Acute Bronchitis Disease Information

Acute bronchitis is an infection of the bronchial (say: “brawn-kee-ull”) tree. The bronchial tree is made up of the tubes that carry air into your lungs. When these tubes get infected, they swell and mucus (thick fluid) forms inside them. This makes it hard for you to breathe. You may cough up mucus and wheeze (make a whistling sound when you breathe).

What causes acute bronchitis?
Acute bronchitis is almost always caused by viruses that attack the lining of the bronchial tree and cause infection. As your body fights back against these viruses, more swelling occurs and more mucus is made. It takes time for your body to kill the viruses and heal the damage to your bronchial tubes.

In most cases, the same viruses that cause colds cause acute bronchitis. Research has shown that bacterial infection is a much less common cause of bronchitis than we used to think. Very rarely, an infection caused by a fungus can cause acute bronchitis.

How do people get acute bronchitis?
The viruses that cause acute bronchitis are sprayed into the air or onto people’s hands when they cough. You can get acute bronchitis if you breathe in these viruses. You can also get it if you touch a hand that is coated with the viruses.

If you smoke or are around damaging fumes (such as those in certain kinds of factories), you are more likely to get acute bronchitis and to have it longer. This is because your bronchial tree is already damaged.

How is acute bronchitis treated?
Most cases of acute bronchitis will go away on their own after a few days or a week. It's a good idea to get plenty of rest, drink lots of noncaffeinated fluids (for example, water and fruit juices) and increase the humidity in your environment.

Because acute bronchitis is usually caused by viruses, antibiotics (medicines that kill bacteria) usually do not help. Even if you cough up mucus that is colored or thick, antibiotics probably won’t help you get better any faster.

If you smoke, you should cut down on the number of cigarettes you smoke, or stop smoking altogether. This will help your bronchial tree heal faster.

For some people with acute bronchitis, doctors prescribe medicines that are usually used to treat asthma. These medicines can help open the bronchial tubes and clear out mucus. They are usually given with an inhaler. An inhaler sprays the medicine right into the bronchial tree. Your doctor will decide if this treatment is right for you.

How long will the cough from acute bronchitis last?

You should call your doctor if:
You continue to wheeze and cough for more than 2 weeks, especially at night or when you are active.
You continue to cough for more than 2 weeks and sometimes have a bad-tasting fluid come up into your mouth.
You have a cough, you feel very sick and weak, and you have a high fever that doesn’t go down.
You cough up blood.
You have trouble breathing when you lie down.
Your feet swell.

Sometimes the cough from acute bronchitis lasts for several weeks or months. Usually this happens because the bronchial tree is taking a long time to heal. However, a cough that doesn’t go away may be a sign of another problem, like asthma or pneumonia.

How can I keep from getting acute bronchitis again?
One of the best ways to keep from getting acute bronchitis is to wash your hands often to get rid of any viruses.

If you smoke, the best defense against acute bronchitis is to quit. Smoking damages your bronchial tree and makes it easier for viruses to cause infection. Smoking also slows down the healing, so it takes longer for you to get well.

Ostomy Disease Information

An ostomy is a surgically created opening connecting an internal organ to the surface of the body. Different kinds of ostomies are named for the organ involved. The most common types of ostomies in intestinal surgery are an "ileostomy" (connecting the ileal part of the small intestine to the abdominal wall) and a "colostomy" (connecting the colon, or, large intestine to the abdominal wall).

An ostomy may be temporary or permanent. A temporary ostomy may be required if the intestinal tract can't be properly prepared for surgery because of blockage by disease or scar tissue. A temporary ostomy may also be created to allow inflammation or an operative site to heal without contamination by stool. Temporary ostomies can usually be reversed with minimal or no loss of intestinal function. A permanent ostomy may be required when disease, or its treatment, impairs normal intestinal function, or when the muscles that control elimination do not work properly or require removal. The most common causes of these conditions are low rectal cancer and inflammatory bowel disease.

An ostomy connects either the small or the large intestine to the surface of the body.

HOW WILL I CONTROL MY BOWEL MOVEMENTS?
Once your ostomy has been created, your surgeon or wound ostomy continence nurse (a WOC nurse specializes in ostomy care) will teach you to attach and care for a pouch called an ostomy appliance. An ostomy appliance, or pouch, is designed to catch eliminated fecal material (stool). The pouch is made of plastic and is held to the body with an adhesive. The adhesive, in turn, protects the skin from moisture. The pouch is disposable and is emptied or changed as needed. The system is quite secure; "accidents" are not common, and the pouches are odor-free.

Your bowel movements will naturally empty into the pouch. The frequency and quantity of your bowel movements will vary, depending on the type of ostomy you have, your diet, and your bowel habits prior to surgery. You may be instructed to modify your eating habits in order to control the frequency and consistency of your bowel movements. If the ostomy is a colostomy, irrigation techniques may be learned which allow for increased control over the timing of bowel movements.

An ostomy appliance is a plastic pouch, held to the body with an adhesive skin barrier, that provides secure and odor-free control of bowel movements.

WILL OTHER PEOPLE KNOW THAT I HAVE AN OSTOMY?
Not unless you tell them. An ostomy is easily hidden by your usual clothing. You probably have met people with an ostomy and not realized it!

WHERE WILL THE OSTOMY BE?
An ostomy is best placed on a flat portion of the abdominal wall. Before undergoing surgery to create an ostomy, it is best for your surgeon or WOC nurse to mark an appropriate place on your abdominal wall not constricted by your belt-line. A colostomy is usually placed to the left of your navel and an ileostomy to the right.

WILL MY PHYSICAL ACTIVITIES BE LIMITED?
The answer to this question is usually no. Public figures, prominent entertainers, and even professional athletes have ostomies that do not significantly limit their activities. All your usual activities, including active sports, may be resumed once healing from surgery is complete.

WILL AN OSTOMY AFFECT MY SEX LIFE?
Most patients with ostomies resume their usual sexual activity. Many people with ostomies worry about how their sexual partner will think of them because of their appliance. This perceived change in one's body image can be overcome by a strong relationship, time and patience. Support groups are also available in many cities.

WHAT ARE THE COMPLICATIONS OF AN OSTOMY?
Complications from an ostomy can occur. Most, like local skin irritation are typically minor and can be easily remedied. Problems such as a hernia associated with the ostomy or prolapse of the ostomy (a protrusion of the bowel) occasionally require surgery if they cause significant symptoms. Weight loss or gain may affect the function of an ostomy.

Living with an ostomy will require some adjustments and learning, but an active and fulfilling life is still possible and likely. Your colon and rectal surgeon and WOC nurse will provide you with skills and support to help you better live with your ostomy.

Kidney Stones Disease Information

Kidney stones, one of the most painful of the urologic disorders, have beset humans for centuries. Scientists have found evidence of kidney stones in a 7,000-year-old Egyptian mummy. Unfortunately, kidney stones are one of the most common disorders of the urinary tract. Each year, people make almost 3 million visits to health care providers and more than half a million people go to emergency rooms for kidney stone problems.

