full recovery and to avoid relapse. Remember, don't rush recovery!


PREVENTING PNEUMONIA IS POSSIBLE

Because pneumonia is a common complication of influenza (flu), getting a flu shot every fall is good pneumonia prevention.

A vaccine is also available to help fight pneumococcal pneumonia, one type of bacterial pneumonia. Your doctor can help you decide if you, or a member of your family, need the vaccine against pneumococcal pneumonia. It is usually given only to people at high risk of getting the disease and its life-threatening complications.

The greatest risk of pneumococcal pneumonia is usually among people who:
Have chronic illnesses such as lung disease, heart disease, kidney disorders, sickle cell anemia, or diabetes.
Are recovering from severe illness
Are in nursing homes or other chronic care facilities
Are age 65 or older

If you are at risk, ask your doctor for the vaccine.

Ask your doctor about any revaccination recommendations. The vaccine is not recommended for pregnant women or children under age two.

Since pneumonia often follows ordinary respiratory infections, the most important preventive measure is to be alert to any symptoms of respiratory trouble that linger more than a few days. Good health habits, proper diet and hygiene, rest, regular exercise, etc., increase resistance to all respiratory illnesses. They also help promote fast recovery when illness does occur.


IF YOU HAVE SYMPTOMS OF PNEUMONIA

Call your doctor immediately. Even with the many effective antibiotics, early diagnosis and treatment are important.

Follow your doctor's advice. In serious cases, your doctor may advise a hospital stay. Or recovery at home may be possible.

Continue to take the medicine your doctor prescribes until told you may stop. This will help prevent recurrence of pneumonia and relapse.

Remember, even though pneumonia can be treated, it is an extremely serious illness. Don't wait, get treatment early.

Sources:
1. National Center for Health Statistics. National Vital Statistics Report. Deaths: Leading Causes for Mortality 2002. Vol. 53(17), 2005

© 2007 American Lung Association®. All rights reserved

Plague Disease Information

Plague is a life-threatening infection caused by the organism Yersinia pestis, the bacterium that caused the 14th-century Black Death plague pandemic.

Plague-causing bacteria still exist in the environment today, although their effect has abated dramatically. The major threat of plague these days comes not through natural transmission, but through intentional transmission, perhaps by terrorists as an agent of biological warfare.

In nature, infected fleas transmit Y. pestis primarily among rodents. When a plague outbreak among rodents kills many of them in short order, infected fleas that were feeding on the rodents' blood jump to other animals and humans, spreading the infection.

During the Black Death, plague caused 20 million to 30 million deaths in Europe. More recent pandemics through the late 19th century killed millions of people worldwide. Improved living conditions and health services have made such large-scale outbreaks of natural plague unlikely, but occasional isolated plague cases continue.

These days, weapons may be more likely than rats to cause a plague pandemic. Plague bacteria could conceivably be put into a form that could be sprayed through the air, infecting anyone inhaling the bacteria and causing pneumonic plague. This form of plague affects your lungs and can spread from person to person. Fortunately, when given promptly, antibiotics can effectively treat plague most of the time.
Signs and symptoms

There are three types of plague: bubonic, septicemic and pneumonic. Signs and symptoms of plague vary depending on the type and on how you contract it. It's possible to develop more than one type of plague.

Bubonic plague
This is the most common type of plague in humans, accounting for the majority of naturally occurring cases. Bubonic plague is caused by a bite from an infected flea and is characterized by an enlarged, infected lymph node called a bubo.

Signs and symptoms of bubonic plague generally appear within two to eight days after a plague-infected flea bites you. After you're bitten, the bacteria travel through your lymphatic system, infecting the first lymph node they reach. The resulting bubo is usually 1 to 10 centimeters in diameter, swollen, painful and warm to the touch. It can cause so much pain that you can't move the affected part of your body. The bubo usually develops in your groin, but may also appear in your armpit or neck, depending on where the flea bit you. More than one bubo can develop, but typically buboes affect only one area of your body.

Buboes may not be noticeable until a day or more after other symptoms appear. Other signs and symptoms of bubonic plague 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. You can contract this form of plague when bacteria transmitted by a fleabite enter directly into your bloodstream, or as a complication of bubonic or pneumonic plague. If septicemic plague occurs as a complication of bubonic plague, buboes may be present.

Signs and symptoms of septicemic plague 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

The gangrene associated with septicemic plague inspired the nickname Black Death for the 14th-century pandemic.

Pneumonic plague
Pneumonic plague is the least common form of plague — accounting for 12 percent of U.S. cases in the last 50 years — but the most rapidly fatal. Primary pneumonic plague can occur when you inhale infectious droplets coughed into the air by a person or animal with pneumonic plague. Early signs and symptoms, which generally occur about two days after inhaling contaminated droplets, include:
High fever
Weakness
Signs of pneumonia, including chest pain, difficulty breathing and a cough with bloody sputum
Nausea and vomiting

You can also develop pneumonic plague as a complication of bubonic or septicemic plague if the bacteria spread to your lungs. This is called secondary pneumonic plague.

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.

Plague resulting from a bioterrorist attack
It's possible that plague bacteria could be turned into an aerosol and then might be spread over large populations as a bioterrorist weapon. An attack of this kind would cause pneumonic plague — the most deadly and most contagious type. In 1970, the World Health Organization estimated that if plague bacteria were sprayed over a city of 5 million people, up to 150,000 people could be infected and 36,000 might die.

According to a consensus statement by a group of scientists published in the Journal of the American Medical Association, the incubation period for pneumonic plague following a bioterrorist attack might last from one to six days, but more often from two to four days. Signs and symptoms would mirror those of naturally occurring pneumonic plague, but might also include nausea, vomiting, abdominal pain and diarrhea.

Other indications that a bioterrorist event or germ warfare is behind a pneumonic plague outbreak include a high incidence of pneumonic plague in humans in regions of the country that haven't had outbreaks among animals or rodents, or when plague occurs in people without any known risk factors.
Causes

Plague has afflicted humans throughout history. The first recorded plague outbreak began in Egypt in A.D. 541.

The Black Death pandemic in the 14th century killed one-third of Europe's population. Europeans living during early pandemics believed the disease was a punishment from the gods or an unlucky confluence of astrological or supernatural elements.

The most recent plague pandemic began in China in the late 1800s and, due to booming international trade and ships with high rat populations, spread quickly throughout Asia and other parts of the world. That outbreak caused more than 12 million deaths in India and China alone.

The cause of plague, the Yersinia pestis bacterium, was discovered in 1894 by Alexandre Yersin. Soon after, scientists realized that fleas transmitted the bacteria.

In World War II, the Japanese army released plague-carrying fleas over a part of China, causing outbreaks of the disease. After World War II, both the United States and the former Soviet Union pursued biological weapons programs that developed means of exposing large populations to plague bacteria. Today, plague is one of a number of feared potential agents of bioterrorism, along with anthrax, smallpox, botulism, tularemia and nerve gases.
Risk factors

Naturally occurring plague outbreaks are most common in rural areas and in urban areas characterized by overcrowding, poor sanitation and a high rat population. Outbreaks can happen at any time of year.

In the United States, plague outbreaks occur most often between April and November. Most U.S. cases occur in Western states, including New Mexico, Arizona, Colorado and California.

Rock squirrels and ground squirrels are the most common sources of infection in the United States. Other rodents, including chipmunks and prairie dogs, may host plague-carrying fleas. Animals that may be infected and pose a transmission risk to humans include wild rabbits and domestic cats that have contact with wild rodents.

The disease usually spreads through fleabites, but you can also contract plague after being exposed to an infected animal that may have coughed infectious droplets into the air or through a break in your skin after handling an animal with plague. Groups at increased risk include veterinarians, cat owners, hunters, campers and hikers in areas with recent plague outbreaks among animals.
When to seek medical advice

Call your doctor if you or someone close to you develops signs or symptoms of plague within a week of any of the following:
Being exposed to a sick or dead animal
Being bitten by a flea or by an unknown insect
Spending time in an area with a known, recent plague outbreak or with a large number of dead or dying animals
Having close contact — within three feet — with a person or animal with pneumonic plague
Traveling to a high-risk region of the United States or another country with high plague rates
Screening and diagnosis

Your doctor may suspect plague if you live in a high-risk region. With the exception of a visible bubo, signs and symptoms often mimic other, more common infectious diseases.

You'll likely be asked to describe the type and severity of your symptoms and tell your doctor about your recent history, including whether you've been exposed to sick animals or traveled to areas with plague outbreak.

