Infectious Disease

What to do when infection strikes


Despite your effort to live right, you still come down with the flu in the middle of finals or just before the big paper is due. No matter how much exercise you do or nutritious food you eat or sleep you get, some bug will attack you.

Episodic, self-limited infections like colds and flu are the most common forms of illness you contract. Learning how to prevent these infections and how to take care of yourself during their earliest stages can minimize your down time from these pesky illnesses.

It's also important to recognize the symptoms that mean an illness requires professional help. This chapter will help you determine when to seek medical aid before the disease progresses. Immunizations are valuable in preventing some very serious diseases, and they should be kept up-to-date.

In sum, we tell you how to prevent and manage infections, when to see a doctor, and how immunizations work and when they should be taken.

How does the body fight infection?

The body has four principal methods of handling infection. The primary method is the barrier, and the skin is the major barrier to infection. There are also local barriers, such as the mucous membranes and the ciliated cells of the respiratory tract. They protect the body by removing foreign material. Mucus also contains blocking antibodies that prevent viruses and bacteria from entering the body.

Saliva and the digestive juices of the stomach are other local barriers. They provide neutralizing antibodies, and their acid content kills many infectious agents. Eyelids are another barrier. Their blinking action cleans the eyeball and prevents infection.

Antibodies are the second line of defense in the body's fight against infection. These are specific proteins (immunoglobulins) made by lymphocytes, special types of white blood cells. Antibodies combine with other proteins to kill or neutralize infectious agents. Each antibody works against a specific agent, whether it is a bacterium or a virus. After you have been exposed to a particular infection, your body's white blood cells are stimulated to make antibodies against that infection.

Vaccinations (immunizations) induce your body to make antibodies without your having to contract the illness (see section below on immunizations). Once the antibodies have been produced, they remain in the bloodstream for years, ready to protect you from getting the infection at all or from getting the same infection a second time. They attach to the invading virus or bacterium and, along with other proteins, kill it before it can infect your body's cells, or they block the invader from entering new cells.

Neutrophils are the third line of defense. These white blood cells engulf and kill bacteria. They accumulate at the site of an infection and wage war against the invading bacteria. The visible result of this war is pus, or exudate, which consists of white blood cells and the killed bacteria.

In the fourth line of defense the body drains the infection into regional lymph nodes, where a complex interaction of various types of white blood cells attempts to kill the infectious agent as well as make antibodies against it. Thus, whenever you have an infection, the lymph nodes around the infected area become enlarged and painful. Swelling and tenderness from an infection usually last 2 to 4 weeks. If lymph nodes remain enlarged when there is no apparent infection, you should see your physician for an evaluation.

Is it important to be vaccinated?

Definitely. Vaccines now prevent many diseases that once terrified and killed millions. Because of the smallpox vaccine the World Health Organization was able to state that the world was free of smallpox in 1980. Before there was a vaccine to prevent polio, each outbreak of the disease crippled thousands of people. Even today polio strikes thousands of children, primarily in third-world countries, who don't get vaccinations.

Other diseases such as measles, mumps, and rubella continue to break out on high school and college campuses among students who have been inadequately vaccinated. These diseases can have serious consequences. Vaccinations against other diseases such as pneumococcal pneumonia, hepatitis B, and influenza are available; contact your student health service for information.

You should always have a copy of your own immunization record available. It may be needed for routine physical examinations and may save you from an unnecessary injection if you become ill or are injured. (See below for recommended immunizations.)

Additional immunization may be needed for international travel. If you are traveling to an area where, for example, yellow fever or cholera is endemic, inoculation against this disease may be necessary. The United States Public Health Service determines international immunization requirements and is the up-to-date source of information.

An immunization that needs to be updated on a regular basis is the one against tetanus. Tetanus, commonly known as lockjaw, can be fatal. Each year there are over 100 cases in the United States. Tetanus is caused by an organism that lives in the soil and is introduced into the body by a puncture wound or a break in the skin. Booster shots should be given at 10-year intervals. But if you have not had a tetanus shot within 5 years and receive a major or particularly dirty wound, you need a tetanus shot at the time of injury.

How do immunizations work?

Immunizations work by exposing the body to a killed or an inactivated part (antigen) of the disease-causing organism. The body recognizes and responds to the invasion of the inactive substance but cannot tell the difference between active and inactive organisms. Therefore, the immune system immediately produces antibodies that will fight off the infectious organism when the body is exposed to it in the future.

As stated earlier, there are specific antibodies for each type of infection. Once produced, antibodies persist for a very long time-usually for years-and when you are exposed to infectious agents, your body usually fights them off without your knowing it.

Are vaccinations safe?

Vaccinations are very safe. However, 5 to 10 percent of those who are vaccinated have brief, mild reactions-low-grade fever, rash, muscle aches, or joint pain-that may last for 1 to 3 days. Mild painkillers will usually relieve the discomfort. Almost everyone feels some pain and soreness at the injection site. This can be relieved by applying an ice pack.

Immunization is vital protection - don't put it off. Diphtheria, tetanus, polio, measles, rubella and mumps are diseases that all have two things in common: 1) they can strike persons at any age, and 2) they can all be prevented through immunization.

What are recommended immunizations for adults?

Tetanus-Diphteria: A booster dose of tetanus-diphtheria is needed every 10 years after infancy to maintain protection.

Measles, Mumps, Rubella: Two doses of measles, mumps, and rubella (MMR) vaccine is recommended for protection against these three diseases. Persons who were vaccinated at any age with inactivated vaccine (available from 1963-1967) should be revaccinated. As of March 1989, a second vaccination against measles (rubeola) is now being recommended for everyone. Check with your physician or student health service.

Polio: Once your series of childhood vaccinations is complete, immunization is not necessary for persons over 18 years of age. It is recommended for those who intend to travel to areas where polio is prevalent.

Other: Other vaccines you may get are Hepatitis A and Hebatitis B and vaccines for travel. Many college students should also consider menningococcus vaccine if they are living in crowded settings like a dormitory. Check with your physician for more information.

Make sure you're adequately protected. Check your immunization records. If your records are incomplete or if there is any question as to which vaccines you have received, call your physician or local health department clinic.

What are bacteria?

Bacteria are microscopic organisms that can live independently outside human cells, unlike viruses, which are totally dependent on living cells. Bacteria are single-celled and sometimes group in chains or clusters. They can be grown in the laboratory by incubation in a nutrient broth such as sheep blood. Bacteria do not require the support of other cells to live, although they do require a food environment. They are complete organisms capable of growth and reproduction.

Some bacteria live in harmony with the human body and perform important functions. One example lives in the colon and helps us digest our food. Other bacteria live in the mouth or on the skin but do not cause disease unless they have an opportunity to invade the tissues. The result can be skin infections, boils, abscesses, and tooth decay.

Some bacteria are normal inhabitants in one site but cause infection when introduced elsewhere. Bacteria normally found in the intestine can be pushed up into the bladder by improper wiping or by sexual activity, causing a urinary tract infection.

Still other bacteria are harmful and generally cause illness. These bacteria are readily passed from person to person. Examples are streptococcus, which can spread strep throat through a fraternity, and salmonella, which could give an entire family gastroenteritis.

How are bacteria spread?

Bacteria are spread in several ways: through the air in tiny drops of moisture released in coughs and sneezes, through direct contact by eating with unwashed hands or touching the nose, through sexual contact with an infected person, or through sharing eating utensils with an infected person. Bacteria can also infect a cut that is not properly cleaned.

How can a bacterial infection be avoided?

Maintain good hygiene by washing your hands after using the bathroom and before preparing or eating food. Clean cuts with soap and water and then rinse the area with, or apply, an antiseptic. Stay away from people who cough and sneeze, especially if they don't cover their faces. Although common colds are caused by viruses, they can progress to bacterial infections. Don't share food or utensils with people who are sick. Avoid touching your nose and putting unwashed fingers in your mouth; these are common ways of transferring bacteria to mucous membranes.