Most kidney stones pass out of the body without any intervention by a physician. Stones that cause lasting symptoms or other complications may be treated by various techniques, most of which do not involve major surgery. Also, research advances have led to a better understanding of the many factors that promote stone formation and thus better treatments for preventing stones.

Introduction to the Urinary Tract

The urinary tract, or system, consists of the kidneys, ureters, bladder, and urethra. The kidneys are two bean-shaped organs located below the ribs toward the middle of the back, one on each side of the spine. The kidneys remove extra water and wastes from the blood, producing urine. They also keep a stable balance of salts and other substances in the blood. The kidneys produce hormones that help build strong bones and form red blood cells.


The urinary tract.

Narrow tubes called ureters carry urine from the kidneys to the bladder, an oval-shaped chamber in the lower abdomen. Like a balloon, the bladder’s elastic walls stretch and expand to store urine. They flatten together when urine is emptied through the urethra to outside the body.

What is a kidney stone?

A kidney stone is a hard mass developed from crystals that separate from the urine within the urinary tract. Normally, urine contains chemicals that prevent or inhibit the crystals from forming. These inhibitors do not seem to work for everyone, however, so some people form stones. If the crystals remain tiny enough, they will travel through the urinary tract and pass out of the body in the urine without being noticed.

Kidney stones may contain various combinations of chemicals. The most common type of stone contains calcium in combination with either oxalate or phosphate. These chemicals are part of a person’s normal diet and make up important parts of the body, such as bones and muscles.

A less common type of stone is caused by infection in the urinary tract. This type of stone is called a struvite or infection stone. Another type of stone, uric acid stones, are a bit less common, and cystine stones are rare.


Kidney stones in the kidney, ureter, and bladder.

Urolithiasis is the medical term used to describe stones occurring in the urinary tract. Other frequently used terms are urinary tract stone disease and nephrolithiasis. Doctors also use terms that describe the location of the stone in the urinary tract. For example, a ureteral stone—or ureterolithiasis—is a kidney stone found in the ureter. To keep things simple, the general term kidney stones is used throughout this fact sheet.

Gallstones and kidney stones are not related. They form in different areas of the body. Someone with a gallstone is not necessarily more likely to develop kidney stones.

Who gets kidney stones?

For unknown reasons, the number of people in the United States with kidney stones has been increasing over the past 30 years. In the late 1970s, less than 4 percent of the population had stone-forming disease. By the early 1990s, the portion of the population with the disease had increased to more than 5 percent. Caucasians are more prone to develop kidney stones than African Americans. Stones occur more frequently in men. The prevalence of kidney stones rises dramatically as men enter their 40s and continues to rise into their 70s. For women, the prevalence of kidney stones peaks in their 50s. Once a person gets more than one stone, other stones are likely to develop.

What causes kidney stones?

Doctors do not always know what causes a stone to form. While certain foods may promote stone formation in people who are susceptible, scientists do not believe that eating any specific food causes stones to form in people who are not susceptible.

A person with a family history of kidney stones may be more likely to develop stones. Urinary tract infections, kidney disorders such as cystic kidney diseases, and certain metabolic disorders such as hyperparathyroidism are also linked to stone formation.

In addition, more than 70 percent of people with a rare hereditary disease called renal tubular acidosis develop kidney stones.


Shapes of various stones. Sizes are usually smaller than shown here.

Cystinuria and hyperoxaluria are two other rare, inherited metabolic disorders that often cause kidney stones. In cystinuria, too much of the amino acid cystine, which does not dissolve in urine, is voided, leading to the formation of stones made of cystine. In patients with hyperoxaluria, the body produces too much oxalate, a salt. When the urine contains more oxalate than can be dissolved, the crystals settle out and form stones.

Hypercalciuria is inherited, and it may be the cause of stones in more than half of patients. Calcium is absorbed from food in excess and is lost into the urine. This high level of calcium in the urine causes crystals of calcium oxalate or calcium phosphate to form in the kidneys or elsewhere in the urinary tract.

Other causes of kidney stones are hyperuricosuria, which is a disorder of uric acid metabolism; gout; excess intake of vitamin D; urinary tract infections; and blockage of the urinary tract. Certain diuretics, commonly called water pills, and calcium-based antacids may increase the risk of forming kidney stones by increasing the amount of calcium in the urine.

Calcium oxalate stones may also form in people who have chronic inflammation of the bowel or who have had an intestinal bypass operation, or ostomy surgery. As mentioned earlier, struvite stones can form in people who have had a urinary tract infection. People who take the protease inhibitor indinavir, a medicine used to treat HIV infection, may also be at increased risk of developing kidney stones.

Foods and Drinks Containing Oxalate

People prone to forming calcium oxalate stones may be asked by their doctor to limit or avoid certain foods if their urine contains an excess of oxalate.

High-oxalate foods—higher to lower
rhubarb
spinach
beets
swiss chard
wheat germ
soybean crackers
peanuts
okra
chocolate
black Indian tea
sweet potatoes

Foods that have medium amounts of oxalate may be eaten in limited amounts.

Medium-oxalate foods—higher to lower
grits
grapes
celery
green pepper
red raspberries
fruit cake
strawberries
marmalade
liver

Source: The Oxalosis and Hyperoxaluria Foundation.

What are the symptoms of kidney stones?

Kidney stones often do not cause any symptoms. Usually, the first symptom of a kidney stone is extreme pain, which begins suddenly when a stone moves in the urinary tract and blocks the flow of urine. Typically, a person feels a sharp, cramping pain in the back and side in the area of the kidney or in the lower abdomen. Sometimes nausea and vomiting occur. Later, pain may spread to the groin.

If the stone is too large to pass easily, pain continues as the muscles in the wall of the narrow ureter try to squeeze the stone into the bladder. As the stone moves and the body tries to push it out, blood may appear in the urine, making the urine pink. As the stone moves down the ureter, closer to the bladder, a person may feel the need to urinate more often or feel a burning sensation during urination.

If fever and chills accompany any of these symptoms, an infection may be present. In this case, a person should contact a doctor immediately.

How are kidney stones diagnosed?

Sometimes “silent” stones—those that do not cause symptoms—are found on x rays taken during a general health exam. If the stones are small, they will often pass out of the body unnoticed. Often, kidney stones are found on an x ray or ultrasound taken of someone who complains of blood in the urine or sudden pain. These diagnostic images give the doctor valuable information about the stone’s size and location. Blood and urine tests help detect any abnormal substance that might promote stone formation.

The doctor may decide to scan the urinary system using a special test called a computerized tomography (CT) scan or an intravenous pyelogram (IVP). The results of all these tests help determine the proper treatment.

Preventing Kidney Stones

A person who has had more than one kidney stone may be likely to form another; so, if possible, prevention is important. To help determine their cause, the doctor will order laboratory tests, including urine and blood tests. The doctor will also ask about the patient’s medical history, occupation, and eating habits. If a stone has been removed, or if the patient has passed a stone and saved it, a stone analysis by the laboratory may help the doctor in planning treatment.

The doctor may ask the patient to collect urine for 24 hours after a stone has passed or been removed. For a 24-hour urine collection, the patient is given a large container, which is to be refrigerated between trips to the bathroom. The collection is used to measure urine volume and levels of acidity, calcium, sodium, uric acid, oxalate, citrate, and creatinine—a product of muscle metabolism. The doctor will use this information to determine the cause of the stone. A second 24-hour urine collection may be needed to determine whether the prescribed treatment is working.