If your doctor suspects plague, he or she may confirm the diagnosis through microscopic examination of fluid extracted from your bubo, bronchi or trachea. Needle aspiration is used to obtain fluid from your bubo. Fluid is extracted from your airways using endoscopy. In this procedure, a thin, flexible tube is inserted through your nose or mouth and down your throat. A suction device is sent down the tube to extract a fluid sample from your airways.

Your doctor may also test blood drawn from your veins to diagnose plague. Y. pestis bacteria generally are present in your bloodstream only if you have septicemic plague.
Complications

Complications of plague may include:
Gangrene of your fingers and toes resulting from clots in the small blood vessels of your extremities
Severe shock
Sudden, severe lung failure (acute respiratory distress syndrome)
Bloodstream infection (septicemia)
Inflammation of the membranes and fluid surrounding your brain and spinal cord (meningitis)
Death

With prompt treatment, the overall fatality rate from plague is between 5 percent and 14 percent in the United States. Without treatment, mortality rates can be as high as 60 percent for bubonic plague and 100 percent for pneumonic plague. Death can occur within days after symptoms first appear if treatment doesn't begin promptly.
Treatment

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 directly into your veins (intravenously) or your muscles (intramuscularly) for at least 10 days. Streptomycin and gentamicin are the most effective drugs against plague. Other alternatives include intravenous doxycycline (Vibramycin), ciprofloxacin (Cipro) and chloramphenicol (Chloromycetin).

If you have serious complications, such as bleeding abnormalities, organ failure and respiratory distress, then respiratory support, intravenous fluids and oxygen may be necessary. Your doctor is required by law to report documented plague infection to local health officials.

Even if you don't have signs or symptoms, you'll need treatment with preventive, oral antibiotics for seven days after direct exposure to a person with pneumonic plague.
Prevention

Previously, a vaccine was available for bubonic plague, but its efficacy was never well studied and the manufacturer stopped producing it in 1999. Clinical trials on a new plague vaccine are in the earliest stages.

Although no effective vaccine is available, antibiotics offer effective preventive therapy if you're at risk or have been exposed to plague. Ask your doctor immediately about preventive antibiotics if you:
Have had close contact with a person or animal with known or suspected pneumonic plague
Have been bitten by a flea or unknown insect in an area known to have recent plague cases
Are planning to spend time in a region with recent plague outbreak

Take the following precautions if you live or spend time in regions where plague outbreaks occur:
Avoid contact with sick or dead animals. If you hunt, wear gloves when handling dead animals.
Rodent-proof your home. Remove potential nesting areas, such as piles of brush, rock, firewood and junk. Don't leave pet food or any other foods in areas that rodents can easily access.
Prevent your pets from contracting fleas. Use flea-control products and don't allow pets to wander unsupervised. Ask your veterinarian for recommended flea-control brands and guidelines.
Take precautions when outdoors. Closely supervise your children and pets when spending time outside in areas with large rodent populations. Use insect repellent on your skin and clothing.

Know the risk factors and the symptoms of plague so that you can identify it early and contact your doctor immediately. If you know of recent plague cases in your area, report sick or dead animals to your local health department or to police.

By Mayo Clinic Staff
Sep 1, 2006

Neuroblastoma Disease Information

Neuroblastoma is a cancer that develops from nerve cells found in several areas of the body. Neuroblastoma most commonly affects children age 5 or younger, though it may rarely occur in older children and adults. Neuroblastoma is the most common cancer in babies.

Neuroblastoma develops in tissue that makes up the sympathetic nervous system — the system of nerves that automatically regulates your heart rate, blood pressure and digestion. Neuroblastoma most commonly arises in and around the adrenal glands, which sit atop the kidneys. However, neuroblastoma can also develop in other areas of the abdomen and in the chest, neck and pelvis.

About 650 people are diagnosed with neuroblastoma each year in the United States, according to the American Cancer Society. For those diagnosed at an early stage, the chance for a cure is good. For older children and those with advanced neuroblastoma, outcomes generally aren't good. However, research into new treatments continues and may one day improve survival rates for children with neuroblastoma.
Signs and symptoms

Signs and symptoms of neuroblastoma vary depending on what part of the body is affected. About two-thirds of all neuroblastomas occur in the abdomen, usually in or near the adrenal glands. About 15 percent of neuroblastomas arise in the chest. Less frequently, neuroblastoma occurs in the neck or pelvis. Occasionally the site of origin of a neuroblastoma can't be determined.

Neuroblastoma in the abdomen may cause signs and symptoms such as:
Abdominal pain
A feeling of fullness in the abdomen
A mass under the skin that isn't tender when touched
Changes in bowel habits, such as constipation
Changes in urinary habits, such as having to go to the bathroom more often
Swelling in the legs

Neuroblastoma in the chest may cause signs and symptoms such as:
Wheezing
Swelling in the face
Changes to the eyes, including drooping eyelids and unequal pupil size

Other signs and symptoms that may indicate neuroblastoma include:
Lumps of tissue under the skin
Eyeballs that seem to protrude from the sockets (proptosis)
Back pain
Curvature of the spine (scoliosis)
Fever
Unexplained weight loss
Bone pain
Causes

In general, cancer begins with a genetic mutation that allows normal, healthy cells to continue growing without responding to the signals to stop, which normal cells do. Cancer cells grow and multiply out of control. The accumulating abnormal cells form a mass (tumor). Cancer cells may invade nearby tissues and can break off from an initial tumor to spread elsewhere in the body (metastasize).

Neuroblastoma begins in neuroblasts — immature nerve cells that a fetus makes as part of its development process in the womb. As the fetus matures, neuroblasts eventually turn into nerve cells and fibers and the cells that make up the adrenal glands. The majority of neuroblasts mature by birth, though studies have found a small number of immature neuroblasts in newborns. In most cases, these neuroblasts will mature or disappear. Others, however, form a tumor — a neuroblastoma.

It isn't clear what causes the initial genetic mutation that leads to neuroblastoma. However, because neuroblastoma usually affects very young children, researchers believe the mutation occurs during pregnancy, or possibly even before conception.
Risk factors

The only factor known to increase the risk of neuroblastoma is a family history of the cancer. However, only 1 percent to 2 percent of all neuroblastomas are believed to be related to family history. Babies with inherited neuroblastoma usually develop the disease around 9 months — earlier than do children with no family history, who are diagnosed at 17 months on average.
When to seek medical advice

Contact your child's doctor if your child has any signs or symptoms that worry you. Mention any changes in your child's behavior or habits.
Screening and diagnosis

Your child's doctor conducts a physical exam to check out any signs and symptoms. He or she asks you questions about your child's habits and behaviors. Your child's doctor may also order blood and urine tests to look for clues that may indicate the cause of any signs and symptoms. Urine tests may be used to check for high levels of certain chemicals that result from the neuroblastoma cells being unable to process catecholamines.

In rare cases, neuroblastoma may be detected before a baby is born. Fetal ultrasounds may detect neuroblastoma after 32 weeks of development and sometimes earlier. Analysis of the mother's urine can give other clues that may lead doctors to suspect neuroblastoma.

Biopsy and bone marrow aspiration
Your child's doctor may order a biopsy of the mass to confirm the diagnosis. An incisional biopsy is a surgical procedure to remove a sample of tissue from the tumor to test for cancer. Doctors examine the sample under a microscope and may use other tests on the tissue to spot specific abnormalities. If the cancer is small and confined to one area, the surgeon may remove the entire tumor and send it to a laboratory for examination (excisional biopsy).

Your child may also undergo bone marrow biopsy and bone marrow aspiration procedures to see if neuroblastoma has spread to the bone marrow — the spongy material inside the largest bones where blood cells are formed. In order to remove bone marrow for testing, the surgeon inserts a needle into your child's hipbones or lower back and draws out the marrow.