What can be done for a bacterial infection?

Bacterial infections can be treated with antibiotics prescribed by your doctor. Because specific antibiotics must be used to treat specific bacterial infections, your doctor may do a culture of the infected area to determine the responsible organism and thus the correct antibiotic.

What are viruses?

Viruses are incomplete submicroscopic structures that depend on the function of a host cell for growth and reproduction. They consist of a protein coat and a DNA or RNA core. In a laboratory they must be grown in living cells in special culture media. While bacteria are a hundred times larger than viruses and can be viewed through a light microscope, viruses are visible only through an electron microscope.

Viruses are disease-producing agents that must grow inside bacterial, plant, or animal cells to survive and reproduce. Using the host cell's nutrients and cellular processes, the virus reproduces hundreds or even thousands of times. It then ruptures the host cell it has been living in, killing it, and spreads to infect other cells.

How do viruses enter the body?

Viruses enter the human body in different ways, as do bacteria-via airborne droplets from respiratory infections or in the food we eat, for example. Viruses can be passed from hand to mouth or introduced directly into the bloodstream by an infected transfusion or a dirty needle associated with drug abuse. They can also be spread by sexual contact.

Once introduced, each virus has its own affinity, or tropism, for a specific body part. For example, viruses that cause the common cold affect the nose, sinuses, and respiratory tract. The agent that causes viral gastroenteritis goes to the gastrointestinal tract.

How can a virus be stopped?

Most viral infections are eventually limited and controlled by the body's ability to make antibodies that either kill the virus after its release or prevent it from invading new cells. Each antibody is specific to a particular virus and will protect only against that virus.

Then why do people keep getting colds over and over?

Every cold may feel the same, but each is caused by a different virus. There are over 150 cold viruses known to infect mankind, and there are probably many more that we don't yet recognize.

This is the reason no one has come up with a cure. The common cold is actually a syndrome of very similar upper respiratory symptoms, caused by many different viruses.

Are there medicines like antibiotics for curing viral infections?

No. As of 2000, there were no medications to cure a viral infection. Since viruses reside within the body's own cells, almost no medications, including antibiotics, can attack them without attacking and killing the body's host cells.

There are very few antiviral drugs. They are not cures but can control further spread of the virus. For example, acyclovir has been found effective in limiting herpes outbreaks in both acute and recurrent cases. Tamiflu works against the influenza virus, and many different drugs to control the HIV virus.

If there are no drugs that can kill viruses, how should viral infections be treated?

By and large, the only treatment for a viral illness is symptomatic-rest, fluids, and acetaminophen or aspirin for aches and fever. You must give your body's natural immune system enough time to defeat the virus. For the common cold this is usually 3 to 10 days, but the period can vary widely, depending on the virus.

Are there other causes of disease besides viruses and bacteria?

Yes. Parasites are infectious organisms that depend on a host for different stages of their life cycles. They range in size from the microscopic ameba, a cause of dysentery, to the giant roundworm, which can grow to 14 inches long. Other parasites that cause disease are giardia (giardiasis, an intestinal disease); trichomonad (trichomoniasis, a vaginal infection); and plasmodium (malaria, a blood and liver infection).

Intracellular parasites must live inside the body cells to obtain certain nutrients. Some examples of these are rickettsia, which causes the tick-borne disease Rocky Mountain spotted fever, and chlamydia, which is associated with eye and urogenital diseases. (See Sexual Health.)

How are parasites transmitted?

Parasites are usually passed from one host to another through close personal contact or through infested food or water. Undercooked pork is a source of trichinosis, a disease caused by the ingestion of a parasite that penetrates the body's muscle tissue. Drinking water contaminated with fecal material can transmit the parasite giardia. Malaria is transmitted to people through the bite of an anopheline mosquito that is infected with the malarial parasite.

How are parasitic infections treated?

Usually parasitic diseases can be treated successfully with antibiotics, but the responsible parasites can be very difficult to detect. For example, trichinae hide inside muscle tissue, and the only way to detect them is to do a muscle biopsy. Malarial parasites hide in red blood cells and the liver, and it takes special chemical stains to demonstrate them. Giardia attaches to the wall of the intestine; discovery is by laboratory examination of the stool.

What causes "the flu"?

Strictly defined, "the flu" is a specific respiratory infection caused by one of the influenza viruses. Most people, however, use the word flu to refer to a host of illnesses whose miseries range from nasal congestion to chest congestion and coughing to stomach symptoms of vomiting, diarrhea, or both. True influenza is a highly contagious acute disease that spreads readily among large groups in indoor environments such as classrooms. As soon as someone with one of the influenza viruses starts sneezing or coughing, that person spreads the disease in aerosolized droplets or on unwashed hands.

How do I know if I have influenza?

Usually there is a sudden onset of fever (101 degrees or higher), chills, aches, dry cough, headache, and exhaustion. You may have symptoms for as long as two weeks.

How can I keep from getting influenza?

The influenza viruses have been subtyped into two major categories, type A and type B. Each year a vaccine is developed to deal with the variants of the flu virus most likely to cause the next epidemic. Anyone who is susceptible to the disease or has a chronic illness should ask the doctor in October or November if an influenza vaccine is recommended.

How does a cold differ from influenza?

Influenza is caused by a small group of viruses and may be epidemic or may occur worldwide as a pandemic. Because there are only a few strains of influenza viruses, it is possible to make vaccines against them.

Over 150 different viruses can cause the common cold, so no one vaccine can contain enough strains to be effective. Colds are usually milder than influenza and occur sporadically, not in worldwide pandemics.

Cold Symptoms Influenza Symptoms Both
Runny nose Fever 101 degrees or higher Sore throat
Nasal congestion Chills Headache
Watery eyes Muscle aches Cough
Sporadic occurrence Epidemic or pandemic Fatigue

Do colds spread the same way that influenza does?

No. Unlike influenza, most colds are not spread by coughing and sneezing but by hand contact with nasal discharge, which is heavily laden with the cold virus.

Is there any way to keep from getting colds?

To avoid a cold during the cold season, wash your hands frequently, don't rub your eyes or touch your nose, and, if possible, stay away from people who have colds. Remember, there are over 150 different cold viruses. Your lab partner's cough may be caused by a virus different from the one you just recovered from.

Some experts believe that colds occur when the body's natural barriers to infection break down and the viruses that normally inhabit the nasal passages take advantage of the opportunity to invade and spread. The breakdown is more likely to happen when a student is overly stressed and fatigued-studying late for finals, partying too much, skipping meals, or worrying about grades or social obligations.

The best prevention is a familiar prescription: avoid becoming run-down. Get enough sleep, eat right, and drink plenty of fluids (nonalcoholic).

What is the quickest way to cure a cold?

There's no actual cure, but you can try to limit its impact. You can help your body fight the virus in the same way you tried to avoid getting it in the first place-by getting plenty of rest and drinking 8 to 10 glasses of fluids a day. Fever tends to dehydrate you, so increase your fluid intake at such times. Cough drops can help soothe a dry throat and reduce coughing. Eat normally and cut back on your activities, especially physical exercise.

Avoid blowing your nose, which sends infected mucus back up inot your sinuses. There is not universal agreement that that zinc lozenges or echinacea works.

If I have a cold that doesn't seem to be getting better, should I see a doctor?

Warning signs of a more serious infection are chest pain, shortness of breath, yellow or green sputum, severe sore throat, or inability to swallow liquids. If you have any of these symptoms or if your temperature goes over 101 degrees (a normal temperature is roughly 98.6 degrees), you should seek medical help.

Will nonprescription medications make me feel better?

Aspirin, if you can take it without ill effects, works well for reducing aches and pains and fever. Acetaminophen works just as well to control fever, although it is not so effective against the aches and pains.