How are kidney stones treated?

Fortunately, surgery is not usually necessary. Most kidney stones can pass through the urinary system with plenty of water—2 to 3 quarts a day—to help move the stone along. Often, the patient can stay home during this process, drinking fluids and taking pain medication as needed. The doctor usually asks the patient to save the passed stone(s) for testing. It can be caught in a cup or tea strainer used only for this purpose.
Lifestyle Changes

A simple and most important lifestyle change to prevent stones is to drink more liquids—water is best. Someone who tends to form stones should try to drink enough liquids throughout the day to produce at least 2 quarts of urine in every 24-hour period.

In the past, people who form calcium stones were told to avoid dairy products and other foods with high calcium content. Recent studies have shown that foods high in calcium, including dairy products, may help prevent calcium stones. Taking calcium in pill form, however, may increase the risk of developing stones.

Patients may be told to avoid food with added vitamin D and certain types of antacids that have a calcium base. Someone who has highly acidic urine may need to eat less meat, fish, and poultry. These foods increase the amount of acid in the urine.

To prevent cystine stones, a person should drink enough water each day to dilute the concentration of cystine that escapes into the urine, which may be difficult. More than a gallon of water may be needed every 24 hours, and a third of that must be drunk during the night.
Medical Therapy

A doctor may prescribe certain medications to help prevent calcium and uric acid stones. These medicines control the amount of acid or alkali in the urine, key factors in crystal formation. The medicine allopurinol may also be useful in some cases of hyperuricosuria.

Doctors usually try to control hypercalciuria, and thus prevent calcium stones, by prescribing certain diuretics, such as hydrochlorothiazide. These medicines decrease the amount of calcium released by the kidneys into the urine by favoring calcium retention in bone. They work best when sodium intake is low.

Rarely, patients with hypercalciuria are given the medicine sodium cellulose phosphate, which binds calcium in the intestines and prevents it from leaking into the urine.

If cystine stones cannot be controlled by drinking more fluids, a doctor may prescribe medicines such as Thiola and Cuprimine, which help reduce the amount of cystine in the urine.

For struvite stones that have been totally removed, the first line of prevention is to keep the urine free of bacteria that can cause infection. A patient’s urine will be tested regularly to ensure no bacteria are present.

If struvite stones cannot be removed, a doctor may prescribe a medicine called acetohydroxamic acid (AHA). AHA is used with long-term antibiotic medicines to prevent the infection that leads to stone growth.

People with hyperparathyroidism sometimes develop calcium stones. Treatment in these cases is usually surgery to remove the parathyroid glands, which are located in the neck. In most cases, only one of the glands is enlarged. Removing the glands cures the patient’s problem with hyperparathyroidism and kidney stones.
Surgical Treatment

Surgery may be needed to remove a kidney stone if it
does not pass after a reasonable period of time and causes constant pain
is too large to pass on its own or is caught in a difficult place
blocks the flow of urine
causes an ongoing urinary tract infection
damages kidney tissue or causes constant bleeding
has grown larger, as seen on follow-up x rays

Until 20 years ago, open surgery was necessary to remove a stone. The surgery required a recovery time of 4 to 6 weeks. Today, treatment for these stones is greatly improved, and many options do not require major open surgery and can be performed in an outpatient setting.

Extracorporeal Shock Wave Lithotripsy
Extracorporeal shock wave lithotripsy (ESWL) is the most frequently used procedure for the treatment of kidney stones. In ESWL, shock waves that are created outside the body travel through the skin and body tissues until they hit the denser stones. The stones break down into small particles and are easily passed through the urinary tract in the urine.

Several types of ESWL devices exist. Most devices use either x rays or ultrasound to help the surgeon pinpoint the stone during treatment. For most types of ESWL procedures, anesthesia is needed.

In many cases, ESWL may be done on an outpatient basis. Recovery time is relatively short, and most people can resume normal activities in a few days.

Complications may occur with ESWL. Some patients have blood in their urine for a few days after treatment. Bruising and minor discomfort in the back or abdomen from the shock waves can occur. To reduce the risk of complications, doctors usually tell patients to avoid taking aspirin and other medicines that affect blood clotting for several weeks before treatment.

Sometimes, the shattered stone particles cause minor blockage as they pass through the urinary tract and cause discomfort. In some cases, the doctor will insert a small tube called a stent through the bladder into the ureter to help the fragments pass. Sometimes the stone is not completely shattered with one treatment, and additional treatments may be needed.

As with any interventional, surgical procedure, potential risks and complications should be discussed with the doctor before making a treatment decision.


Extracorporeal shock wave lithotripsy.

Percutaneous Nephrolithotomy
Sometimes a procedure called percutaneous nephrolithotomy is recommended to remove a stone. This treatment is often used when the stone is quite large or in a location that does not allow effective use of ESWL.

In this procedure, the surgeon makes a tiny incision in the back and creates a tunnel directly into the kidney. Using an instrument called a nephroscope, the surgeon locates and removes the stone. For large stones, some type of energy probe—ultrasonic or electrohydraulic—may be needed to break the stone into small pieces. Often, patients stay in the hospital for several days and may have a small tube called a nephrostomy tube left in the kidney during the healing process.

One advantage of percutaneous nephrolithotomy is that the surgeon can remove some of the stone fragments directly instead of relying solely on their natural passage from the kidney.


Percutaneous nephrolithotomy.

Ureteroscopic Stone Removal
Although some stones in the ureters can be treated with ESWL, ureteroscopy may be needed for mid- and lower-ureter stones. No incision is made in this procedure. Instead, the surgeon passes a small fiberoptic instrument called a ureteroscope through the urethra and bladder into the ureter. The surgeon then locates the stone and either removes it with a cage-like device or shatters it with a special instrument that produces a form of shock wave. A small tube or stent may be left in the ureter for a few days to help urine flow. Before fiber optics made ureteroscopy possible, physicians used a similar “blind basket” extraction method. But this technique is rarely used now because of the higher risks of damage to the ureters.


Ureteroscopic stone removal.

Hope through Research

The Division of Kidney, Urologic, and Hematologic Diseases of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) funds research on the causes, treatments, and prevention of kidney stones. The NIDDK is part of the National Institutes of Health in Bethesda, MD.

New medicines and the growing field of lithotripsy have greatly improved the treatment of kidney stones. Still, NIDDK researchers and grantees seek to answer questions such as
Why do some people continue to have painful stones?
How can doctors predict, or screen, those at risk for getting stones?
What are the long-term effects of lithotripsy?
Do genes play a role in stone formation?
What is the natural substance(s) found in urine that blocks stone formation?

Researchers are also developing new medicines with fewer side effects

Points to Remember
A person with a family history of stones or a personal history of more than one stone may be more likely to develop more stones.
A good first step to prevent the formation of any type of stone is to drink plenty of liquids—water is best.
Someone who is at risk for developing stones may need certain blood and urine tests to determine which factors can best be altered to reduce that risk.
Some people will need medicines to prevent stones from forming.
People with chronic urinary tract infections and stones will often need a stone removed if the doctor determines that the stone is causing the infection. Patients must receive careful follow-up to be sure that the infection has cleared.