Staging
Once neuroblastoma is diagnosed, your child's doctor may order further testing to determine the extent of the cancer and whether it has spread to distant organs — a process called staging. Tests and procedures to determine the stage of your child's neuroblastoma include:
X-rays
Bone scans
Computerized tomography (CT) scans
Magnetic resonance imaging (MRI) scans

Using the information from those procedures, your child's doctor assigns a stage to the neuroblastoma. Stages of neuroblastoma include:
I. Neuroblastoma at this stage is localized, meaning it's confined to one area, and may be totally removed with surgery. Lymph nodes connected to the tumor may have signs of cancer, but other lymph nodes don't have cancer.
IIA. Neuroblastoma at this stage is localized, but may not be as easily removed through surgery. Lymph nodes connected to the tumor may have signs of cancer, but other lymph nodes don't have cancer.
IIB. Neuroblastoma at this stage is localized and may or may not be easily removed through surgery. Both the lymph nodes connected to the tumor and the lymph nodes nearby contain cancer cells.
III. Neuroblastoma at this stage is considered advanced, and it isn't possible to remove the tumor through surgery. The tumor may be a larger size at this stage. Lymph nodes may or may not contain cancer cells.
IV. Neuroblastoma at this stage is considered advanced and has spread (metastasized) to other parts of the body.
IVS. This stage is a special category of neuroblastoma that doesn't behave like other forms of neuroblastoma, though it isn't clear why. Stage IVS neuroblastoma applies only to children younger than 1 year old. Stage IVS indicates that neuroblastoma has spread to another part of the body — most commonly the skin, liver or bone marrow. Despite the extent of neuroblastoma, babies with this stage have a good chance of recovery. Neuroblastoma at this stage sometimes goes away on its own and often doesn't require treatment.
Complications

Complications of neuroblastoma may include:
Spread of the cancer (metastasis). Neuroblastoma that advances may spread (metastasize) to other parts of the body. Common places for neuroblastoma to spread include the lymph nodes, bone marrow, eyes, liver, skin and the sac that surrounds the spinal cord (dura).
Spinal cord compression. Tumors may grow and press on the spinal cord, causing spinal cord compression. Spinal cord compression may cause pain and paralysis. Treating the cancer may resolve these signs and symptoms.
Signs and symptoms caused by tumor secretions. Neuroblastomas may secrete certain chemicals that irritate certain other normal tissues, causing signs and symptoms called paraneoplastic syndromes. One paraneoplastic syndrome that occurs rarely in people with neuroblastoma causes rapid eye movements and difficulty with coordination. Another rare syndrome causes abdominal swelling and diarrhea.

Long-term and late side effects of cancer treatment. As more and more children are surviving cancer and living into adulthood, doctors are increasingly aware of the long-term side effects of cancer treatment. Doctors recommend childhood cancer survivors be seen every year by a doctor who understands the long-term and late side effects that can affect children after cancer treatment.

Side effects vary depending on treatment, but may include impaired growth, thyroid problems, second cancers and infertility, which may be caused by chemotherapy drugs. Difficulty thinking and trouble processing thoughts may be long-term side effects of radiation, especially brain radiation or total body irradiation (TBI).
Treatment

Your child's doctor selects a treatment plan based on several factors that affect your child's prognosis. Factors include your child's age, the stage of the cancer, the type of cells involved in the cancer, and whether there are any abnormalities in the chromosomes and genes. Using this information, your child's doctor categorizes the cancer as low risk, intermediate risk or high risk.

What treatment your child receives for neuroblastoma depends on the risk category. Treatment may include surgery, chemotherapy, radiation, bone marrow stem cell transplant or a combination of these treatments.

Surgery
Surgeons use scalpels and other surgical tools to remove cancer cells. In children with low-risk neuroblastoma, surgery to remove the tumor may be the only treatment needed. Whether the tumor can be completely removed depends on its location and its size. Tumors that are attached to nearby vital organs — such as the lungs or the spinal cord — may be too risky to remove. In intermediate-risk and high-risk neuroblastoma, surgeons may try to remove as much of the tumor as possible. Other treatments, such as chemotherapy and radiation, may then be used to kill remaining cancer cells.

Chemotherapy
Chemotherapy uses chemicals to kill cancer cells. Chemotherapy targets rapidly growing cells in the body, including cancer cells. Unfortunately, chemotherapy also damages healthy cells that grow quickly, such as cells in the hair follicles and in the gastrointestinal system, which can cause side effects. Children with low-risk neuroblastoma that can't be removed surgically may receive low doses of chemotherapy. Sometimes chemotherapy is administered before surgery (neoadjuvant chemotherapy) to shrink the tumor to a size that's more easily removed. In other cases, chemotherapy may be the only treatment.

Children with intermediate-risk neuroblastoma often receive a combination of moderate-intensity chemotherapy drugs. Chemotherapy is often given before surgery to improve the chances that the entire tumor can be removed.

Children with high-risk neuroblastoma usually receive high doses of chemotherapy drugs to shrink the tumor and to kill any cancer cells that have spread elsewhere in the body. Chemotherapy is usually used before surgery and before bone marrow stem cell transplant.

Radiation therapy
Radiation therapy uses high doses of energy particles to destroy cancer cells. Radiation therapy primarily affects the area where it's aimed. Your child's radiation therapy team tries to protect the healthy cells near the cancer, but some healthy cells may be damaged by the radiation. What side effects your child experiences depends on where the radiation is directed.

Children with low-risk or intermediate-risk neuroblastoma may receive radiation therapy if surgery and chemotherapy haven't been helpful. Children with high-risk neuroblastoma may receive radiation therapy after chemotherapy and surgery to prevent cancer from recurring.

Stem cell transplant
Children with high-risk neuroblastoma may receive a transplant using their own blood stem cells (autologous stem cell transplant). The bone marrow makes stem cells, which mature and develop into the red and white cells and platelets that make up the blood. Your child undergoes a procedure that filters and collects stem cells from his or her blood. Then high doses of chemotherapy are used to kill any remaining cancer cells in your child's body. Your child's stem cells are then injected into his or her body, where they can form new, healthy blood cells.
Coping skills

When your child is diagnosed with cancer, it's common to feel a range of emotions — from shock and disbelief to guilt and anger. In the midst of this emotional roller coaster, you're expected to make decisions about your child's treatment. And while you're trying to sort it all out, friends and family may be calling for updates and to find out if they can help. It's overwhelming, to say the least. Everyone finds his or her own way of coping with stressful situations, but if you're feeling lost, you might try to:
Gather all the information you can. Learn all you can about neuroblastoma. Talk with your health care team. Keep a list of questions to ask at your child's next appointment. Visit your local library and ask a librarian for help searching for information. Consult the National Cancer Institute (NCI) and the American Cancer Society (ACS) for more information. Both organizations can provide you with information through their Web sites or toll-free telephone information lines. Call the NCI at 800-4-CANCER, or 800-422-6237. Call the ACS at 800-ACS-2345, or 800-227-2345. Knowing more about your child's condition may make you more confident when choosing treatment options.
Organize a support network. In the coming weeks and months, your child will undergo a number of tests and procedures that will be time-consuming and may require traveling to a specialized medical center. If you want to be with your child through this time, you may have to take time off from work. Some people will be able to organize this with their employers. For others, time off from work and time without income won't be possible. Find friends and family you can count on in this situation. Loved ones can accompany your child to doctor visits or sit by his or her bedside in the hospital when you can't be there. If you can take time away from work to be with your child, your friends and family can help out by spending time with your other children or helping around your house. Don't feel guilty about asking for help. Your friends and family feel helpless, too, and they want to help.
Take advantage of resources for kids with cancer. Seek out special resources for families of kids with cancer. Social workers and other members of your health care team can tell you what programs are available. Support groups for parents and siblings put you in touch with people who understand what you're feeling. Your family may be eligible for summer camps, temporary housing and other support.
Maintain normalcy as much as possible. Small children can't understand what is happening to them as they undergo treatment for their cancer. To help your child cope, try to maintain your normal routine as much as possible. Try to arrange appointments so that your child can have a set nap time each day. Have routine meal times. Allow time for play when your child feels up to it. If your child must spend time in the hospital, bring items from home that help him or her feel more comfortable. Ask your health care team about other ways to comfort your child through his or her treatment. Some hospitals have recreation therapists or child-life workers who can give you more specific ways to help your child to cope with all that's happening.

By Mayo Clinic Staff
Aug 14, 2006

Lupus Disease Information

Lupus is a chronic inflammatory disease that occurs when your body's immune system attacks your own tissues and organs. Inflammation caused by lupus can affect many different body systems, including your joints, skin, kidneys, blood cells, heart and lungs.

Lupus occurs more frequently in women than it does in men, though it isn't clear why. Four types of lupus exist — systemic lupus erythematosus, discoid lupus erythematosus, drug-induced lupus erythematosus and neonatal lupus. Of these, systemic lupus erythematosus is the most common and serious form of lupus.

The outlook for people with lupus was once grim, but diagnosis and treatment of lupus has improved considerably. With treatment, most people with lupus can lead active lives.
Signs and symptoms


No two cases of lupus are exactly alike. Signs and symptoms may come on suddenly or develop slowly, may be mild or severe, and may be temporary or permanent. Most people with lupus experience episodes — called "flares" — of worsening signs and symptoms that eventually improve or even disappear completely for a time.