Acetaminophen is the choice for reducing a temperature of over 100 degrees because aspirin for high fever has been associated with the development of Reye's syndrome in children and adolescents. Reye's syndrome is a very rare but serious brain and liver inflammation. The standard recommended dosage is two acetaminophen tablets every 4 hours.

Are there any other simple remedies for respiratory infections?

Treat the symptoms. By relieving them, you will feel better and the time to your recovery will pass more quickly.

Breathing steam or using a vaporizer may help to loosen mucus. The simplest method to steam your breathing passages is to fill a sink with hot water, make a tent with a towel over your head, and inhale the steam for 10 minutes; take breaks if it gets too hot. Doing this three or four times a day may make you more comfortable.

Some people believe that large doses of vitamin C prevent colds or speed recovery, although very little controlled research has shown this to be effective. Some studies suggest it may decrease the duration of a cold by 1 or 2 days. Taking 250 to 500 milligrams a day may help, but 1,000 milligrams or more a day can cause stomach irritation and diarrhea.

Believe it or not, a recent study found that hot chicken soup was helpful in shortening the duration of a cold. So try it if you like it. The researchers couldn't determine how or why it worked, just that the study sample who ate the chicken soup recovered faster. (Warm liquids are known to ease a sore throat, probably because the warmth increases the blood flow to the throat.)

What do over-the-counter cold remedies do?

The innumerable remedies available are all designed to reduce symptoms but not to shorten the course of the disease. Unfortunately, they may actually make your symptoms worse by overdrying the mucous membranes of the nose and mouth. This inhibits the natural function of the membranes to moisten the air you breathe and block further infection.

Reading the label can help you decipher what is in these medications. Most contain either a decongestant or an antihistamine. Many contain aspirin, which you should avoid if your fever is over 100 degrees because of the association of aspirin with Reye's syndrome, the acute brain and liver disease referred to earlier.

What are the differences between decongestants and antihistamines?

Decongestants are drying agents that can relieve nasal congestion and stuffiness. They act by constricting blood vessels. Their stimulant-like action can cause jitteriness.

Antihistamines are agents that dry membranes by blocking the action of histamine, a chemical compound that causes itching and swelling. The body produces histamine in response to an infection or an inflammation or an allergen such as pollen (See allergies in Common Medical Problems). Antihistamines are effective for allergic conditions because they work specifically against the body's reaction to an allergen, but for colds-although they may relieve the symptoms of runny nose and sneezing-they may be ineffective and can cause undesirable side effects like drowsiness and dryness.

Some over-the-counter products combine decongestants and antihistamines. If you find one that helps reduce the miseries of a cold, go ahead and use it, but with caution and restraint. Remember, they are only going to relieve some of the symptoms; they are not going to "cure" your cold. Be aware they may make you drowsy or jittery. Remember, too, that over-drying can thicken mucus and cause bronchial complications. Know the side effects of these products and check with your doctor before using them if you are taking medication for another condition.

Won't antibiotics make my cold go away faster?

Taking antibiotics to treat a viral infection is worthless. Antibiotics work solely against the bacterial processes of metabolism and reproduction. Viruses use host cells for these functions. Antibiotics won't work against viruses because viruses don't have the same functions as bacteria.

In addition, antibiotics, unless you have developed a secondary bacterial infection, can be dangerous because of the serious side effects they may cause. They kill the normal bacteria in the colon and the vagina, often causing an imbalance that leads to intestinal and vaginal infections. Antibiotics can upset your stomach, causing nausea and vomiting. And there is always the possibility of an allergic reaction to the antibiotic. This can be serious, causing rash, swelling, wheezing, shortness of breath, and even shock.

Another possible result of the needless use of antibiotics is the emergence of bacteria that are resistant to them. Antibiotics may also interact with other medications you are taking, reducing the effectiveness of those medications. If you are taking birth control pills and are prescribed an antibiotic, check with your clinician to see if there could be an interaction that may reduce the effectiveness of your birth control pills.

When are antibiotics useful?

Antibiotics are indicated for certain bacterial infections. They work selectively for each specific infection and should be taken only if prescribed by your clinician.

To determine if an antibiotic is necessary, the doctor or the nurse may take a specimen (for example, from the throat) for culture. If a specific bacterium is identified as the cause of the infection, the appropriate antibiotic will be prescribed.

What causes a sore throat?

Among the most common complaints, a sore throat can have many causes-a cold, the flu, or a more serious disease like mononucleosis. Then again it may be the only symptom of localized tonsillitis.

A sore throat can also be the result of postnasal drip, self-induced vomiting associated with bulimia, cigarette or marijuana smoking, or oral sex with an infected partner.

The first effect is usually pain on swallowing. There may be tender or swollen lymph nodes in the neck, and fever may develop. If you look at your throat in a mirror, you may see redness, a white exudate (pus) covering the back of the throat or the tonsils, blisters on the roof of the mouth, and a coating on the tongue.

What can be done to relieve a sore throat?

A sore throat usually lasts only a few days. Gargling with warm salt water 3 to 6 times a day will relieve the pain, reduce the swelling, and remove the exudate, or pus, covering the tongue and tonsils. Drink lots of warm fluids. If you have a fever, take acetaminophen.

Medicated throat lozenges or sprays such as Chloraseptic, Cepacol, or menthol eucalyptus may also help to reduce pain. Prolonged use of these products is not recommended; they may conceal a serious infection.

Will antibiotics cure a sore throat?

Not usually. Most sore throats are brief viral infections. Antibiotics are often taken and then credited with the cure, when your body's own immune system is responsible.

Strep throat, however, an acute bacterial infection caused by streptococci, responds to antibiotics. The diagnosis is established by a throat culture.

When should I go to the doctor about a sore throat?

See a doctor if you have any of the following problems:

  1. You are having trouble swallowing fluids and are therefore becoming dehydrated.
  2. You have a fever of 101 degrees or higher.
  3. You have been exposed to strep throat, or you have a history of strep throat or rheumatic fever.
  4. You develop painful lymph nodes in the neck.
  5. Other bodily symptoms develop (abdominal pains, cramps).
  6. You do not get better in 4 to 7 days.

Since minor sore throats are so common, you should learn to self-treat them, keeping in mind the potentially serious problems listed above.

What is tonsillitis?

Tonsillitis is either a bacterial or a viral infection of the tonsils, the small masses of lymphoid tissue lying on either side of the entrance to the throat.

Because they are composed of lymphoid tissue, the tonsils help fight infection. They are largest in early childhood and then shrink naturally by age 10 to 12.

How is tonsillitis cured?

Allowing the body's natural defenses an opportunity to fight the infection is usually the preferred treatment. Frequent gargling to clean the surface and throat lozenges to ease the pain are recommended.

Should tonsils be removed?

Most physicians today do not recommend removing the tonsils except for specific reasons. Enlarged tonsils that interfere with breathing and swallowing may be grounds for removal, as are frequent tonsil infections. If you are having infections frequently, see an ear, nose, and throat specialist for an opinion.

What causes sinus headaches?

A headache is the characteristic feature of sinusitis, a painful inflammation of the sinuses usually caused by bacteria. The sinuses are air-filled cavities in the skull, lined with mucous membranes similar to those lining the nasal passages and the mouth. The sinuses warm and moisten the air you breathe.

Sinusitis is often a secondary bacterial infection that accompanies a cold. Allergies, polyps, and even tooth decay can cause an infection in the sinuses. The symptoms include pain around the upper cheeks, forehead, and eyes that sometimes get worse when you bend forward; dizziness or lightheadedness; and a thick yellow-green nasal discharge.

How can sinusitis be treated?

Breathing moist air helps to loosen the mucus and permit drainage, the goal of treatment. Put a towel over your head and breathe the steam from a sink or pan filled with hot water. Repeat this procedure 3 to 6 times a day for 5 to 10 minutes. It also helps to increase the humidity in your environment with a vaporizer, humidifier, or even a pan of water simmering on the stove. A warm, moist compress placed over the sinuses can make you more comfortable.