Cataract Disease Information

A cataract is a clouding of the lens in the eye that affects vision. Most cataracts are related to aging. Cataracts are very common in older people. By age 80, more than half of all Americans either have a cataract or have had cataract surgery.

A cataract can occur in either or both eyes. It cannot spread from one eye to the other.

What is the lens?

The lens is a clear part of the eye that helps to focus light, or an image, on the retina. The retina is the light-sensitive tissue at the back of the eye.

In a normal eye, light passes through the transparent lens to the retina. Once it reaches the retina, light is changed into nerve signals that are sent to the brain.

The lens must be clear for the retina to receive a sharp image. If the lens is cloudy from a cataract, the image you see will be blurred.
Are there other types of cataract?

Yes. Although most cataracts are related to aging, there are other types of cataract:
Secondary cataract. Cataracts can form after surgery for other eye problems, such as glaucoma. Cataracts also can develop in people who have other health problems, such as diabetes. Cataracts are sometimes linked to steroid use.
Traumatic cataract. Cataracts can develop after an eye injury, sometimes years later.
Congenital cataract. Some babies are born with cataracts or develop them in childhood, often in both eyes. These cataracts may be so small that they do not affect vision. If they do, the lenses may need to be removed.
Radiation cataract. Cataracts can develop after exposure to some types of radiation.
Normal vision
The same scene as viewed by a person with cataract

Causes and Risk Factors
What causes cataracts?

The lens lies behind the iris and the pupil (see diagram). It works much like a camera lens. It focuses light onto the retina at the back of the eye, where an image is recorded. The lens also adjusts the eye's focus, letting us see things clearly both up close and far away. The lens is made of mostly water and protein. The protein is arranged in a precise way that keeps the lens clear and lets light pass through it.

But as we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract. Over time, the cataract may grow larger and cloud more of the lens, making it harder to see.

Researchers suspect that there are several causes of cataract, such as smoking and diabetes. Or, it may be that the protein in the lens just changes from the wear and tear it takes over the years.
How can cataracts affect my vision?

Age-related cataracts can affect your vision in two ways:

Clumps of protein reduce the sharpness of the image reaching the retina.

The lens consists mostly of water and protein. When the protein clumps up, it clouds the lens and reduces the light that reaches the retina. The clouding may become severe enough to cause blurred vision. Most age-related cataracts develop from protein clumpings.

When a cataract is small, the cloudiness affects only a small part of the lens. You may not notice any changes in your vision. Cataracts tend to "grow" slowly, so vision gets worse gradually. Over time, the cloudy area in the lens may get larger, and the cataract may increase in size. Seeing may become more difficult. Your vision may get duller or blurrier.

The clear lens slowly changes to a yellowish/brownish color, adding a brownish tint to vision.

As the clear lens slowly colors with age, your vision gradually may acquire a brownish shade. At first, the amount of tinting may be small and may not cause a vision problem. Over time, increased tinting may make it more difficult to read and perform other routine activities. This gradual change in the amount of tinting does not affect the sharpness of the image transmitted to the retina.

If you have advanced lens discoloration, you may not be able to identify blues and purples. You may be wearing what you believe to be a pair of black socks, only to find out from friends that you are wearing purple socks.
When are you most likely to have a cataract?

The term "age-related" is a little misleading. You don't have to be a senior citizen to get this type of cataract. In fact, people can have an age-related cataract in their 40s and 50s. But during middle age, most cataracts are small and do not affect vision. It is after age 60 that most cataracts steal vision.
Who is at risk for cataract?

The risk of cataract increases as you get older. Other risk factors for cataract include:
Certain diseases such as diabetes.
Personal behavior such as smoking and alcohol use.
The environment such as prolonged exposure to sunlight.
What can I do to protect my vision?

Wearing sunglasses and a hat with a brim to block ultraviolet sunlight may help to delay cataract. If you smoke, stop. Researchers also believe good nutrition can help reduce the risk of age-related cataract. They recommend eating green leafy vegetables, fruit, and other foods with antioxidants.

If you are age 60 or older, you should have a comprehensive dilated eye exam at least once every two years. In addition to cataract, your eye care professional can check for signs of age-related macular degeneration, glaucoma, and other vision disorders. Early treatment for many eye diseases may save your sight.

Symptoms and Detection
What are the symptoms of a cataract?

The most common symptoms of a cataract are:
Cloudy or blurry vision.
Colors seem faded.
Glare. Headlights, lamps, or sunlight may appear too bright. A halo may appear around lights.
Poor night vision.
Double vision or multiple images in one eye. (This symptom may clear as the cataract gets larger.)
Frequent prescription changes in your eyeglasses or contact lenses.
These symptoms also can be a sign of other eye problems. If you have any of these symptoms, check with your eye care professional.
How is a cataract detected?

Cataract is detected through a comprehensive eye exam that includes:
Visual acuity test. This eye chart test measures how well you see at various distances.
Dilated eye exam. Drops are placed in your eyes to widen, or dilate, the pupils. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours.
Tonometry. An instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test.

Your eye care professional also may do other tests to learn more about the structure and health of your eye.

Treatment
How is a cataract treated?

The symptoms of early cataract may be improved with new eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying lenses. If these measures do not help, surgery is the only effective treatment. Surgery involves removing the cloudy lens and replacing it with an artificial lens.

A cataract needs to be removed only when vision loss interferes with your everyday activities, such as driving, reading, or watching TV. You and your eye care professional can make this decision together. Once you understand the benefits and risks of surgery, you can make an informed decision about whether cataract surgery is right for you. In most cases, delaying cataract surgery will not cause long-term damage to your eye or make the surgery more difficult. You do not have to rush into surgery.

Sometimes a cataract should be removed even if it does not cause problems with your vision. For example, a cataract should be removed if it prevents examination or treatment of another eye problem, such as age-related macular degeneration or diabetic retinopathy. If your eye care professional finds a cataract, you may not need cataract surgery for several years. In fact, you might never need cataract surgery. By having your vision tested regularly, you and your eye care professional can discuss if and when you might need treatment.

If you choose surgery, your eye care professional may refer you to a specialist to remove the cataract.

If you have cataracts in both eyes that require surgery, the surgery will be performed on each eye at separate times, usually four to eight weeks apart.

Many people who need cataract surgery also have other eye conditions, such as age-related macular degeneration or glaucoma. If you have other eye conditions in addition to cataract, talk with your doctor. Learn about the risks, benefits, alternatives, and expected results of cataract surgery.
What are the different types of cataract surgery?

There are two types of cataract surgery. Your doctor can explain the differences and help determine which is better for you:

Phacoemulsification, or phaco. A small incision is made on the side of the cornea, the clear, dome-shaped surface that covers the front of the eye. Your doctor inserts a tiny probe into the eye. This device emits ultrasound waves that soften and break up the lens so that it can be removed by suction. Most cataract surgery today is done by phacoemulsification, also called "small incision cataract surgery."