The signs and symptoms of lupus that you experience will depend on which body systems are affected by the disease. But, in general, lupus signs and symptoms may include:
Fatigue
Fever
Weight loss or gain
Joint pain, stiffness and swelling
Butterfly-shaped rash (malar rash) on the face that covers the cheeks and bridge of the nose
Skin lesions that appear or worsen with sun exposure
Mouth sores
Fingers and toes that turn white or blue when exposed to cold or during stressful periods (Raynaud's phenomenon)
Shortness of breath
Chest pain
Dry eyes
Easy bruising
Anxiety
Depression
Memory loss
Causes

Lupus is an autoimmune disease, which means that instead of just attacking foreign substances, such as bacteria and viruses, your immune system also turns against healthy tissue. This leads to inflammation and damage to various parts of the body, including the joints, skin, kidneys, heart, lungs, blood vessels and brain.

Doctors don't know what causes autoimmune diseases, such as lupus. It's likely that lupus results from a combination of your genetics and your environment. Doctors believe that you may inherit a predisposition to lupus, but not lupus itself. Instead, people with an inherited predisposition for lupus may only develop the disease when they come into contact with something in the environment that can trigger lupus, such as a medication or a virus.

Types of lupus
Four types of lupus exist. Though similar, each type of lupus has a different prognosis and treatment.
Systemic lupus erythematosus can affect nearly any part of your body. Body systems most commonly involved include the skin, joints, lungs, kidneys and blood. When people talk about lupus, they're usually referring to systemic lupus erythematosus.
Discoid lupus erythematosus affects only the skin. People with discoid lupus, also called cutaneous lupus, experience a circular rash on the face, neck and scalp. A small number of people with discoid lupus may develop systemic lupus erythematosus, though it isn't possible to predict who will develop the more serious form of lupus.
Drug-induced lupus erythematosus occurs after you take certain prescription medications. Not everyone who takes these medications develops lupus. Drug-induced lupus affects a wide variety of body systems. Signs and symptoms usually go away when you stop taking the medication that caused your lupus.
Neonatal lupus is a rare form of lupus that affects newborn babies. A mother with certain antibodies that are linked to autoimmune diseases can pass them to the developing fetus — even if the mother has no signs or symptoms of an autoimmune disease. The antibodies can cause neonatal lupus. A baby with neonatal lupus may experience a rash in the weeks following birth. Neonatal lupus may last about six months before disappearing.
Risk factors

While doctors don't know what causes lupus in many cases, they have identified factors that may increase your risk of the disease, including:
Sex. Lupus is more common in women than in men.
Age. Although lupus affects people of all ages, including infants, children and older adults, it's most often diagnosed between the ages of 15 and 45.
Race. Lupus is more common in blacks and in Asians.
Sunlight. Exposure to the sun may bring on lupus skin lesions or trigger an internal response in susceptible people. Exactly why ultraviolet radiation has this effect isn't well understood, but scientists suspect that sunlight may cause skin cells to express certain proteins on their surface. Antibodies that are normally present in the body then latch onto these proteins, initiating an inflammatory response. Damaged skin cells also seem to die more frequently in people with lupus, leading to even more inflammation.
Certain prescription medications. Drug-induced lupus results from the long-term use of certain prescription drugs. Although many medications can potentially trigger lupus, examples of drugs most clearly linked with the disease include the antipsychotic chlorpromazine, high blood pressure medications such as hydralazine, the tuberculosis drug isoniazid and the heart medication procainamide, among others. It usually takes several months or years of therapy with these drugs before symptoms appear, and even then, only a small percentage of people will ever develop lupus.
Infection with Epstein-Barr virus. Almost everyone has been infected with a common human virus called Epstein-Barr virus. Epstein-Barr virus causes nonspecific signs and symptoms, such as fever and sore throat. Once the initial infection subsides, the virus remains dormant in the cells of your immune system unless something reactivates the virus. For reasons that aren't clear, recurrent Epstein-Barr infections seem to increase the risk of developing lupus.
Exposure to chemicals. It's difficult to prove that chemicals can cause or increase the risk of a disease. But some studies have shown that people who work in jobs that involve exposure to mercury and silica may have an increased risk of lupus.
When to seek medical advice

If you develop an unexplained rash, ongoing fever, persistent aching or fatigue, see your doctor.

If you've already been diagnosed with lupus, meet with your doctor on a regular basis so that your condition and treatment can be monitored. Make an appointment with your doctor if new symptoms arise.
Screening and diagnosis

Diagnosing lupus is difficult because signs and symptoms vary considerably from person to person. Signs and symptoms of lupus may change over time and overlap with those of many other disorders. For these reasons, doctors may not initially consider lupus until the signs and symptoms become more obvious. Even then, lupus can be challenging to diagnose because nearly all people with lupus experience fluctuations in disease activity. At times the disease may become severe and at other times subside completely.

American College of Rheumatology criteria for a lupus diagnosis
The American College of Rheumatology (ACR) has developed clinical and laboratory criteria to help physicians diagnose and classify lupus. If you have four of the 11 criteria at one time or individually over time, you probably have lupus. Your doctor may also consider the diagnosis of lupus even if you have fewer than four of these signs and symptoms. The criteria identified by the ACR include:
Face rash, which doctors call a malar rash, that is butterfly shaped and covers the bridge of the nose and spreads across the cheeks
Scaly rash, called a discoid rash, which appears as raised, scaly patches
Sun-related rash, which appears after exposure to sunlight
Mouth sores, which are usually painless
Joint pain and swelling that occurs in two or more joints
Swelling of the linings around the lungs or the heart
Kidney disease
A neurological disorder, such as seizures or psychosis
Low blood counts, such as low red blood count, low platelet count (thrombocytopenia), or a low white cell count (leukopenia)
Positive anti-nuclear antibody tests, which indicate that you may have an autoimmune disease
Other positive blood tests that may indicate an autoimmune disease, such as a positive double-stranded anti-DNA test, positive anti-Sm test, positive anti-phospholipid antibody test or false-positive syphilis test

Laboratory tests
Your doctor may order blood and urine tests to determine your diagnosis, including:
Complete blood count. This test measures the number of red blood cells, white blood cells and platelets as well as the amount of hemoglobin, a protein in red blood cells. Results may indicate you have anemia, which commonly occurs in lupus. A low white blood cell or platelet count may occur in lupus as well.
Erythrocyte sedimentation rate. This blood test determines the rate at which red blood cells settle to the bottom of a tube in an hour. A faster than normal rate may indicate a systemic disease, such as lupus. The sedimentation rate isn't specific for any one disease, but it may be elevated if you have lupus, another inflammatory condition or an infection.
Kidney and liver assessment. Blood tests can assess how well your kidneys and liver are functioning. Lupus can affect these organs.
Urinalysis. An examination of a sample of your urine may show an increased protein level or red blood cells in the urine, which may occur if lupus has affected your kidneys.
Antinuclear antibody (ANA) test. A positive test for the presence of these antibodies — produced by your immune system — indicates a stimulated immune system, which is common in lupus and other autoimmune diseases. A positive ANA doesn't always mean that you have lupus, however. ANA levels can be elevated if you have an infection or if you're taking certain medications. If you test positive for ANA, your doctor may advise more-specific antibody testing and refer you to a rheumatologist, a doctor who specializes in musculoskeletal and autoimmune disorders such as arthritis or lupus.
Chest X-ray. An image of your chest may reveal abnormal shadows that suggest fluid or inflammation in your lungs. It may also show an enlarged heart as a result of a buildup of fluid within the pericardium (pericardial effusion).
Electrocardiogram (ECG). This test measures the pattern of electrical impulses generated in your heart. It can help identify irregular rhythms or damage.
Syphilis test. A false-positive result on a syphilis test can indicate anti-phospholipid antibodies in your blood, another indication of lupus. The presence of anti-phospholipid antibodies has been associated with an increased risk of blood clots, strokes and recurrent miscarriages.
Complications