Never travel to a high altitude (greater than 5,000 feet) location or in an airplane when you have sinusitis. The pressure in the sinuses may be transmitted to the inner ear and eardrum, causing an ear infection and possibly perforating the eardrum.

If your sinusitis lasts for more than 2 or 3 days after a cold, you should see a doctor. You may require an antibiotic, and the doctor may take X rays for an accurate diagnosis.

How can a sinus infection be prevented?

Proper rest, good nutrition, and regular exercise can help prevent this and many other infections. If you are susceptible to sinus infections, keeping the air you breathe moist with a humidifier is a preventive measure. Arid, desert air or heated air can dry and crack the sensitive sinus tissue, leaving it vulnerable to infection.

Avoid using a nasal spray. It may dry the external nasal passages temporarily but usually causes a rebound swelling of the sinuses when you stop its use. Also, you can become resistant to it in 3 to 4 days, and it will lose its effectiveness. If you use a spray, do so for only 1 or 2 days.

Decongestants used for more than a day or two can also overdry the mucous membranes and leave thick mucus that is unable to drain.

Avoid blowing your nose, and in particular blowing one nostril at a time. This may force an infection up into the opposite nasal passage and the inner ear.

What exactly is a secondary bacterial infection?

A secondary bacterial infection develops after a viral infection has weakened your natural immune system. Bacteria can then gain access through the disrupted mucous cell lining or through cracks in the skin, and a compromised immune system has fewer defenses against infection.

This type of infection, which usually occurs 3 to 10 days after the initial viral infection, is considered a relapse of the original illness. It is often accompanied by fever, swollen glands, and a purulent (pus-filled) discharge on the tonsils, in the sputum, or in the nasal discharge.

Taking care of yourself and allowing enough down time to fully recover from a virus is the best way to prevent a secondary bacterial infection.

What causes ear infections, and are they serious?

An infection of the ear canal not only can be extremely painful but may result in permanent hearing loss if left untreated. Ear infections are very common in swimmers and in persons who use hot tubs, because their ears are apt to fill with water that contains bacteria. Another common cause of an ear infection is the insertion of cotton swabs, bobby pins, or fingers into the ear canal in an attempt to clean it.

How can ear infections be prevented?

External otitis, the inflammation that frequently follows swimming and is therefore known as swimmer's ear, can best be prevented by draining water out of the ear after swimming or showering. An over-the-counter preparation called swimmer's eardrops is available to be used after swimming to help dry the ear. These drops contain a drying agent like alcohol or boric acid. If you are prone to ear infections, it would be wise to use these drops when you have finished swimming and showering for the day.

The first symptom of this outer ear infection is usually itching. Another early warning sign is pain when the ear lobe is pulled. There may be a discharge from the ear and a loss of hearing, but what usually gets your attention is steadily increasing pain.

Don't use cotton swabs or other objects to clean your ears or to remove wax. If wax tends to become impacted, go to the student health center to have your ears examined and the wax properly removed. There are special softening drops and irrigation tools that a doctor or a nurse practitioner will use to do the job safely and effectively.

What is the best treatment for swimmer's ear?

The treatment is the use of antibiotic eardrops with cortisone to fight the infection and reduce swelling. You should avoid swimming during the 5 to 7 days of treatment. During a shower use earplugs or cotton covered with Vaseline to keep the water out.

What's the difference between swimmer’s ear and an ear infection that causes dizziness?

They occur in different parts of the ear. The ear consists of three principal parts: the external ear, the middle ear, and the inner ear. Each has its own particular function and problems.

Swimmer's ear is usually limited to the external ear. The inner ear has specialized organs of balance (the labyrinth, or vestibular apparatus) and hearing (the cochlea). An infection in the inner ear (usually caused by a virus) causes positional dizziness in which there is the sensation that the room is spinning or that you are spinning. The sensation can be intensified by moving the head up and down or from side to side. Often there are no other symptoms, but occasionally there will be nausea and vomiting.

If you have dizziness, pain, loss of balance, loss of hearing, or ringing in the ears, consult an otolaryngologist, an ear, nose, and throat specialist. Depending on the cause, these symptoms may last a few hours or a few months.

Can the middle ear become infected?

Yes. An infection in the middle ear can cause pain, hearing loss, and a feeling of pressure or fullness, as though you have water in your ear. The three tiny bones in the middle ear transmit sound vibrations to the inner ear. The middle ear is separated from the external ear canal by the eardrum, a delicate membrane, sometimes called the tympanic membrane, and is connected to the nasopharynx by the Eustachian, or auditory, tube. The Eustachian tube equalizes the air pressure between the middle ear and the outside world. It can become partially blocked by an infection or during air travel but usually unblocks in a short time as the pressure equalizes. Swallowing while pinching your nostrils can help to open the tubes.

However, if an infection or an allergy is causing swelling of the mucous membranes that line the nose and the sinuses, the Eustachian tube can become completely blocked. It is then unwise to fly because the blocked tube will not allow the pressure to equalize. This can result in extreme pain and may even rupture the eardrum. A blocked Eustachian tube can also lead to a buildup of fluid in the middle ear and a decrease in hearing. Occasionally this fluid becomes infected.

If you think you have a blocked Eustachian tube from a sinus infection, a short course (1 to 3 days-no longer) of nasal sprays containing phenylephrine (Neo-Synephrine) may clear it. If the blockage is caused by an allergy, an antihistamine may help.

If this does not alleviate the problem, or if the pain becomes more severe and you have swollen lymph nodes, you must see a clinician. Without antibiotics middle ear infections can progress to perforation of the eardrum or to extension into the bones of the skull.

Is bleeding from the ear a symptom of infection?

Not usually. The discharge of blood, or of even a clear fluid, indicates the possibility of serious injury, such as a skull fracture or a ruptured eardrum from a blow to the side of the head. Unless the cause of bleeding is obviously a superficial scratch in the outer ear canal, medical attention should be sought immediately.

What is bronchitis and what causes it?

Bronchitis is an inflammation-acute or chronic - of the breathing tubes, or bronchioles. These tubes, lined by sensitive mucous membranes, are the smaller branches of the bronchi. Mucous glands secrete small amounts of clear mucus. Sweeper, or ciliated, cells move the mucus upward to remove bacteria and other foreign material. This natural, ongoing process cleanses the lungs.

When a virus or a physical or chemical agent attacks the mucous membrane, it strips away many of these protective cells and disturbs the cleansing function of the tissue. Smoking is also a contributing factor. With any type of bronchial inflammation, there is a burning pain under the breastbone with every deep breath. This is usually accompanied by a dry, sometimes wheezing cough and, if there is infection, by fever, muscle aches, and fatigue.

Acute bronchitis is most often caused by a virus, after which a secondary bacterial infection may develop. Bacteria can easily invade after the virus has stripped away the protective cells of the bronchioles. A bacterial infection usually produces more abundant, yellow-green mucus.

People who even occasionally smoke or who have asthma are more susceptible to bronchitis. They should see a physician as soon as possible when an attack starts.

What is the best treatment for bronchitis?

Increasing the humidity and breathing steam 6 to 10 times a day for 10 minutes at a time will help soothe inflamed membranes and loosen secretions. Without normal ciliary action, mucus is retained and depends for removal on prolonged bouts of coughing. You can spend all day coughing and move a small amount of thick mucus only an inch. When you fall asleep, the mucus persists in the bronchioles and causes nighttime coughing.

A hot shower or steam inhalation makes breathing more comfortable. Drinking plenty of fluids helps to liquefy secretions. Warm drinks with honey and lemon are often soothing.

Avoid using a decongestant or an antihistamine unless prescribed by your physician. They will dry membranes further and make it more difficult to raise the mucus.

Use an expectorant cough syrup (read the label) or one that contains a loosening agent such as guaifenesin, which is found in Robitussin or Vicks cough syrup. If your cough is productive, keep coughing to bring up the mucus. If your cough is nonproductive and painful, look for a cough syrup or lozenge that is a suppressant, in order to reduce irritation. Cough drops are OK, but most are just sugar. Avoid exercise, smog, and smoking. These will make your bronchitis worse.