Extracapsular surgery. Your doctor makes a longer incision on the side of the cornea and removes the cloudy core of the lens in one piece. The rest of the lens is removed by suction.

After the natural lens has been removed, it often is replaced by an artificial lens, called an intraocular lens (IOL). An IOL is a clear, plastic lens that requires no care and becomes a permanent part of your eye. Light is focused clearly by the IOL onto the retina, improving your vision. You will not feel or see the new lens.

Some people cannot have an IOL. They may have another eye disease or have problems during surgery. For these patients, a soft contact lens, or glasses that provide high magnification, may be suggested.
What are the risks of cataract surgery?

As with any surgery, cataract surgery poses risks, such as infection and bleeding. Before cataract surgery, your doctor may ask you to temporarily stop taking certain medications that increase the risk of bleeding during surgery. After surgery, you must keep your eye clean, wash your hands before touching your eye, and use the prescribed medications to help minimize the risk of infection. Serious infection can result in loss of vision.

Cataract surgery slightly increases your risk of retinal detachment. Other eye disorders, such as high myopia (nearsightedness), can further increase your risk of retinal detachment after cataract surgery. One sign of a retinal detachment is a sudden increase in flashes or floaters. Floaters are little "cobwebs" or specks that seem to float about in your field of vision. If you notice a sudden increase in floaters or flashes, see an eye care professional immediately. A retinal detachment is a medical emergency. If necessary, go to an emergency service or hospital. Your eye must be examined by an eye surgeon as soon as possible. A retinal detachment causes no pain. Early treatment for retinal detachment often can prevent permanent loss of vision. The sooner you get treatment, the more likely you will regain good vision. Even if you are treated promptly, some vision may be lost.

Talk to your eye care professional about these risks. Make sure cataract surgery is right for you.
Is cataract surgery effective?

Cataract removal is one of the most common operations performed in the United States. It also is one of the safest and most effective types of surgery. In about 90 percent of cases, people who have cataract surgery have better vision afterward.
What happens before surgery?

A week or two before surgery, your doctor will do some tests. These tests may include measuring the curve of the cornea and the size and shape of your eye. This information helps your doctor choose the right type of IOL.

You may be asked not to eat or drink anything 12 hours before your surgery.
What happens during surgery?

At the hospital or eye clinic, drops will be put into your eye to dilate the pupil. The area around your eye will be washed and cleansed.

The operation usually lasts less than one hour and is almost painless. Many people choose to stay awake during surgery. Others may need to be put to sleep for a short time.

If you are awake, you will have an anesthetic to numb the nerves in and around your eye.

After the operation, a patch may be placed over your eye. You will rest for a while. Your medical team will watch for any problems, such as bleeding. Most people who have cataract surgery can go home the same day. You will need someone to drive you home.
What happens after surgery?

Itching and mild discomfort are normal after cataract surgery. Some fluid discharge is also common. Your eye may be sensitive to light and touch. If you have discomfort, your doctor can suggest treatment. After one or two days, moderate discomfort should disappear.

For a few days after surgery, your doctor may ask you to use eyedrops to help healing and decrease the risk of infection. Ask your doctor about how to use your eyedrops, how often to use them, and what effects they can have. You will need to wear an eye shield or eyeglasses to help protect your eye. Avoid rubbing or pressing on your eye.

When you are home, try not to bend from the waist to pick up objects on the floor. Do not lift any heavy objects. You can walk, climb stairs, and do light household chores.

In most cases, healing will be complete within eight weeks. Your doctor will schedule exams to check on your progress.
Can problems develop after surgery?

Problems after surgery are rare, but they can occur. These problems can include infection, bleeding, inflammation (pain, redness, swelling), loss of vision, double vision, and high or low eye pressure. With prompt medical attention, these problems can usually be treated successfully.

Sometimes the eye tissue that encloses the IOL becomes cloudy and may blur your vision. This condition is called an after-cataract. An after-cataract can develop months or years after cataract surgery.

An after-cataract is treated with a laser. Your doctor uses a laser to make a tiny hole in the eye tissue behind the lens to let light pass through. This outpatient procedure is called a YAG laser capsulotomy. It is painless and rarely results in increased eye pressure or other eye problems. As a precaution, your doctor may give you eyedrops to lower your eye pressure before or after the procedure.
When will my vision be normal again?

You can return quickly to many everyday activities, but your vision may be blurry. The healing eye needs time to adjust so that it can focus properly with the other eye, especially if the other eye has a cataract. Ask your doctor when you can resume driving.

If you received an IOL, you may notice that colors are very bright. The IOL is clear, unlike your natural lens that may have had a yellowish/brownish tint. Within a few months after receiving an IOL, you will become used to improved color vision. Also, when your eye heals, you may need new glasses or contact lenses.
What can I do if I already have lost some vision from cataract?

If you have lost some sight from cataract or cataract surgery, ask your eye care professional about low vision services and devices that may help you make the most of your remaining vision. Ask for a referral to a specialist in low vision. Many community organizations and agencies offer information about low vision counseling, training, and other special services for people with visual impairments. A nearby school of medicine or optometry may provide low vision services.

Menstruation Information

Menstruation (a period) is a major stage of puberty in girls; it's one of the many physical signs that a girl is turning into a woman. And like a lot of the other changes associated with puberty, menstruation can be confusing. Some girls can't wait to start their periods, whereas others may feel afraid or anxious. Many girls (and guys!) don't have a complete understanding of a woman's reproductive system or what actually happens during the menstrual cycle, making the process seem even more mysterious.

Puberty and Periods

When girls begin to go through puberty (usually starting between the ages of 8 and 13), their bodies and minds change in many ways. The hormones in their bodies stimulate new physical development, such as growth and breast development. About 2 to 2½ years after a girl's breasts begin to develop, she usually gets her first menstrual period.
Teks yang tidak ingin ditampilkan
About 6 months or so before getting her first period, a girl might notice an increased amount of clear vaginal discharge. This discharge is common. There's no need for a girl to worry about discharge unless it has a strong odor or causes itchiness.

The start of periods is known as menarche. Menarche doesn't happen until all the parts of a girl's reproductive system have matured and are working together.

Baby girls are born with ovaries, fallopian tubes, and a uterus. The two ovaries are oval-shaped and sit on either side of the uterus (womb) in the lowest part of the abdomen called the pelvis. They contain thousands of eggs, or ova. The two fallopian tubes are long and thin. Each fallopian tube stretches from an ovary to the uterus, a pear-shaped organ that sits in the middle of the pelvis. The muscles in a female's uterus are powerful and are able to expand to allow the uterus to accommodate a growing fetus and then help push the baby out during labor.

As a girl matures and enters puberty, the pituitary gland releases hormones that stimulate the ovaries to produce other hormones called estrogen and progesterone. These hormones have many effects on a girl's body, including physical maturation, growth, and emotions.

About once a month, a tiny egg leaves one of the ovaries — a process called ovulation — and travels down one of the fallopian tubes toward the uterus. In the days before ovulation, the hormone estrogen stimulates the uterus to build up its lining with extra blood and tissue, making the walls of the uterus thick and cushioned. This happens to prepare the uterus for pregnancy: If the egg is fertilized by a sperm cell, it travels to the uterus and attaches to the cushiony wall of the uterus, where it slowly develops into a baby.