Inflammation caused by lupus can affect many areas of your body, including your:
Kidneys. Lupus can cause serious kidney damage, and kidney failure is one of the leading causes of death among people with lupus. A blood test called serum creatinine level is used to monitor kidney function. Signs and symptoms of kidney problems may include generalized itching, chest pain, nausea, vomiting and weight gain.
Central nervous system. If your central nervous system is affected by lupus, you may experience headaches, dizziness, memory problems, behavior changes, even seizures.
Blood and blood vessels. Lupus may lead to blood problems, including anemia and increased risk of bleeding or blood clotting. It can also cause inflammation of the blood vessels (vasculitis).
Lungs. Having lupus increases your chances of developing an inflammation of the chest cavity lining (pleurisy) that can make breathing painful. You may also be more susceptible to a noninfectious form of pneumonia.
Heart. Lupus can cause inflammation of your heart muscle (myocarditis and endocarditis), your arteries (coronary vasculitis) or heart membrane (pericarditis). Having lupus also greatly increases your risk of cardiovascular disease and heart attacks. Controlling high blood pressure and high blood cholesterol, not smoking, and getting regular exercise are essential to help reduce the risk of heart disease.
Infection. People with lupus are vulnerable to infection because both the disease and its treatments — corticosteroid and cytotoxic drugs, in particular — affect the immune system. And in a vicious cycle, infection can bring on a lupus flare, increasing the risk of infection even more.
Cancer. Having lupus appears to increase your risk of cancer — especially non-Hodgkin's lymphoma, which affects the lymph system; lung cancer; and liver and bile duct cancers. Immunosuppressant drugs that are sometimes used to treat lupus also can increase the risk of cancer.
Bone tissue death (avascular necrosis). This occurs when the blood supply to a bone diminishes, often leading to tiny breaks in the bone and eventually to the bone's collapse. The hip joint is commonly affected, although avascular necrosis can occur in other bones as well. Avascular necrosis can be caused by lupus itself or by high doses of corticosteroids used to treat the disease.
Pregnancy complications. Women with lupus have an increased risk of miscarriage. Some women with lupus experience a flare during pregnancy. Lupus increases the risk of high blood pressure during pregnancy (preeclampsia) and preterm birth.
Treatment

Treatment for lupus depends on your signs and symptoms. Determining whether your signs and symptoms should be treated and what medications to use requires a careful discussion of the benefits and risks with your doctor. As your signs and symptoms flare and subside, you and your doctor may find that you'll need to change medications or dosages.

Common medications used to treat lupus
Three types of drugs are commonly used to treat lupus when your signs and symptoms are mild or moderate. More aggressive lupus may require more aggressive drugs. In general, when first diagnosed with lupus, your doctor may discuss these medications:
Nonsteroidal anti-inflammatory drugs. Aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen sodium (Aleve) and ibuprofen (Advil, Motrin, others) may be used to treat a variety of signs and symptoms associated with lupus. NSAIDs are available over-the-counter, or stronger versions can be prescribed by your doctor. Check with your doctor before taking over-the-counter NSAIDs because some have been associated with serious side effects in people with lupus. Side effects of NSAIDs include stomach bleeding and an increased risk of heart problems.
Antimalarial drugs. Although there's no known relationship between lupus and malaria, these medications have proved useful in treating signs and symptoms of lupus. Antimalarials may also prevent flares of the disease. Hydroxychloroquine (Plaquenil) is the most commonly prescribed antimalarial. Side effects of antimalarial drugs include vision problems and muscle weakness.
Corticosteroids. These drugs counter the inflammation of lupus, but can have serious long-term side effects, including weight gain, easy bruising, thinning bones (osteoporosis), high blood pressure, diabetes and increased risk of infection. The risk of side effects increases with higher doses and longer term therapy. To help reduce these risks, your doctor will try to find the lowest dose that controls your symptoms and prescribe corticosteroids for the shortest possible time. Taking the drug every other day can also help reduce side effects. Corticosteroids are sometimes combined with another medication to help reduce the dose, and therefore the toxicity, of both drugs. Taking calcium and vitamin D supplements while using corticosteroids can reduce the risk of osteoporosis.

Treatment for specific signs and symptoms
What treatments you may consider depend on your signs and symptoms. Treatments for specific signs and symptoms include:
Joint pain and swelling. Pain in your joints may be initially controlled with NSAIDs. If you experience more significant joint pain, you and your doctor may consider antimalarial drugs or corticosteroids.
Skin rashes. Avoid skin rashes by staying out of the sun, wearing sunblock year-round and keeping your skin covered. Despite your best attempts to avoid the sun, even indoor fluorescent lighting can trigger skin rashes in people with lupus. Skin rashes are sometimes treated with topical corticosteroids. These creams are applied to the affected area to reduce the inflammation in your skin cells. Oral steroids or antimalarial drugs also can be used.
Fatigue. Fatigue is treated by determining the underlying cause. Your fatigue may be caused by difficulty sleeping, depression or poorly controlled pain. In these cases, your doctor would treat the underlying cause. If you and your doctor can't determine a cause for your fatigue, you may consider medications such as corticosteroids and antimalarial drugs.
Swelling around the heart and lungs. Swelling around your heart and lungs that causes chest pain may be controlled NSAIDs, antimalarial drugs or corticosteroids.

Treatment for aggressive lupus
Life-threatening cases of lupus — those including kidney problems, inflammation in the blood vessels, and central nervous system problems, such as seizures — may require more aggressive treatment. In these cases, you and your doctor may consider:
High-dose corticosteroids. High-dose corticosteroids can be taken orally or administered through a vein in your arm (intravenously). A high-dose regimen of corticosteroids may help control dangerous signs and symptoms quickly, but can also cause serious side effects, including infections, mood swings, high blood pressure and osteoporosis. To minimize side effects, your doctor will give you the lowest dose needed to control your signs and symptoms and then reduce the dosage over time.
Immunosuppressive drugs. Drugs that suppress the immune system may be helpful in serious cases of lupus, but can cause serious side effects. The most commonly used immunosuppressive drugs include cyclophosphamide (Cytoxan) and azathioprine (Imuran). The drug mycophenolate mofetil (CellCept), another immunosuppressant, can be used to treat lupus-related kidney problems. All three of these drugs can be taken orally, and cyclophosphamide can also be given intravenously. Side effects include an increased risk of infection, liver damage, infertility and an increased risk of cancer.

High-dose corticosteroids can be combined with immunosuppressive drugs to reduce the dosage of each drug, which may reduce the risk of side effects. Sometimes, even with aggressive treatment, your kidneys may fail. In that case, you may need kidney dialysis or, if kidney failure is permanent, a kidney transplant.

Clinical trials
Researchers are developing new treatments for lupus in clinical trials. These studies give people with lupus the chance to try new treatments, but they don't guarantee a cure. If you're interested in a clinical trial, discuss the options with your doctor to determine the benefits and risks.

Treatments being studied in clinical trials include:
Stem cell transplant. A stem cell transplant uses your own adult stem cells to rebuild your immune system. Doctors hope this treatment can help people with life-threatening cases of lupus. Before a stem cell transplant you're given a drug that coaxes the adult stem cells out of your bone marrow and into your bloodstream. The stem cells are then filtered from your blood and frozen for later use. Strong immunosuppressive drugs are administered to wipe out your immune system. Then the adult stem cells are put back into your body where they can rebuild your immune system.
Dehydroepiandrosterone (DHEA). Some clinical trials have shown that a synthetic form of the hormone DHEA may improve quality of life in people with lupus, though others haven't found this. Your body uses DHEA to make male and female sex hormones. Researchers are conducting further clinical trials to better understand whether DHEA may be useful for people with lupus.
Rituximab (Rituxan). Rituximab decreases the number of B cells, a type of white blood cell, in your body and has shown some promise in treating lupus in people who haven't responded to other immunosuppressants. However, rituximab has been linked to a fatal brain infection in two people with lupus.
Self-care

Take steps to care for your body if you have lupus. Simple steps can help you prevent lupus flares and, should they occur, better cope with the signs and symptoms you experience. Try to:
Get adequate rest. People with lupus often experience persistent fatigue that's different from normal tiredness and that isn't necessarily relieved by rest. For that reason, it can be hard to judge when you need to slow down. Many experts recommend eight to 10 hours of sleep a night and naps or breaks during the day as needed. Friends and family members need to understand and respect your need for rest.
Be sun smart. Because ultraviolet light can trigger a flare, wear protective clothing such as a hat, long-sleeved shirt and long pants, and use sunscreens with a sun protection factor (SPF) of at least 15 every time you go outside, even if it's just a quick trip to the mailbox. Be sure that your ears, scalp and the backs of your hands are protected. Avoid tanning beds and stay out of the sun entirely when it's strongest, from 10 a.m. to 4 p.m. Because fluorescent and halogen lights also can emit UV rays and thus aggravate lupus, you may need to wear sunscreen and protective clothing indoors or use plastic devices that block UV emissions from indoor lights.
Get regular exercise. Exercise can help you recover from a flare, reduce your risk of heart attack, help fight depression and promote general well-being. Exercise as much as your body allows — aim for 30 minutes of activity most days of the week. You'll likely feel fatigued and not up to exercising sometimes, and that's OK. Rest when you need to. Time outdoor activities so that you avoid the sun when it's most intense, and if you're having a flare, stay out of the sun entirely.
Don't smoke. Smoking increases your risk of cardiovascular disease and can worsen the effects of lupus on your heart and blood vessels.
Eat a healthy diet. A healthy diet emphasizes fruits, vegetables and whole grains. Sometimes you may have dietary restrictions, especially if you have high blood pressure, kidney damage or gastrointestinal problems. And although no specific foods have been shown to cause or worsen lupus, it's best to avoid any food that seems to make your symptoms worse.
Coping