Is pleurisy an infectious disease?

Pleurisy, an inflammation of the tissues lining the chest cavity, is most often caused by a viral infection. It can also be caused by a bacterial infection, tuberculosis, a blood clot in the lung, or a serious systemic disease such as lupus. The pleura is the sac, or thin membrane, that surrounds each lung. This membrane contains many nerve fibers and blood vessels. An infection of the pleura can be very painful because of the proximity of nerves to the area of inflammation.

The major symptom is intense pain, localized to the involved area of the chest. The pain is usually aggravated by breathing or motion.

What is pinkeye?

Pinkeye, or conjunctivitis, is an inflammation of the conjunctiva, the sensitive, transparent mucous membrane that lines the inner eyelids and covers the front portion of the eyeball. The inflammation causes the white of the eye to turn red and feel gritty. Overnight a discharge of pus may form and dry, leaving a crust around the eyelid.

What causes conjunctivitis?

It can be caused by allergy, bacterial or viral infection, or chemicals such as those in contact lens cleaning solutions and nonprescription eye drops. Infectious conjunctivitis is highly contagious and can be spread from one eye to the other or from one person to another by sharing towels or makeup. Pinkeye is often caused by the improper use and cleaning of contact lenses. If you use contacts, it is important to thoroughly wash your hands and dry them with a clean towel before cleaning and inserting your lenses. It is also important to follow strictly the instructions for the solutions you use. This will lead not only to fewer eye infections but to greater comfort in wearing the lenses.

What should be done about conjunctivitis?

If you have conjunctivitis, stop using contact lenses, wash your hands before and after touching your eyes, and don't share towels or makeup. Cool compresses and sunglasses may make you more comfortable until you receive medical care at your health center to determine the cause. Treatment is specific to the cause and may include antibiotic drops or allergy drops.

What is a sty?

A sty is the common term for an infection in or around an eyelash follicle. It is similar to a small localized boil or abscess and can be very painful until it bursts.

How can a sty be treated?

You can apply a warm compress, using a clean cloth, and pull out the affected eyelash. The bacteria causing the infection can be spread to other parts of the eye, so be sure to first wash your hands and the area around the eye and to use a clean cloth or a sterile gauze pad.

Can someone who had chickenpox as a child get it again?

Probably not. Chickenpox is usually a disease of childhood, but if you didn't get it then, you are susceptible at any other time in your life. It is more serious for an adult and can have more complications, including severe cough, pneumonia, and even brain infection.

If you had chickenpox as a child, your body developed antibodies that normally protect you for the rest of your life. However, the infection could recur if you are taking a medication, or have a disease, that suppresses your immune system.

Anyone who has a chronic disease or is taking corticosteroids (cortisone, prednisone, and so forth) or is pregnant, and is exposed to chickenpox, should immediately see a physician to find out if a shot of a specific blocking immunoglobulin is recommended for protection against the disease.

For exposed susceptible persons, chickenpox is highly contagious. It can be spread by coughs, nasal secretions, and the discharge from the blisters that form. People who have chickenpox should be quarantined to prevent its spread. It is contagious for 1 to 3 days before symptoms appear and until the final lesions have crusted over. Fatigue, fever, headache, sore throat, swollen glands, and a red rash that blisters in 2 to 4 days are the common symptoms. The best treatment is bed rest and plenty of fluids.

What do chickenpox blisters look like?

They start as a rash, usually on the trunk, and spread to the face, arms, and legs. At first the lesions are small, raised, red bumps. Then they blister and burst, finally crusting over and healing 7 to 10 days after they first appear.

The blisters can be very itchy, and scarring can result if the area is scratched. They can also become secondarily infected by bacteria. Use an ice pack, calamine lotion, and antihistamine pills to reduce the itching. If any blisters fill with pus, use a topical antibiotic cream. Take acetaminophen for fever. Avoid aspirin because of its link with Reye's syndrome.

What is shingles and how is it related to chickenpox?

Shingles is an acute, painful, localized outbreak of the same rash and blisters that characterize chickenpox. Both diseases are caused by members of the herpes virus family. There is some evidence that the chickenpox virus, like other herpes viruses, can become dormant. Something reactivates the virus many years after the initial chickenpox infection, resulting in a painful outbreak in a limited area of skin supplied by the nerves. This is called herpes zoster or, more commonly, shingles.

Reactivation is most common in later life (over age 50) but can occur in young people if there are changes in their immune status. Other illnesses, such as AIDS or leukemia, can compromise the immune system as can certain medications, like corticosteroids. Or the immune status changes for no apparent reason.

Is shingles contagious?

Yes. A shingles victim should see a doctor promptly and avoid contacts that might infect others. The first symptom is usually a burning or itching of the skin served by the particular nerve in which the virus lay dormant. The blisters, which are very painful as well as very contagious, develop 2 to 4 days later.

What causes mononucleosis and is it very contagious?

Infectious mononucleosis is a relatively contagious infection caused by the Epstein-Barr (EB) virus, which is found in saliva and other bodily secretions. A mono victim can be contagious up to a month before becoming symptomatic and as long as 5 months after recovery. Often the effects of the illness are at first too minor to be noticed, however, which was the experience of one student.

Sharon had been feeling tired as the end of the semester rolled around. The more she had to do and the later she stayed up studying, the weaker she felt. During the week of finals, with mild fever, sore throat, and no appetite, she was unable to do any more than lie in bed. With term papers unfinished and taking tests out of the question, she was in danger of falling behind an entire semester.

Her resident adviser noted her class absences and insisted that she visit student health. After talking to Sharon, the doctor performed an examination and ordered blood tests and a throat culture.

When her doctor made the diagnosis of infectious mononucleosis, Sharon was relieved to find the reason for her symptoms but very distressed about the possibility of having to leave college. The doctor assured her that dropping out was not necessary, advised her on how to take care of herself, and gave her a written medical excuse.

Her professors were understanding and allowed her to complete term papers and take the finals later. The effects of her illness were gone in 3 to 4 weeks, and she was able to continue with a full academic program in the next semester.

Despite the reputation mononucleosis has for being devastating, for most students it is a very mild illness with low-grade fever, headache, sore throat, enlarged lymph nodes, and fatigue. They may not even realize they have had mono or mistake it for a cold. As many as 50 percent of college entrants have already had the disease. Studies indicate that by graduation, 80 percent of the senior class will have had mono, many without knowledge of the fact.

Why do some people catch mono so easily and others seem to be immune to it?

There are several features that make the spread of mono erratic. The victim can spread it both before and after being actively sick. Because the virus is found in the throat and saliva, it is easily spread by sharing bites of food or a drinking glass and by coughing, sneezing, or kissing.

The main reason mono seems to skip some people and affect others is that on the average, half the people an infected person comes in contact with have already had the disease and are probably immune. And over half the people who get mono have such a mild case that they have no symptoms and therefore don't know they are infected.

Is it possible to keep up with course work when you have mono?

Usually, yes. Since over half the mono cases are completely asymptomatic and a high percentage of the rest are very mild, it is likely that you will be able to continue your studies. Most cases with mild symptoms last only 10 to 21 days. Isolation is unnecessary and impractical. It's OK for you to attend classes.

Is there any way to prevent mono?

Not really, since the virus is so well distributed. Maintaining good general health and hygiene will probably help you avoid contracting the disease, or at least limit the severity of the infection if you do get it.

How is mono diagnosed?

A physical examination and blood tests are required. Mono can be recognized in part by its characteristic clinical symptoms, but it is diagnosed by blood studies that show changes in white blood cells and the presence of specific antibodies. The changes in the white blood cells occur 2 to 10 days after the onset of the disease, but these are nonspecific.