If the egg isn't fertilized, though — which is the case during most of a woman's monthly cycles — it doesn't attach to the wall of the uterus. When this happens, the uterus sheds the extra tissue lining. The blood, tissue, and unfertilized egg leave the uterus, going through the vagina on the way out of the body. This is a menstrual period. This cycle happens almost every month for several more decades (except, of course, when a female is pregnant) until a woman reaches menopause and no longer releases eggs from her ovaries.
How Often Does a Girl Get Her Period?

Just as some girls begin puberty earlier or later than others, the same applies to periods. Some girls may start menstruating as early as age 10, but others may not get their first period until they are 15 years old.

The amount of time between a girl's periods is called her menstrual cycle (the cycle is counted from the start of one period to the start of the next). Some girls will find that their menstrual cycle lasts 28 days, whereas others might have a 24-day cycle, a 30-day cycle, or even longer. Following menarche, menstrual cycles last 21–45 days. After a couple of years, cycles shorten to an adult length of 21–34 days.

Irregular periods are common in girls who are just beginning to menstruate. It may take the body a while to sort out all the changes going on, so a girl may have a 28-day cycle for 2 months, then miss a month, for example. Usually, after a year or two, the menstrual cycle will become more regular. Some women continue to have irregular periods into adulthood, though.

As a girl gets older and her periods settle down — or she gets more used to her own unique cycle — she will probably find that she can predict when her period will come. In the meantime, it's a good idea to keep track of your menstrual cycle with a calendar.
How Long and How Much?

The amount of time that a girl has her period also can vary. Some girls have periods that last just 2 or 3 days. Other girls may have periods that last 7 days or longer. The menstrual flow — meaning how much blood comes out of the vagina — can vary widely from girl to girl, too.

Some girls may be concerned that they're losing too much blood. It can be a shock to see all that blood, but it's unlikely that a girl will lose too much, unless she has a medical condition like von Willebrand disease. Though it may look like a lot, the average amount of blood is only about 2 tablespoons (30 milliliters) for an entire period. Most teens will change pads 3 to 6 times a day, with more frequent changes when their period is heaviest, usually at the start of the period.

Especially when menstrual periods are new, you may be worried about your blood flow or whether your period is normal in other ways. Talk to a doctor or nurse if:
your period lasts longer than a week
you have to change your pad very often (soaking more than one pad every 1–2 hours)
you go longer than 3 months between periods
you have bleeding in between periods
you have an unusual amount of pain before or during your period
your periods were regular then became irregular
Cramps, PMS, and Pimples

Some girls may notice physical or emotional changes around the time of their periods. Menstrual cramps are pretty common — in fact, more than half of all women who menstruate say they have cramps during the first few days of their periods. Doctors think that cramps are caused by prostaglandin, a chemical that causes the muscles of the uterus to contract.

Depending on the girl, menstrual cramps can be dull and achy or sharp and intense, and they can sometimes be felt in the back as well as the abdomen. These cramps often become less uncomfortable and sometimes even disappear completely as a girl gets older.

Many girls and women find that over-the-counter pain medications (like acetaminophen or ibuprofen) can relieve cramps, as can taking a warm bath or applying a warm heating pad to the lower abdomen. Exercising regularly throughout the monthly cycle may help lessen cramps, too. If these things don't help, ask your doctor for advice.

Some girls and women find that they feel sad or easily irritated during the few days or week before their periods. Others may get angry more quickly than normal or cry more than usual. Some girls crave certain foods. These types of emotional changes may be the result of premenstrual syndrome (PMS).

PMS is related to changes in the body's hormones. As hormone levels rise and fall during a woman's menstrual cycle, they can affect the way she feels, both emotionally and physically. Some girls, in addition to feeling more intense emotions than they usually do, notice physical changes along with their periods — some feel bloated or puffy because of water retention, others notice swollen and sore breasts, and some get headaches.

PMS usually goes away soon after a period begins, but it can come back month after month. Eating right, getting enough sleep, and exercising may help relieve some of the symptoms of PMS. Talk to your doctor if you are concerned about your premenstrual symptoms.

It's also not uncommon for girls to have an acne flare-up during certain times of their cycle; again, this is due to hormones. Fortunately, the pimples associated with periods tend to become less of a problem as girls get older.
Pads, Tampons, and Liners

Once you begin menstruating, you'll need to use something to absorb the blood. Most girls use a pad or a tampon. But some use menstrual cups, which a girl inserts into her vagina to catch and hold the blood (instead of absorbing it, like a tampon).

There are so many products out there that it may take some experimenting before you find the one that works best for you. Some girls use only pads (particularly when they first start menstruating), some use only tampons, and some switch around — tampons during the day and pads at night, for example.

Girls who worry about leakage from a tampon often use a pantiliner, too, and some girls use liners alone on very light days of their periods.

Periods shouldn't get in the way of exercising, having fun, and enjoying life. Girls who are very active, particularly those who enjoy swimming, often find that tampons are the best option during sports.

If you have questions about pads, tampons, or coping with periods, ask a parent, health teacher, school nurse, or older sister.

Reviewed by: Mary L. Gavin, MD

Childhood Immunization Information

A vaccine is a medicine that's given to help prevent a disease. Vaccines help the body produce antibodies. These antibodies protect against the disease.

Vaccines not only help keep your child healthy, they help all children by stamping out serious childhood diseases.

Are vaccines safe?
Vaccines are generally quite safe. The protection provided by vaccines far outweighs the very small risk of serious problems. Vaccines have made many serious childhood diseases rare today. Talk to your family doctor if you have any questions.

Do vaccines have side effects?
Some vaccines may cause mild temporary side effects such as fever, or soreness or a lump under the skin where the shot was given. Your family doctor will talk to you about possible side effects with certain vaccines.

When should my child be vaccinated?
Recommendations about when to have your child vaccinated change from time to time. You can get a copy of the most current vaccination schedule on the World Wide Web from an organization such as the American Academy of Family Physicians or the American Academy of Pediatrics, or you can ask your family doctor. Vaccinations usually start when your child is 2 months old and most are finished by the time he or she is 6 years old.

Are there any reasons my child should not be vaccinated?
In some special situations, children shouldn't be vaccinated. For example, some vaccines shouldn't be given to children who have certain types of cancer or certain diseases, or who are taking drugs that lower the body's ability to resist infection. The MMR vaccine shouldn't be given to children who have a serious allergy to eggs.

If your child has had a serious reaction to the first shot in a series of shots, your family doctor will probably talk with you about the pros and cons of giving him or her the rest of the shots in the series.

Talk to your doctor if you have any questions about whether your child should receive a vaccine.

What is the flu vaccine?
The flu vaccine is a shot. Your child can't get the flu from the vaccine because it contains viruses that are dead. This vaccine is given at the beginning of the flu season, usually in October or November. Because flu viruses change from year to year, it is very important for your child to get the shot each year so that he or she will be protected.

The flu vaccine is safe for children 6 months of age and older. If your child is between 6 and 23 months of age, it's especially important for him or her to get the flu vaccine each year. Children in this age group are more likely to have complications from the flu.