Coping with lupus can be stressful. People with lupus often experience anxiety, depression and frustration because the disease is unpredictable. Knowing you have a serious disease can also be scary. To help you cope with lupus, try to:
Learn all you can about lupus. Write down all the questions you have about lupus and ask them at your next appointment. Ask your doctor or nurse for reputable sources of further information. The more you know about lupus, the more confident you'll feel in your treatment choices.
Gather support among your friends and family. Talk about lupus with your friends and family. They may have questions about lupus and how it affects your life. Answer their questions honestly. Explain ways your friends and family can help out when you're having flares. Lupus can be frustrating for your loved ones because they usually can't see it and you may not appear sick. They can't tell if you're having a good day or a bad day unless you tell them. Be open about what you're feeling so that your friends and family know what to expect.
Take time for yourself. Cope with stress in your life by taking time for yourself. Use that time to read, meditate, listen to music or write in a journal. Find activities that calm and renew you.
Connect with others who have lupus. Talk to other people who have lupus. You can connect with other people who have lupus through support groups in your community or through online message boards. Though your friends and family love you, sometimes you'll feel as if they can't quite understand what you're feeling. Other people with lupus can offer unique support because they're facing many of the same obstacles and frustrations that you're facing.
Complementary and alternative medicine

If your medications aren't controlling all of your signs and symptoms or if you're frustrated by lupus flares, you might turn to complementary and alternative medicine for solutions. Mainstream doctors are becoming more open to discussing these options with their patients. But, since few of these treatments have been extensively studied in clinical trials, it's difficult to assess whether these treatments are helpful for lupus. In some cases, the risks of these treatments aren't known.

If you're interested in trying complementary and alternative medicine therapies, discuss these treatments with your doctor first. He or she can help you weigh the benefits and risks and tell you if the treatments will interfere with your current lupus medications.

Some common complementary and alternative treatments for lupus include:
Fish oil. Fish oil supplements contain omega-3 fatty acids that may be beneficial for people with lupus. Preliminary studies have found some promise, though more study is needed. Side effects of fish oil supplements can include nausea, belching and a fishy taste in the mouth. Fish oil can interfere with medications, so check with your doctor first.
Flaxseed. Flaxseed contains a fatty acid called alpha-linolenic acid, which may decrease inflammation in the body. Some studies have found that flaxseed may improve kidney function in people who have lupus that affects the kidneys, though more study is needed. Side effects of flaxseed include bloating and abdominal pain. Flaxseed can also interfere with medications, so check with your doctor first.

Other complementary and alternative medicine treatments are available. Discuss the options with your doctor.

By Mayo Clinic Staff
Oct 20, 2007

Meningitis Disease Information

Meningitis is an inflammation of the membranes (meninges) and cerebrospinal fluid surrounding your brain and spinal cord, usually due to the spread of an infection.

In the past, most meningitis cases occurred in children younger than 5 years. But as a result of the protection offered by current childhood vaccines, most meningitis cases now occur in young people between the ages of 15 and 24. Older adults also tend to have a higher incidence of meningitis than do young children.

The cause of most cases of meningitis is a viral infection, but bacterial and fungal infections also can lead to meningitis. The severity of the inflammation and the best treatment depend on the cause of the infection. Bacterial meningitis is generally much more serious than viral meningitis, and timely treatment is necessary.

Left untreated, bacterial meningitis can be fatal. If you suspect that you or someone in your family has signs or symptoms of meningitis, seek medical care right away. There's no way to tell what kind of meningitis you have without seeing your doctor and undergoing testing.
Signs and symptoms

It's easy to mistake the early signs and symptoms of meningitis for the flu. They may develop over a period of one or two days and typically include:
A high fever
Severe headache
Vomiting or nausea with headache
Confusion, or difficulty concentrating — in the very young, this may appear as inability to maintain eye contact
Seizures
Sleepiness or difficulty waking up
Stiff neck
Sensitivity to light
Lack of interest in drinking and eating
Skin rash in some cases, such as in viral or meningococcal meningitis

Earlier signs and symptoms that may suggest a serious infection, although not necessarily meningitis, include leg pain, ice-cold hands and feet, and abnormally pale skin tone.

Signs in newborns
Newborns and young infants may not have the classic signs and symptoms of headache and stiff neck. Instead, they may cry constantly, seem unusually sleepy or irritable, and eat poorly. Sometimes the soft spots on an infant's head may bulge. A very late sign may be a spasm consisting of extreme hyperextension of the body (opisthotonos). Young infants may prefer to lie in bed rather than be held.

If you or your child has bacterial meningitis, delaying treatment increases the risk of permanent brain damage. In addition, bacterial meningitis can prove fatal in a matter of days. Seek medical care right away if you or anyone in your family has any signs or symptoms.
Causes

Meningitis usually results from a viral infection, but the cause also may be a bacterial infection. Less commonly, a fungal infection may cause meningitis. Because bacterial infections are the most damaging, identifying the source of the infection is an important part of developing a treatment plan.

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

A number of strains of bacteria can cause acute bacterial meningitis. The most common include:
Streptococcus pneumoniae (pneumococcus). This bacterium is the most common cause of bacterial meningitis in infants and young children in the United States. It can also cause pneumonia and ear and sinus infections. When pneumococcal meningitis is associated with an ear infection, it's not always clear which came first — the meningitis or the ear infection — because they usually occur together.
Neisseria meningitidis (meningococcus). This bacterium is another leading cause of bacterial meningitis. Meningococcal meningitis commonly occurs when bacteria from an upper respiratory infection enter your bloodstream. This infection is highly contagious and may cause local epidemics in college dormitories and boarding schools and on military bases.
Haemophilus influenzae (haemophilus). Before the 1990s, Haemophilus influenzae type b (Hib) bacterium was the leading cause of bacterial meningitis. But new Hib vaccines — available as part of the routine childhood immunization schedule in the United States — have greatly reduced the number of cases of this type of meningitis. When it occurs, it tends to follow an upper respiratory infection, ear infection (otitis media) or sinusitis.
Listeria monocytogenes (listeria). These bacteria can be found almost anywhere — in soil, in dust and in foods that have become contaminated. Contaminated foods have included soft cheeses, hot dogs and luncheon meats. Many wild and domestic animals also carry the bacteria. Fortunately, most healthy people exposed to listeria don't become ill, although pregnant women, newborns and older adults tend to be more susceptible. Listeria can cross the placental barrier, and infections in late pregnancy may cause a baby to be stillborn or die shortly after birth.

Viral meningitis
Viruses cause a greater number of cases of meningitis each year than do bacteria. Viral meningitis is usually mild and often clears on its own in 10 days or less. A group of common viruses known as enteroviruses, which cause stomach flu, are responsible for about 90 percent of viral meningitis in the United States.

The most common signs and symptoms of enteroviral infections are rash, sore throat, joint aches and headache. Many older children and adults with enteroviral meningitis describe the "worst headache I've ever had." These viruses tend to circulate in late summer and early fall. Viruses associated with mumps, herpes infection, West Nile virus or other diseases also can cause viral meningitis.

Chronic meningitis
Ongoing (chronic) forms of meningitis occur when slow-growing organisms invade the membranes and fluid surrounding your brain. Although acute meningitis strikes suddenly, chronic meningitis develops over four weeks or more. Nevertheless, the signs and symptoms of chronic meningitis — headaches, fever, vomiting and mental cloudiness — are similar to those of acute meningitis. This type of meningitis is rare.

Fungal meningitis
Fungal meningitis is relatively uncommon. Cryptococcal meningitis is a fungal form of the disease that affects people with immune deficiencies, such as AIDS. It's life-threatening if not treated with an antifungal medication.

Other causes
Meningitis can also result from noninfectious causes, such as drug allergies, some types of cancer and inflammatory diseases such as lupus.
Risk factors

Not completing the childhood vaccine schedule increases your risk of meningitis. So do a few other risk factors:
Age. Children younger than 5 years, young people ages 15 to 24 and older adults are more likely to develop meningitis than is the rest of the population.
Living in a community setting. College students living in dormitories, personnel on military bases and children in boarding schools and child care facilities are at increased risk of meningococcal meningitis, probably because infectious diseases tend to spread quickly wherever large groups of people congregate.
Pregnancy. If you're pregnant, you're more likely to contract listeriosis — an infection caused by listeria bacteria, which may also cause meningitis. If you have listeriosis, your unborn baby is at risk, too.
Working with animals. People who work with domestic animals, including dairy farmers and ranchers, have a higher risk of contracting listeria, which can lead to meningitis.
Compromised immune system. Factors that may compromise your immune system — including AIDS, diabetes and use of immunosuppressant drugs — also make you more susceptible to meningitis. Removal of your spleen, an important part of your immune system, also may increase your risk.
When to seek medical advice

If you or someone in your family has signs or symptoms of meningitis — such as fever, severe headache, confusion, vomiting and stiff neck — seek medical care right away. There's no way to know what kind of meningitis you or your child has without seeing your doctor and undergoing testing.