The test for the antibody specific to mononucleosis will not be positive until at least 14 days after onset of the illness. Called a mono spot test, it detects the presence of a short-lived (2 to 3 months) antibody that will be in the bloodstream if you have an active case of mononucleosis.

How do I know if I have had mono in the past?

A long-lasting antibody that shows up in the bloodstream 6 to 8 weeks after infection will persist for the rest of your life, usually giving you immunity from reinfection.

If most cases of mono are so mild, why does it have a reputation of being such a serious disease?

In rare cases mono can be very serious and debilitating. In addition to headache, sore throat, swollen lymph nodes (particularly around the throat and neck), fever, fatigue, and loss of appetite, mono can cause the lymph nodes in your liver and spleen to become enlarged.

The spleen, located in the upper left quadrant of the abdomen, just under the ribs, is a reservoir for red blood cells. An enlarged spleen can rupture from a relatively mild blow, resulting in massive internal bleeding. Rapid surgical intervention is necessary to prevent bleeding to death. If you have been diagnosed as having mono, you should avoid all contact sports for at least 6 to 8 weeks. If you suffer any sharp pain in the upper left abdomen, see your physician or go to an emergency room immediately.

Because the mono virus attacks the lymphatic system, your body's line of defense against infection, you are vulnerable to other infections such as strep throat.

What is the treatment for mono?

There is no cure or specific medication or other treatment for mono. Because it is a viral illness, antibiotics don't work. The best therapy is to listen to your body and get plenty of rest, including daytime naps.

Despite a reduced appetite, eat small, frequent meals and drink lots of fluids. Take acetaminophen for headaches and fever. Gargle with salt water and use lozenges for a sore throat.

Since the mono virus can cause an inflammation of the liver, you should stay away from alcohol. Avoid contact sports and overheating. A brisk walk may be all the exercise you need. It may be helpful to have your doctor prescribe medications for other symptoms such as diarrhea or nausea.

How do I know when I've completely recovered from mono?

Your temperature is normal, your appetite has returned, and there is no more swelling or enlargement of the liver or the spleen. This usually takes 4 to 8 weeks after the first symptoms appear.

Is there such a thing as chronic mono? Can I get mono a second time?

Most cases (99 percent) of mono are brief and self-limited. Because the body produces a protective antibody after being infected, it is thought unlikely that anyone can get mono again.

It is possible, however, to get another infection that mimics mono nearly exactly but is caused by a different virus to which you have no antibody protection. Some of the viruses that cause mimicking infections are cytomegalovirus, adenovirus, and the virus that causes viral hepatitis. Again, since these are viral infections, there is no specific treatment.

Some recent research has evaluated evidence that a very small number of persons may have a lingering infection from mono that causes fever, sore throat, headache, and fatigue. It seems to be more prevalent in people older than 30. Experts are divided about whether it represents a persistent mono infection, a psychiatric syndrome, a different viral infection, or an entirely different disease process unrelated to mono. No serious consequences such as cancer or secondary infections have been found in people with this uncertain condition. The best treatment is to seek medical care, pace yourself, and stay as active as you can.

What is the relationship between mono and hepatitis?

Infectious mononucleosis causes hepatitis in about 80 percent of all cases. The liver is located in the upper right quadrant of of the abdomen, just below the rib cage. Its function is threefold:

  1. It filters and neutralizes toxins such as chemicals and drugs, including alcohol, and eliminates metabolic byproducts from cellular processes.
  2. It converts glucose from the food you eat to glycogen, or energy, which it stores.
  3. It creates, or synthesizes, substances needed by the body.

Hepatitis caused by the mono virus usually lasts only a short time and doesn't cause permanent problems.

Is hepatitis always caused by mono?

No. Hepatitis is a nonspecific term meaning liver (hepar) inflammation (-itis). There are many causes of hepatitis, including viral infections, drug use, alcohol abuse, and ingested toxins (such as excessive acetaminophen), or it may be secondary to disease in another organ like the gallbladder. Hepatitis is usually caused by a virus or a drug. A physician must determine the cause and the treatment.

A number of viruses in addition to the EB virus, which causes mononucleosis, inflame the liver-primarily the hepatitis A and hepatitis B viruses. Both are infectious and can be transmitted from person to person, although by different routes.

Certain drugs can cause an inflammation of the liver. Antibiotics, birth control pills, some thyroid medicines, anesthetics, tranquilizers, anti-inflammatory medications, and many other drugs are implicated in hepatitis.

Alcohol can also be a cause of hepatitis. The liver is the only organ that breaks down and eliminates alcohol from the body. Almost any alcohol consumption can slightly inflame the liver. However, large amounts of alcohol or excessive drinking over a long time can cause serious hepatitis.

What causes a yellowish skin color when people have hepatitis?

The yellow discoloration of the skin and other tissues, called jaundice, occurs when the liver is unable to process and eliminate bilirubin, a natural breakdown product of red blood cells. When bilirubin is not cleared from the body, it accumulates and can give the skin and the whites of the eyes a yellow tint. The urine may have a darker, tea color because of deposits of bilirubin.

If someone in the dorm comes down with hepatitis, how can other students avoid getting it?

It depends on the type of hepatitis. If the cause is a drug or alcohol, no one else can get it without using the same drug or drinking alcohol.

Viral hepatitis type A is spread by the oral-fecal route. Therefore persons handling food under unsanitary conditions (for example, not washing their hands) may transmit it. Another common source is infected shellfish.

Hepatitis type A is normally a mild, self-limited infection that does not become serious or chronic. Anyone who has had close contact with a hepatitis type A patient can go to a medical center within 10 days of exposure to get an injection of gamma globulin. This injection may not prevent the disease, but it can minimize its severity. Travelers to areas of poor hygiene and high rates of hepatitis A (Mexico, South America, and so forth) can also get an injection of Gamma globulin or a vaccination against Hepatitis A before departure. Gamma globulin injections offer limited protection for about 6 weeks. Gamma globulin shots are optional. They are expensive and painful and may not be needed. They are usually not required.

Hepatitis type B is much more serious, may become chronic, and is occasionally fatal. Luckily, it is transmitted less easily than type A. Type B is transmitted by sexual contact or by the exchange of blood products in much the same way as the AIDS virus. Drug abusers who share needles are likely to pass it back and forth. It can also be transmitted by transfusions of contaminated blood.A vaccine is now available against Hepatitis A

Many cases of hepatitis are caused by the use of contaminated needles in ear piercing and tattooing. Some practitioners clean the needle with alcohol alone, which is insufficient to kill the hepatitis virus.

If you have been exposed to hepatitis B, you may need an injection. Its effectiveness is similar to that for hepatitis A. It doesn't prevent the infection, but it decreases the effects. The injection is not needed if your contact was casual-a roommate, a dorm resident, a fraternity or sorority member, a food handler. You will need it only if your exposure was through blood products or sexual contact. See your physician if you believe you should have the injection.

Are some people at higher risk of getting hepatitis B?

Yes. Certain persons are in risk groups because of their occupations or lifestyles. Health care workers such as dentists, physicians, nurses, lab technicians, paramedics, and dental hygienists are at risk of infection because they may be handling the blood products of an infected individual.

Intravenous drug users are at high risk because a contaminated needle may often be shared by several users. Sexual transmission of hepatitis type B may occur if one partner is a carrier of the virus or has an active infection. Homosexuals are at greater risk. Kidney dialysis patients are at risk for hepatitis because of the number of transfusions and injections they receive. If you are in one of these groups, get advice about vaccination to prevent hepatitis B from your student health service or local clinic.

What causes urinary tract infections?

Knowledge of male and female anatomy will help you understand the causes of urinary tract infections (UTIs) and the reasons they are common in women and uncommon in men.

The urethra, the canal through which the urine is carried from the bladder for excretion, is very short in women and much longer in men. In women the urethral outlet is hidden under the labia, the folds surrounding the vulva. The orifice is close to the vaginal opening and to the anus; both are potential sources of infection. The vaginal opening is colonized by bacteria, and additional bacteria can find their way there to thrive on the moist environment. The bacteria can be forced into the urethra and thus into the bladder by mechanical action, resulting in a bladder infection, or cystitis.