What is the DTaP vaccine?
The DTaP vaccine is 3 vaccines in 1 shot. It protects against diphtheria, tetanus and pertussis. It's given as a series of 5 shots.

Diphtheria is a disease that attacks the throat and heart. It can lead to heart failure and death. Tetanus is also called "lockjaw." It can lead to severe muscle spasms and death.

Pertussis (also called "whooping cough") causes severe coughing that makes it hard to breathe, eat and drink. It can lead to pneumonia, convulsions, brain damage and death.

Having your child immunized when he or she is young (which means making sure he or she gets all of the DTaP shots) protects your child against these diseases for about 10 years. After this time, your child will need booster shots.

What is the Td vaccine?
The Td vaccine is used as a booster to the DTaP vaccine. It helps prevent tetanus and diphtheria. It's given when your child is 11 years old or older and every 10 years throughout life.

What is the IPV vaccine?
The IPV (inactivated poliovirus) vaccine helps prevent polio. It's given 4 times as a shot. It has replaced the older oral polio vaccine.

Polio can cause muscle pain and paralysis of one or both legs or arms. It may also paralyze the muscles used to breathe and swallow. It can lead to death.

What is the MMR vaccine?
The MMR vaccine protects against the measles, mumps and rubella. It's given as 2 shots.

Measles causes fever, rash, cough, runny nose and watery eyes. It can also cause ear infections and pneumonia. Measles can also lead to more serious problems, such as brain swelling and even death.

Mumps causes fever, headache and painful swelling of one or both of the major saliva glands. Mumps can lead to meningitis (infection of the coverings of the brain and spinal cord) and, very rarely, to brain swelling. Rarely, it can cause the testicles of boys or men to swell, which can make them unable to have children.

Rubella is also called the German measles. It causes slight fever, a rash and swelling of the glands in the neck. Rubella can also cause brain swelling or a problem with bleeding.

If a pregnant woman catches rubella, it can cause her to lose her baby or have a baby who is blind or deaf, or has trouble learning.

Some people have suggested that the MMR vaccine causes autism. However, good research has shown that there is no link between autism and childhood vaccinations.

What is the Hib vaccine?
The Hib vaccine helps prevent Haemophilus influenza type b, a leading cause of serious illness in children. It can lead to meningitis, pneumonia and a severe throat infection that can cause choking. The Hib vaccine is given as a series of 3 or 4 shots.

What is the varicella vaccine?
The varicella vaccine helps prevent chickenpox. It is given to children once after they are 12 months old or to older children if they have never had chickenpox or been vaccinated. Booster shots may be given if found necessary by further research.

What is the HBV vaccine?
The HBV vaccine helps prevent hepatitis B virus (HBV), an infection of the liver that can lead to liver cancer and death. The vaccine is given as a series of 3 shots. The HBV vaccine and Hib vaccine can also be given together in the same shot.

What is the pneumococcal conjugate vaccine?
The pneumococcal conjugate vaccine (PCV) protects against a type of bacteria that is a common cause of ear infections. This bacteria can also cause more serious illnesses, such as meningitis and bacteremia (infection in the blood stream). Infants and toddlers are given 4 doses of the vaccine. The vaccine may also be used in older children who are at risk for pneumococcal infection.

What is the meningococcal conjugate vaccine?
The meningococcal conjugate vaccine (MCV4) protects against 4 strains ("types") of bacterial meningitis caused by the bacteria N. meningitidis. Bacterial meningitis is an infection of the fluid around the brain and spinal cord. It is a serious illness that can cause high fever, headache, stiff neck and confusion. It can also cause more serious complications, such as brain damage, hearing loss or blindness.

Children should get the MCV4 vaccine at 11 to 12 years of age. Children older than 12 who have not received the vaccine should receive it before starting high school.

Diphtheria Disease Information

Diphtheria (dif-THEER-e-uh) is a serious bacterial infection, usually affecting the mucous membranes of your nose and throat. Diphtheria typically causes a bad sore throat, fever, swollen glands and weakness. But the hallmark sign is a thick, gray covering in the back of your throat that can make breathing difficult. Diphtheria can also infect your skin.

Years ago, diphtheria was a leading cause of death among children. Today, diphtheria is very rare in the United States and other developed countries thanks to widespread vaccination against the disease.

Medications are available to treat diphtheria. However, in advanced stages, diphtheria can cause damage to your heart, kidneys and nervous system. Even with treatment, diphtheria can be deadly — nearly one out of every 10 people who get diphtheria die of it.
Signs and symptoms

Signs and symptoms of diphtheria may include:
A sore throat and hoarseness
Painful swallowing
Swollen glands (enlarged lymph nodes) in your neck
A thick, gray membrane covering your throat and tonsils
Difficulty breathing or rapid breathing
Nasal discharge
Fever and chills
Malaise

Signs and symptoms usually begin two to five days after a person becomes infected, but they may take as many as 10 days to appear.

Some people become infected with diphtheria-causing bacteria, but they develop only a mild case of the illness and show no signs or symptoms of the disease. They're said to be carriers of the disease, because they may spread the disease without showing signs or symptoms of illness.

Skin (cutaneous) diphtheria
A second type of diphtheria can affect the skin. A wound infected with bacteria is typically red, painful and swollen. A wound infected with diphtheria-causing bacteria also may have patches of a sticky, gray material.

Although it's more common in tropical climates, cutaneous diphtheria also occurs in the United States, particularly among people with poor hygiene who live in crowded conditions.

In rare instances, diphtheria affects the eye.
Causes

The bacterium Corynebacterium diphtheriae causes diphtheria. Usually the bacteria multiply on or near the surface of the mucous membranes of the throat, where they cause inflammation. The inflammation may spread to the voice box (larynx) and may make your throat swell, narrowing your airway. Disease-causing strains of C. diphtheriae release a poison (toxin), which can also damage the heart, brain and nerves.

The bacteria may cause a thick, gray covering to form in your nose, throat or airway — a marker of diphtheria that separates it from other respiratory illnesses. This covering is usually fuzzy gray or black and causes breathing difficulties and painful swallowing.

You contract diphtheria by inhaling airborne droplets exhaled by a person with the disease or by a carrier who has no symptoms. Diphtheria passes from an infected person to others through:
Sneezing and coughing, especially in crowded living conditions (easily)
Contaminated personal items, such as tissues or drinking glasses that have been used by an infected person (occasionally)
Contaminated household items, such as towels or toys (rarely)

You can also come in contact with diphtheria-causing bacteria by touching an infected wound.

People who have been infected by the diphtheria bacteria and who haven't been treated can infect nonimmunized people for up to six weeks — even if they don't show any symptoms.
Risk factors

Children younger than 5 years old and adults older than 60 are particularly at risk of contracting diphtheria, as are:
Children and adults who don't have up-to-date immunizations
People living in crowded or unsanitary conditions
Undernourished people
People who have a compromised immune system

Diphtheria is rare in the United States and Europe, where health officials have been immunizing children against it for decades. In the United States, fewer than five cases have occurred each year since 1980, according to the Centers for Disease Control and Prevention.