Viral meningitis may improve without treatment in a few days, but bacterial meningitis can be serious and can come on very quickly. If you or your child has bacterial meningitis, the sooner the treatment begins, the better the chances of a recovery without serious complications.

Also talk to your doctor if a family member or someone you work with has meningitis. You may need to take medications to prevent getting sick.
Screening and diagnosis

Your family doctor or pediatrician can diagnose meningitis based on a medical history, a physical exam and certain diagnostic tests. During the exam, your doctor may check for signs of infection around the head, ears, throat and the skin along the spine. You or your child may undergo the following diagnostic tests:
Throat culture. A throat culture can find and identify the bacteria causing throat pain, neck pain and headache, but can't determine what pathogens may be in your spinal fluid.
Imaging. X-rays and computerized tomography (CT) scans of the chest, skull or sinuses may reveal swelling or inflammation. These tests can also help your doctor look for infection in other areas of the body that may be associated with meningitis.
Spinal tap (lumbar puncture). The definitive diagnosis of meningitis is often made by analyzing a sample of your cerebrospinal fluid (CSF), which is collected during a procedure known as a spinal tap. In people with meningitis, the CSF fluid often shows a low sugar (glucose) level along with an increased white blood cell count and increased protein. CSF analysis may also help your doctor identify the exact bacterium that's causing the illness. Traditionally, it can take up to a week to get these test results. In March 2007, the Food and Drug Administration approved the Xpert EV test, a test that takes only two and one-half hours. This test identifies any genetic material in the CSF from a class of viruses responsible for approximately 90 percent of viral meningitis cases. A positive test tells your doctor you likely have viral meningitis, and a negative test strongly suggests no viral meningitis, making the less common bacterial form of meningitis more likely. This can help those with viral meningitis avoid unnecessary treatment with antibiotics.
Polymerase chain reaction analysis. If your doctor suspects meningitis, he or she may order a DNA-based test known as a polymerase chain reaction (PCR) amplification to check for the presence of certain causes of meningitis.

If you have chronic meningitis caused by cancer or an inflammatory illness, you may need additional tests.
Complications

The complications of meningitis can be severe. The longer you or your child has the disease without treatment, the greater the risk of seizures and of permanent neurological damage, including hearing loss, blindness, loss of speech, learning disabilities, behavior problems and brain damage, even paralysis.

Non-neurological complications may include kidney failure and adrenal gland failure. Your adrenal glands produce a number of important hormones including cortisol, which helps your body deal with stress.

Bacterial infections of your central nervous system progress quickly. Within a matter of days, the disease can lead to shock and death.
Treatment

Acute bacterial meningitis requires prompt treatment with intravenous antibiotics to ensure recovery and reduce the risk of complications. The antibiotic or combination of antibiotics that your doctor may choose depends on the type of bacteria causing the infection. Often, analyzing a sample of cerebrospinal fluid can help identify the bacteria. If you or your child has bacterial meningitis, your doctor may recommend a broad-spectrum antibiotic until he or she can determine the exact cause of the meningitis.

If you or your child has bacterial meningitis, your doctor may recommend treatments for brain swelling, shock, convulsions or dehydration. Infected sinuses or mastoids — the bones behind the outer ear that connect to the middle ear — may need to be drained. Any fluid that has accumulated between the brain and the membranes that surround it may also need to be drained or surgically removed.

Antibiotics can't cure most viral meningitis, but many cases improve on their own in a week or so without therapy. Treatment of mild cases of viral meningitis is usually with bed rest, plenty of fluids and over-the-counter pain medications to help reduce fever and relieve body aches. If the cause of your meningitis is the herpes virus, your doctor may also recommend an antiviral medication aimed at this virus.
Prevention

Meningitis typically results from contagious infections. Common bacteria or viruses that can cause meningitis can spread through coughing, sneezing, kissing or sharing eating utensils, a toothbrush or a cigarette. You're also at increased risk if you live or work with someone who has the disease.

Careful hand washing is important to avoiding exposure to infectious agents. Teach your children to wash their hands often, especially before they eat and after using the toilet, spending time in a crowded public place or petting animals. Show them how to wash their hands vigorously, covering both the front and back of each hand with soap and rinsing thoroughly under running water. In addition, maintain your immune system by getting enough rest, exercising regularly, and eating a healthy diet with plenty of fresh fruits, vegetables and whole grains.

If you're pregnant, reduce your risk of listeriosis by cooking meat thoroughly and avoiding cheeses made from unpasteurized milk.

Immunizations
Some forms of bacterial meningitis are preventable with the following vaccinations:
Haemophilus influenzae type b (Hib) vaccine. Children in the United States routinely receive this vaccine as part of the recommended schedule of vaccines, starting at about 2 months of age. The vaccine is also recommended for some adults, including those who have sickle cell disease or AIDS and those who don't have a spleen.
Pneumococcal conjugate vaccine (PCV7). This vaccine is also part of the regular immunization schedule for children younger than 2 years in the United States. In addition, it's recommended for children between the ages of 2 and 5 who are at high risk of pneumococcal disease, including children who have chronic heart or lung disease or cancer.
Pneumococcal polysaccharide vaccine (PPV). Older children and adults who need protection from pneumococcal bacteria may receive this vaccine. The Centers for Disease Control and Prevention recommends the PPV vaccine for all adults older than 65 and younger adults and children who have weak immune systems, chronic illnesses such as heart disease, diabetes or sickle cell anemia, and those who don't have a spleen.
Meningococcal conjugate vaccine (MCV4). The Centers for Disease Control and Prevention recommends that a single dose of MCV4 be given to children ages 11 to 12 or to any children ages 11 to 18 who haven't yet been vaccinated. However, this vaccine can be given to younger children who are at high risk of bacterial meningitis or who have been exposed to someone with the disease. It is approved for use in children as young as 2 years old.

By Mayo Clinic Staff
Feb 5, 2008

Rabies Disease Information

Rabies is a serious viral disease that affects your central nervous system. Typically rabies spreads by way of the saliva of infected animals — often, but not always, through a bite.

Once you're infected, the virus spreads from your muscle to your peripheral nerves to your spinal cord and brain. From initial flu-like signs and symptoms, the illness progresses to convulsions, hallucinations, paralysis or breathing failure and almost always death once the infection is established. It's important to seek treatment immediately after exposure.

Your risk of exposure to rabies in the United States is greater when you come into contact with a wild animal. Wild animals are more likely to carry rabies than are domesticated animals.

Each year a few people die of rabies in the United States. Most deaths occur because the person didn't seek medical assistance. Treatment consists of treatment to the wound plus a series of rabies shots, which prevent symptoms and death resulting from rabies infection. If you think you've been exposed to an animal with rabies, call your doctor as soon as possible.
Signs and symptoms

Signs and symptoms of rabies usually appear within one to three months after exposure, though there have been rare cases in which rabies didn't appear for more than six months after exposure. Rabies is nearly always fatal once symptoms appear. Death from breathing failure often happens within a week after the appearance of signs and symptoms.

Early signs and symptoms of rabies in humans are general and not unique to the disease. They may include:
Fever
Headache
Malaise

As the disease progresses, rabies symptoms may include:
Insomnia
Anxiety
Confusion
Slight or partial paralysis
Excitation
Hallucinations
Agitation
Salivation
Difficulty swallowing
Convulsions
Fear of water (hydrophobia) because of the difficulty in swallowing

A bite's severity and its location on your body can determine how quickly signs and symptoms appear. A severe bite to your head might cause problems to appear in a much shorter time than might those of a bite to your leg.
Causes

Most often rabies transmission occurs through the bite of a rabid animal. Rarely, people contract rabies when saliva from an infected animal comes in contact with their eyes, nose, mouth or a wound. This may occur if you're licked by an infected animal.

Inhaling the rabies virus is another potential route of exposure, but one likely to affect only laboratory workers.
Risk factors

Your risk of exposure to rabies in the United States is greater when you come into contact with a wild animal. Most rabies cases reported to the Centers for Disease Control and Prevention (CDC) each year occur in wild animals, including raccoons, skunks and foxes. Though less than 10 percent of bats carry rabies, infected bats have transmitted most of the recent rabies cases in people in the United States.