Sexual activity, horseback riding, bicycle riding, and improper wiping are a few of the mechanical methods by which a urinary tract infection may be started. An abrupt increase in sexual activity commonly results in what is often called, in medical texts, honeymoon cystitis.

Because a man's urethra is much longer than a woman's, it is more difficult for bacteria to gain access to the bladder before they are flushed out. Men are therefore much more prone to infections of the urethra (urethritis). Often the result of a sexually transmitted disease like gonorrhea or the disease caused by chlamydia, the infection can extend to the bladder and eventually the kidneys and can also involve the prostate and the epididymis.

What are the effects of a bladder infection?

In cystitis the walls of the bladder become irritated, reddened, and can actually bleed. The bladder wall is lined with smooth muscle, which contracts involuntarily when irritated. The spasms cause pain and frequent attempts to void.

Because the urine stored in the bladder is always sterile, the only source of a bladder infection is the introduction of bacteria, which multiply and irritate the bladder lining.

The lower part of the urinary tract is closely related to the reproductive organs and differs in men and women. The male urethra is about 10 inches long and provides an outlet for semen as well as urine. A woman's urethra is about 1 inch long and lies, with the bladder, just in front of the reproductive organs. Because it is close to the anus and the entrance to the vagina, a woman's urinary tract is more susceptible to infection.

Is it necessary to see a doctor about a urinary tract infection?

Yes. See a doctor or a nurse practitioner as soon as possible. Prompt treatment can prevent complications, and the sooner treatment is started, the sooner you will feel better. This means less pain and fewer spasms if the infection is in the bladder. If the infection spreads above the bladder and into the kidneys (pyelonephritis), the condition is more serious and there will be other symptoms like pain in the side, fever, chills, nausea, vomiting, and diarrhea.

How is a urinary tract infection diagnosed and treated?

The clinician will ask for a urine sample. Women are also checked for vaginal infections. The urine specimen has to be free of contaminants from vaginal discharge, so follow directions carefully in providing the clean-catch sample.

The specimen will be processed in a laboratory so that the responsible bacteria can be identified. The doctor will then know the proper antibiotic to prescribe. Be sure you take all the medication prescribed, even if you feel better in a few days. This will prevent an antibiotic-resistant strain of bacteria from developing and will ensure that you are completely rid of the original infection.

If you have pain when you urinate, your doctor may prescribe a medication like phenazopyridine. It is not an overall painkiller or a sedative, but it is effective at relieving the discomfort associated with lower urinary tract irritation. This medication will discolor the urine reddish-orange, a normal and expected reaction that has no significance.

You may be asked to return 3 or 4 days after finishing the medication to submit another specimen. Be sure to return for this follow-up to ensure that the infection is completely cured.

What is the course of action for a woman to follow at the first sign of a bladder infection?

Try to flush out the infection by drinking lots of water. The body's natural defense is to empty the bladder by frequent urination.

Avoid foods and drinks and other substances that irritate the bladder, such as caffeine, alcohol, B and C vitamins, and spicy foods. Try one or two cups of herbal teas like mint, comfrey, chamomile, lemon balm, or lemon grass to help soothe the irritated lining of the bladder and the urethra.

Avoid sexual activity until the infection has been controlled. Be sure to wipe from front to back to prevent further contamination from the vagina and the anus.

Some people believe that making the urine more acidic will help. They recommend drinking cranberry juice or taking 250 milligrams of vitamin C four times a day. But be aware that the increased acid may further irritate the already sensitized bladder and urethral tissues.

Sitting in a warm bath will relax the bladder spasms, and you may even be more comfortable urinating this way. A hot water bottle or a heating pad may also relieve the discomfort.

Why do some women get bladder infections every couple of months?

There are several reasons a woman may continue to get urinary tract infections. Probably the most common causes are reinfection (usually during sexual activity) and the relapse of an infection that wasn't completely cured. A thick-rimmed diaphragm may play a role in cystitis by pressing against and partially blocking the outlet of the bladder.

Tight jeans, infrequent urination, or an undiscovered vaginal infection might also be contributing to recurring infection. Consider the possibility of chemical irritants in toilet tissue, soap, scented douches, or feminine hygiene sprays.

In some cases a woman may have been born with an anatomic abnormality in the urethra or the ureters, the tubes that lead from the kidney to the bladder. If there is an obstruction, surgery may be required.

If a woman has three or more infections in a year, she should discuss with her physician the possibility of further diagnostic tests to determine the cause.

How can urinary tract infections be prevented?

If you are susceptible to recurring urinary tract infections, take the following preventive measures:

  1. Drink plenty of water (8 to 10 glasses a day).
  2. Empty your bladder frequently to keep the urinary tract cleansed.
  3. Always empty your bladder before and as soon as possible after intercourse.
  4. Wipe from front to back to avoid contaminating the urethra with bacteria from the vagina and the anus.
  5. Avoid clothing that is tight in the crotch.
  6. To decrease the amount of bacteria on you and your partner, the hands and genital areas should be washed before intercourse.
  7. Rinse underwear thoroughly to remove residual soap.
  8. If you use pads during menstruation, change them often to decrease the amount of bacteria held in the pad.

If you are susceptible to urinary tract infections, consult your physician about possible preventive treatments, including low-dose antibiotics. The physician may want to run further diagnostic tests to determine the cause. Sometimes X rays of the kidneys or a direct visualization of the bladder (cystoscopy) may be necessary to evaluate the condition.

What urinary tract infections do men get?

Urinary tract infections are much less common in men. Men are more likely to get an infection of the urethra (see Sexual Health) than of the bladder, although they are subject to both. Men can also get infections in the prostate, epididymis (coiled tubes that lie on top of the testes), and kidney. The symptoms of urethritis usually include painful urination and a discharge from the tip of the penis. Often these infections are sexually transmitted.

The bladder infections, when they occur, can be serious. The symptoms are frequent urination, blood in urine, pain, and burning; there is usually no discharge. A physician should be consulted as soon as possible. The treatment will usually be antibiotics.

What is epididymitis?

Epididymitis is an inflammation or infection of the epididymis, coiled tubes that transport sperm from the testes to the vas deferens (see Sexual Health for more information). The symptoms of epididymitis include pain or pressure in the scrotum, the sac that holds the testes and epididymis. Occasionally there is fever, painful urination, urethral discharge, and swelling or nodules in the epididymis. The testes may also be tender. Most infections are caused by sexually transmitted diseases such as gonorrhea or the infection caused by chlamydia (see Sexual Health).

If you have symptoms of epididymitis, see a physician at once. A physical examination and laboratory tests of your urine, discharge, and prostatic secretions will be performed to determine the cause. It may also be necessary to contact and treat your sexual partner. The appropriate antibiotic usually cures the infection. In addition to antibiotics, treatment includes scrotal support with a jockstrap, ice packs for 10 to 15 minutes to decrease the pain, and possibly bed rest.

What is a prostate infection?

The prostate gland is located deep in the pelvis at the base of the penis and just in front of the rectum. It surrounds the beginning of the urethra. Its function is to secrete fluid for the semen (see Sexual Health).

It can become acutely infected (prostatitis) by a virus or by bacteria or may just be inflamed. The symptoms of a prostate infection vary from fever and painful urination to pain or pressure at the base of the penis or in the testicles, rectum, or lower back. To determine the cause, a clinician will examine the prostate by doing a rectal exam. Bacterial prostatitis is treated with antibiotics. Warm baths relieve the discomfort of infection and inflammation. In some cases, prostatic massage by the physician is helpful in relieving the congestion in the prostate. Avoiding alcohol and caffeine may also be helpful.

Is appendicitis an infection?