However, diphtheria is still common in developing countries where immunization rates are low. For example, large outbreaks of diphtheria occurred in the 1990s throughout Russia and the independent countries of the former Soviet Union, resulting in some 5,000 deaths. Control measures have since been implemented, but a risk of diphtheria remains in those areas.

Most cases of diphtheria occur in unvaccinated or inadequately vaccinated people. Diphtheria poses a threat to U.S. citizens who may not be fully immunized and who travel to other countries or have contact with immigrants or international travelers coming to the United States.
When to seek medical advice

Call your family doctor immediately if you or your child has signs or symptoms of diphtheria or if anyone in your family is exposed to diphtheria. If you're not sure whether your child has been vaccinated against diphtheria, make an appointment. Make sure your own immunizations are current.
Screening and diagnosis

Doctors may suspect diphtheria in a sick child who has a sore throat with a gray membrane covering the tonsils and throat. Doctors confirm the diagnosis by taking a sample of the membrane from the child's throat with a swab and having the sample grown (cultured) in a laboratory.

Doctors can also take a sample of tissue from an infected wound and have it tested in a laboratory, to check for the type of diphtheria that affects the skin (cutaneous diphtheria).

If a doctor suspects diphtheria, treatment begins immediately, even before the results of bacterial tests are available.
Complications

Left untreated, diphtheria can lead to:
Breathing problems. Diphtheria-causing bacteria may produce a poison (toxin). This toxin damages tissue in the immediate area of infection — the nose and throat, for example. This localized infection produces a tough, gray-colored membrane — which is composed of dead cells, bacteria and other substances — on the inside of your nose and throat. This tough membrane, or covering, is dangerous because it can obstruct breathing.
Heart damage. The diphtheria toxin may spread through your bloodstream and damage other tissues in your body, such as your heart muscle. One complication of diphtheria is inflammation of the heart muscle (myocarditis). Signs and symptoms of myocarditis include fever, vague chest pain, joint pain and an abnormally fast heart rate. Damage to the heart from myocarditis may be only slight, showing up as minor abnormalities on an electrocardiogram, or very severe, leading to congestive heart failure and sudden death.
Kidney damage. The diphtheria toxin may damage the kidneys, affecting their ability to filter wastes from the blood.
Nerve damage. The toxin can also cause nerve damage, targeting certain nerves such as those to the throat, making swallowing difficult. Nerves to the arms and legs may also become inflamed, causing muscle weakness. In severe cases, nerves that help control the muscles used in breathing may be damaged, leading to paralysis of these muscles and trouble breathing.

With treatment, most people with diphtheria survive these complications, but recovery is often slow. Diphtheria is fatal in approximately one in 10 cases.
Treatment

Diphtheria is a serious illness. Doctors treat it immediately and aggressively with these medications:
An antitoxin. After doctors confirm that a person has diphtheria, the infected child or adult receives a special antitoxin. The antitoxin neutralizes the diphtheria toxin already circulating in your body. The antitoxin is injected into a vein (intravenously) or into a muscle (intramuscular injection). But first, doctors may perform skin allergy tests to make sure that the infected person doesn't have an allergy to the antitoxin. Persons who are allergic must first be desensitized to the antitoxin. Doctors accomplish this by initially giving small doses of the antitoxin and then gradually increasing the dosage.
Antibiotics. Diphtheria is also treated with antibiotics, such as penicillin or erythromycin. Antibiotics help kill bacteria in the body, clearing up infections. Antibiotics reduce to just a few days the length of time that a person with diphtheria is contagious.

Children and adults who have diphtheria often need to be in the hospital for treatment. They may be isolated in an intensive care unit because diphtheria can spread easily to anyone not immunized against the disease.

Doctors may remove some of the thick, gray covering in the throat if the covering is obstructing breathing.

There may be other complications of diphtheria that need treatment. Inflammation of the heart (myocarditis) is treated with medications. In advanced cases, a person with diphtheria may need the assistance of a machine that helps them breathe (ventilator) until the infection is successfully treated.

Preventive treatments
If you've been exposed to a person infected with diphtheria, see a doctor for testing and possible treatment. Your doctor may give you a prescription for antibiotics to help prevent you from developing the disease. You may also need a booster dose of the diphtheria vaccine.

Doctors treat people who are found to be carriers of diphtheria with antibiotics to clear their systems of the bacteria, as well.
Prevention

Before antibiotics were available, diphtheria was a common illness in young children. Today, the disease is not only treatable but also preventable with a vaccine.

The diphtheria vaccine is usually combined with vaccines for tetanus and whooping cough (pertussis). Tetanus is a bacterial infection that leads to stiffness of the jaw and other muscles. Whooping cough is a bacterial infection of the respiratory tract. The three-in-one vaccine is known as the diphtheria, tetanus and pertussis, or DTP, vaccine. The latest version of this immunization is known as the DTaP vaccine.

The diphtheria, tetanus and pertussis vaccine is one of the childhood immunizations that doctors in the United States recommend begin during infancy. The vaccine consists of a series of five shots, typically administered in the arm or thigh, and is given to children at ages:
2 months
4 months
6 months
15 to 18 months
4 to 6 years

The diphtheria vaccine is very effective at preventing diphtheria. But there may be some side effects. Some children may experience a mild fever, fussiness, drowsiness or tenderness at the injection site after a diphtheria, tetanus and pertussis shot. Ask your doctor what you can do for your child to minimize or relieve these effects.

Rarely, the diphtheria, tetanus and pertussis vaccine causes serious complications in a child, such as an allergic reaction (hives or a rash develops within minutes of the injection), seizures or shock — complications which are treatable.

Some children — such as those with progressive brain disorders — may not be candidates for the diphtheria, tetanus and pertussis vaccine. But, the number of children to whom these restrictions apply is small.

You can't get diphtheria from the vaccine.

Booster shots
After the initial series of immunizations in childhood, booster shots of the diphtheria vaccine are needed to help you maintain immunity. That's because immunity to diphtheria fades with time.

The first booster shot is needed around age 12, and then every 10 years after that — especially if you travel to an area where diphtheria is common. Ask your doctor whether you're up-to-date on your immunizations. Be sure your child is up-to-date on childhood vaccinations before starting child care or school.

A booster shot of the diphtheria vaccine is given in combination with a booster shot of the tetanus vaccine. The tetanus-diphtheria (Td) vaccine is given by injection, usually into the arm or thigh.

Doctors recommend that anyone older than age 7 who has never been vaccinated against diphtheria receive three doses of the Td vaccine.
Self-care

Recovering from diphtheria requires lots of bed rest. You may need to stay in bed for up to six weeks or until you make a full recovery. Rest is particularly important if your heart has been affected. Strict isolation while you're contagious also is important to prevent spread of the infection. Careful hand washing by everyone in your house is a good way to help avoid spread of the infection. Because of pain and difficulty swallowing, you may need to get your nutrition through liquids and soft foods for a while.

Once you recover from diphtheria, you'll need a full course of diphtheria vaccine to prevent a recurrence. Having diphtheria doesn't guarantee you lifetime immunity. You can get diphtheria more than once if you're not fully immunized against it.

By Mayo Clinic Staff
Mar 14, 2007