Domesticated animals such as cats, dogs and cattle account for only a small percentage of reported rabies cases. By law, most pets and domesticated animals receive vaccinations against rabies.

You're at greatest risk of contracting rabies if your activities bring you into contact with the rabies virus or a potentially rabid mammal. People at risk can include veterinarians, animal caretakers or handlers, laboratory workers, cave explorers, hunters, forest rangers and people visiting bat-inhabited caves.

You're also at risk if you plan to travel to areas where rabies isn't controlled, such as parts of Africa, Asia, Central America and South America.
When to seek medical advice

If you think you may have been exposed to an animal with rabies, thoroughly wash the wound or area of exposure with soap and water. Call your doctor or go to the emergency room immediately.

Quick action is important. Once the earliest signs and symptoms appear, death almost always follows. Promptly contacting your doctor after a potential rabies exposure greatly increases your chance of surviving. No one in the United States has contracted rabies after receiving prompt and appropriate treatment after an exposure.

If you awaken and find a bat in your room, it's possible you had contact with the bat without knowing it. Bats have small teeth that don't always leave noticeable marks. In the case of small rodents, including squirrels, a bite isn't likely to transmit rabies, but it's still best to consult your doctor to make a treatment decision.

Your local or state health department will have up-to-date information on the types of animals in your local community that are potential carriers of rabies, and those in which rabies is unlikely. It's of great help if the animal can be caught and tested for rabies.
Screening and diagnosis

If you've been bitten or have had contact with an animal that may have rabies, certain information may help your doctor determine your risk of contracting rabies and how to treat you. Take note of the following:
Where the incident occurred
A description of the animal
If you were bitten, whether the animal was provoked or confronted
The vaccination status of a domesticated animal
Whether the animal can be safely captured to be tested for rabies

Once a potentially rabid animal is captured, it may be confined for observation. Another option is for health professionals to conduct tests on the animal's brain tissue to determine whether it has rabies. Testing can be done quickly, but only after the animal is dead.

If you have the signs and symptoms of rabies, a number of tests using blood, saliva, spinal fluid, brain tissue or skin tissue taken from the nape of your neck may be required to identify or rule out rabies infection.
Treatment

If your doctor determines that you likely were exposed to rabies, treatment begins at once. The sooner you begin rabies treatment, the greater your chance of recovery.

If you live in the United States and receive treatment for rabies after an animal bite, treatment — called post-exposure prophylaxis — consists of one dose of rabies immune globulin and five doses of rabies vaccine over a 28-day period. Rabies immune globulin and the first dose of rabies vaccine are administered as soon as possible after you've been exposed and have reported the exposure to your doctor. You're given the immune globulin by injection around the site of the bite, and you receive injections of the vaccine into your upper arm muscle.

Immune globulins are disease-fighting proteins that provide you with temporary antibodies. The rabies vaccine helps your body start producing its own antibodies. Antibody production takes time, but the antibodies produced by your body provide longer lasting protection than do the ones contained in rabies immune globulin.

Although the vaccine isn't painful, you might have a mild physical reaction. Watch for reactions such as swelling or redness where the injection occurred. Headache, fever, nausea, muscle aches and dizziness are other possible side effects. Contact your doctor if side effects cause you discomfort.
Prevention

The first thing to do if you've been bitten by an animal is thoroughly wash the wound or area of exposure with soap and water. This is one of the most effective methods to decrease the chance of infection.

If soap isn't available — for example, when hiking — you can use water alone. But be sure to wash with soap and water as soon as possible. Allowing the wound to bleed also can help clean it.

Ways to help prevent exposure to rabies include:
Keep your pets and other domesticated animals up-to-date with regular animal rabies shots.
Avoid contact with wild or unfamiliar animals, whether they're alive or dead.
Seal or close any openings where animals might find entry into your home.
Report stray animals or any that act strangely or sick to your local animal control authorities. Keep the phone number for animal control near your phone. If you don't have animal control personnel in your community, call the police or sheriff's office.
Teach your children to never handle unfamiliar animals.

If your work or activities might bring you into contact with the rabies virus or a potentially rabid mammal, consider getting a preventive vaccination. This vaccination — called pre-exposure prophylaxis — involves three injections over three or four weeks. A booster shot can maintain the vaccination's effectiveness.

Determine your risk before traveling
Talk to your doctor or a travel medicine specialist before visiting developing countries in Asia, Africa or Latin America. In many of these countries, dogs are the major carriers of rabies. Children may be at particular risk since they might be more likely than adults to be approached by stray or rabid animals. Your doctor can help you gauge your risk of exposure to rabies and whether to have pre-exposure prophylaxis. You can also discuss how you would handle an exposure. Some areas of the world don't have complete post-exposure treatment readily available.

By Mayo Clinic Staff
Jan 26, 2007

Liver Transplant Information

A liver transplant is surgery to replace a diseased liver with a healthy liver. When a patient receives a liver transplant, his or her entire liver is removed. It is then replaced by either a complete new liver or a portion of a healthy liver. (Once transplanted, a piece of a healthy liver can grow into a normal-size liver.)

In most cases, the new liver or liver tissue comes from a deceased donor. It is becoming more common, however, for patients to receive liver tissue from a living donor, who may be a family member. In this case, the transplant surgeon removes part of the donor's liver and uses it to replace the patient's liver.
In 2005, about 6,500 liver transplants were performed in the United States.
The number of liver transplants performed per year has been increasing steadily for more than 15 years.

When is a liver transplant needed?

Liver transplantation is needed for patients who are likely to die because of liver failure. Many diseases can cause liver failure. The most common is cirrhosis, which is the scarring and death of liver cells. Cirrhosis caused by hepatitis C is the most common reason for liver transplants.

Other conditions that may ultimately require a liver transplant include:
Diseases of the bile ducts, including biliary atresia, primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC), which can cause liver failure if there is a backup of bile in the liver.
Some inherited diseases, such as Wilson disease, in which dangerous levels of copper build up in the body, and hemochromatosis, where the liver is overwhelmed by iron.
Primary liver cancer or cancer that affects only the liver.
Alcoholism which can cause cirrhosis.

Who is eligible for a liver transplant?

There are many more people who need a liver transplant than there are livers available for donation. Patients are examined by a team of specialists to determine if a liver transplant is appropriate and likely to succeed. If so, they are placed on a national transplant waiting list. This waiting list is prioritized so the sickest people always go to the top of the list. About 17,000 Americans are currently on a waiting list for a liver transplant.

What is the average amount of time that patients wait for a donated liver?

The time that people spend waiting for a liver transplant varies widely. Blood type, body size, severity of illness and availability of donor organs all affect waiting time. Some people who develop sudden and complete liver failure from an acute illness may only have to wait a few days for a transplant. Other people, whose condition is less severe, may stay on the waiting list for many months.

Where do donated livers come from?

Livers for transplantation can come from deceased donors or living donors. In both cases, blood type and body size are the most important factors in determining whether a donated liver may be a match for the patient.Deceased donors typically die of accidents or head injuries. Either they have arranged in advance to be an organ donor or their family grants permission for organ donation when the victim is declared brain dead.

In a living donor transplant, a segment of a healthy person’s liver is transplanted into the sick patient. This can be done because the liver is the only organ that can regenerate itself. Both the donated segment and the remaining section of the donor liver will grow to normal size within weeks. Living donors are generally family members or close relatives of the patient.

What happens during transplant surgery?

Liver transplant surgery takes between six and 12 hours. During the operation, doctors remove the diseased liver and replace it with the donated liver. Most patients stay in the hospital for up to three weeks after surgery.

What are the side effects of a liver transplant?

The most common side effects are caused by the drugs that treat or prevent rejection. These side effects can include fluid retention, raised blood pressure, headaches, diarrhea and nausea. The severity of these side effects varies among patients.

What lifestyle changes are associated with liver transplants?

Most patients can return to a normal or near-normal lifestyle six months to a year after a successful liver transplant. When practical, transplant recipients should avoid exposure to people with infections. Maintaining a balanced diet, getting regular exercise and staying on prescribed medications are all important ways to stay healthy.

What is the outlook for liver transplant patients?

The outlook for patients is often expressed as a five-year survival rate. This refers to the percentage of liver transplant patients who are still alive five years after their transplant. The five-year survival rate for liver transplant patients is about 75 percent. Patients who receive livers from living donors have a slightly higher survival rate than patients whose livers came from deceased donors.

What can healthy people do to help people who need liver transplants?

The most important and valuable thing that anyone can do is to register as an organ donor. ALF provides organ donor cards free of charge; just contact Joy Gordon at 212-668-1000 ext. 234 or jgordon@liverfoundation.org. You can also download and print a card at OrganDonor.gov.