Appendicitis is an infection and inflammation of the appendix, a small pouch attached to the cecum, part of the large intestine, in the lower right of the abdomen. Appendicitis is most common between the ages of 15 and 24 but can occur at any age.

What are the symptoms of appendicitis?

Usually there are fever and lack of appetite. Severe abdominal pain accompanies these symptoms, often starting near the belly button before moving to the lower right quadrant of the abdomen. There may also be vomiting, diarrhea, or both.

What causes appendicitis?

The appendix, which has no apparent function, can become obstructed by food material (seeds, pits, or other foreign material) or become infected. The infection and swelling can cause the appendix to rupture. When the infected bowel contents spill into the peritoneal cavity, peritonitis, a life-threatening condition, results. This is why it is important to seek medical attention for appendicitis, or for any severe abdominal pain, as quickly as possible.

What's the cure for appendicitis?

The only treatment for appendicitis is to have the appendix surgically removed. An appendectomy is a relatively routine operation as long as the appendix has not burst. Because the symptoms of appendicitis closely mimic the symptoms of many other medical problems, the doctor may hospitalize you for observation. During observation, you will be kept without food and will have an intravenous line to keep you hydrated. Serial measurements of your temperature, pulse, and pain will be done. You may also have blood tests, X rays, and repeat examinations. If there is a strong indication of appendicitis during this time of observation, surgery is recommended in suspicious cases rather than risk rupture of the appendix and the resulting peritonitis and gangrene.

Why not just have the normal appendix removed before it becomes infected?

There are risks associated with any operation, no matter how routine. Complications may arise. It would be unwise to surgically remove a structure that may never cause a problem.

What is gastroenteritis?

Gastroenteritis is a nonspecific term that refers to any inflammation of the lining of the stomach and the intestines. The main symptoms are severe abdominal pain, cramps, and diarrhea. Other symptoms that may include fever, chills, nausea, and vomiting depend on which section of the gastrointestinal tract is involved and on the source of the infection.

It may be very difficult to determine the exact cause of gastroenteritis. Often the source is contaminated water or improperly prepared or stored food containing bacteria, parasites, or toxins. Usually gastroenteritis is a self-limiting condition that goes away as soon as the body can rid itself of the irritant. It is important to drink plenty of fluids to replace those lost due to diarrhea. See the section on treating nausea and diarrhea in Common Medical Problems

If you have any of the following symptoms, you should immediately see your physician:

  1. Temperature above 101 degrees
  2. Muscle weakness, paralysis, or numbness (may be caused by a neurotoxin in seafood or by botulism, induced by a toxin [botulin] in improperly canned food)
  3. Severe abdominal pain
  4. Blood in stool or in vomitus
  5. Severe dehydration (major symptoms are lightheadedness when going from lying to standing position, thirst, dry mucous membranes; can be serious if nausea or diarrhea prevents fluid replacement)
  6. Milder symptoms lasting more than 2 or 3 days

Is gastroenteritis caused by anything other than contaminated food and water?

Yes. Some medications - antibiotics, for example - can irritate the colon, change its normal bacteria, and cause diarrhea and cramping. This is why it is not a good idea to take antibiotics as a preventive measure to avoid traveler's diarrhea.

How does improper food handling cause gastroenteritis?

Food is often contaminated by bacteria and is unsafe until it is cooked. For example, as much as 75 percent of the chicken you purchase at the grocery store may be contaminated by organisms of the genus Salmonella, bacteria that cause acute gastroenteritis. Properly cooked (until no pink color remains), this chicken is safe to eat because the bacteria have been killed.

However, when the same cutting board and knife used to prepare the raw chicken are used without proper cleaning to prepare salad ingredients, the salmonella bacteria may contaminate the salad.

Most perishable foods will develop bacterial growth if they are not refrigerated adequately. If food is left out of the refrigerator for too long, it may become unsafe. After cooking, refrigerate food at 45 degrees within 4 hours or less. Even food stored in the refrigerator for too long can become infectious. If you have any question about the safety of a food, throw it out.

Personal hygiene can also be a factor in transmitting disease. To prevent the spread of disease, wash your hands thoroughly after going to the bathroom and before preparing food. Do not handle food if you have an infected cut or abrasion.

If your gastrointestinal symptoms are a consequence of eating oriental food, you may be sensitive to the flavoring agent monosodium glutamate, or MSG. It is commonly used in the preparation of oriental food and can cause severe reactions in people who are sensitive to it. Other reactions to food could be the result of food allergies (see Common Medical Problems).

Why do so many people get diarrhea and nausea when they take field trips or vacations?

Probably because they either eat contaminated food or drink contaminated water. It is very common for travelers to suffer from diarrhea, usually caused by bacteria that get into food or water via fecal contamination.

Third-world countries often have little control over sanitation, and water sources may become contaminated with sewage. It may be difficult for food handlers to maintain adequate personal hygiene. Refrigeration may be inadequate in hot climates.

There are steps you can take to minimize your risk of getting traveler's diarrhea when you travel abroad.

  1. Use only bottled water or beverages, if possible.
  2. Boil tap water at least 10 minutes and allow it to cool.
  3. Disinfect clear tap water with tincture of iodine (5 drops per quart) and allow it to sit for 30 minutes. If the water is cloudy, use 10 drops and allow it to sit for several hours.
  4. Avoid uncooked foods, especially meat and shellfish, and unpasteurized milk as well as foods made from unpasteurized milk such as cheese, creamy desserts, and soups.
  5. Eat only fruits that can be peeled, and peel them yourself.
  6. Avoid salads and raw vegetables. In cleaning them, it is very difficult to remove bacteria and parasite eggs.
  7. Carry bismuth tablets (Pepto-Bismol). Taking 6 to 12 tablets a day can minimize or prevent diarrhea.
  8. Before your departure, ask your physician for advice regarding immunization requirements and medications you should take with you.

Even sparkling, clear mountain streams have been found to be contaminated with giardia, a parasite that causes diarrhea. When you are hiking in the mountains, purify your water supply.

Why would a physical exam include a tuberculin skin test? Hasn't tuberculosis been eradicated in the United States?

No. Tuberculosis (TB) is a bacterial infection that is still very much with us. To determine whether you have been exposed to TB, a small amount of the killed bacteria is injected under the skin of the forearm. The test is based on a delayed reaction. You must return within 48 to 72 hours so that the clinician can judge the response. A positive response (swelling of 5 to 10 millimeters at the site of the injection) means you have been exposed to tuberculosis and may need preventive treatment even if the infection is dormant. Because the bacteria are very difficult to kill, the treatment may involve taking an antibiotic daily for 9 to 12 months.

Why should someone be treated for an infection that isn't active?

Many people are exposed to the bacterium of tuberculosis at some point in their lives-usually without knowing they were exposed. Generally the human body is able to wall off the infection; it remains dormant either in the pulmonary lymph nodes or in the apices (upper parts) of the lungs. While the disease is in this dormant stage, it is not contagious and there are no symptoms of illness.

Unlike other bacteria, the TB bacilli cannot be killed by the body but can only be contained. Therefore the bacteria can become reactivated at any time and cause massive infections in the lung, brain, lymph nodes, kidneys, bone, skin, and intestines.

During this active secondary stage, tuberculosis is very contagious. It can be spread by aerosolized sputum and can be acquired by minimal contact with an active case.


Hopefully, your experience will not be marred by any of the diseases discussed in this section. We have included information we hope you will never need. We believe, however, that prevention is the best medicine and that knowing how these diseases are transmitted can help you avoid them. If you are not lucky enough to escape them all, awareness of what to do in the early stages and throughout the course of a disease can shorten and somehow make more bearable the duration.

Modern medicine plays a vital role in preventing and curing disease, but the foundation of good health is based on common sense measures such as eating right, getting enough sleep, exercising regularly, and maintaining personal hygiene.

When you are rested, well nourished, and physically fit, your resistance is high and you are less likely to succumb to the infectious agents that are a part of our environment.