Medical News Today: How to identify pitting edema

Edema refers to visible swelling caused by a buildup of fluid within tissues. When an indentation remains after the swollen skin is pressed, this is called pitting edema. The effect may also be noticeable after taking off a tight shoe or stocking.

Anyone can have pitting edema, but because some causes are more dangerous than others, it is often a good idea to consult a doctor.

In this article, we describe who is at risk for pitting edema. We also explore accompanying symptoms, treatments, and prevention techniques.

Symptoms of pitting edema

Pitting edema. Image credit: James Heilman, MD, (2017, February 1).
Pitting edema may cause indentations to remain on the skin after pressure is released.
Image credit: James Heilman, MD, (2017, February 1).

This condition is most common in the lower body, particularly in the legs, ankles, and feet.

Swelling caused by edema will usually make the skin feel tight, heavy, or sore. Other symptoms depend on the cause, but they can include:

  • tingling or burning sensations around the swelling
  • pain and aching in the swollen areas
  • skin that feels puffy or stiff
  • skin that is warm or hot to the touch
  • numbness
  • bloating
  • water retention
  • cramps
  • unexplained coughing
  • fatigue or decreased daily energy
  • chest pain
  • shortness of breath and difficulty breathing

People who experience chest pain, shortness of breath, or swelling in only one limb should seek immediate medical attention.

Pitting vs. non-pitting edema

Edema occurs when fluid that accumulates in tissues leads to swelling. When pressure is applied to a swollen area, it may leave a pit, in the skin.

In non-pitting edema, the skin will return to its swollen shape once the pressure has been removed.

Causes of pitting edema

A variety of factors can lead to pitting edema, including:

  • flying
  • poor circulation
  • obesity
  • pregnancy
  • dehydration
  • low levels of protein
  • trauma or injuries

Alternatively, any of the following conditions may be responsible:

Pitting edema may also be a side effect of medications such as:

  • steroids
  • nonsteroidal anti-inflammatory drugs (NSAIDs)
  • medications that supplement estrogen
  • medications for high blood pressure
  • thiazolidinediones, a class of drugs used to treat type 2 diabetes

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Risk factors

sedentary lifestyle shown by woman lying on couch.
A sedentary lifestyle may increase the risk of pitting edema.

Pitting edema can affect anyone, though certain factors can increase a person’s risk.

These include:

  • a sedentary lifestyle
  • living in a warm climate
  • a diet overly rich in sodium
  • obesity
  • multiple pregnancies
  • a history of lymph node surgery
  • thyroid conditions
  • lung diseases, such as emphysema
  • heart disease

When to see a doctor

In most cases, a doctor should determine the cause of pitting edema and, if necessary, refer a person to a specialist.

Some accompanying symptoms require urgent care. Anyone experiencing shortness of breath, difficulty breathing, chest pain, or swelling in a single limb should seek immediate medical attention.

When leg pain and swelling persist after a person has been sitting for several hours, this may indicate deep vein thrombosis. This occurs when a blood clot develops deep in the leg. Anyone who suspects this should seek urgent medical care.

Pitting edema during pregnancy

Pregnancy can cause pitting edema, and it usually resolves as the pregnancy ends.

However, it is a good idea to discuss every new symptom with a doctor, who can test to rule out serious conditions linked with edema, such as very high blood pressure or preeclampsia.

Diagnosis and grading

Pitting edema is often diagnosed with a physical exam. The doctor may apply pressure to the swollen skin for about 15 seconds to check for lasting indentation.

Because some associated conditions are more dangerous than others, it is important to find the underlying cause of the edema. This may require thorough testing. The edema will usually resolve once the cause has been treated.

To properly identify the underlying cause, a doctor may take a detailed medical history and ask about medications. They may then refer the person to a doctor who specializes in issues concerning the veins or circulatory system.

Tests that can aid in a diagnosis of pitting edema include:

  • a physical exam
  • imaging tests, such as X-rays, which can show fluid retention and problems in the lungs
  • blood tests
  • urine tests
  • an echocardiogram, which is an ultrasound scan of the heart

Pitting edema is classified based on the depth and duration of the indentation. The following scale is used to rate the severity:

Grade 1: The pressure applied by the doctor leaves an indentation of 0–2 millimeters (mm) that rebounds immediately. This is the least severe type of pitting edema.

Grade 2: The pressure leaves an indentation of 3–4 mm that rebounds in fewer than 15 seconds.

Grade 3: The pressure leaves an indentation of 5–6 mm that takes up to 30 seconds to rebound.

Grade 4: The pressure leaves an indentation of 8 mm or deeper. It takes more than 20 seconds to rebound.

Understanding the severity of edema can help a doctor to identify the underlying cause and best course of treatment.

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Doctor prescribing treatement.
The treatment plan for pitting edema will depend upon the cause.

This involves addressing the underlying cause of the edema. A range of treatments correspond with the range of causes, but common methods include:

  • elevating the swollen limbs above the level of the heart
  • wearing compression stockings to encourage circulation
  • undergoing vascular surgery
  • increasing blood protein levels
  • taking diuretics to flush out excess fluid


When the underlying cause has been successfully treated, edema is unlikely to recur.

Some adjustments to lifestyle and diet can reduce the likelihood of developing edema, particularly if a person has a high risk.

These changes may include staying active, avoiding sitting or standing for long periods, and doing gentle exercises to reduce swelling.


Pitting edema is a common symptom. It is usually not a cause for concern in itself, but many underlying conditions require treatment, sometimes urgently.

Edema should not cause any long-term complications. After working with a doctor, many people find lasting relief from the symptom.

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Medical News Today: What causes teeth to turn black?

Black teeth can be a sign of an underlying decay or cavities that should be addressed as soon as possible. However, black teeth may also be the result of staining. Different foods and drinks can leave behind a bit of pigment, causing the teeth to turn black.

Teeth owe their color to the high amount of calcium found in the outer layer of the teeth, known as the enamel.

Over time, additional elements left behind by foods and drinks can start to make teeth yellow or gray. If the teeth turn black, however, a person should visit a dentist as soon as possible.

What causes black teeth?

Teeth turn black from either extrinsic or intrinsic causes.

Extrinsic causes

Woman with black teeth <br>Image credit: Calvin Smith, 2009</br>
Black teeth may be caused by tartar buildup and stains.
Image credit: Calvin Smith, 2009

Extrinsic causes of the teeth turning black come from the outside of the tooth.

These can include:

  • damage to the enamel
  • stains
  • tartar buildup

Some direct causes of staining include:

  • frequently eating or drinking a dark food product, such as coffee
  • taking certain medications, such as liquid iron supplements
  • using certain mouth rinses and toothpastes
  • using tobacco
  • having crowns and fillings made with silver sulfide

Intrinsic causes

The tooth may appear black when damaged from the inside. The most common culprits of black teeth in these cases are decay or cavities. For example, a pulp infection or dead tooth may turn a tooth black.

The damage starts on the inside and works its way to the surface. The black color of the tooth may first appear in spots and eventually cover the entire tooth if left untreated.

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It is not normal for a tooth to quickly change from a whitish hue to black. A person will typically notice some other signs before the tooth starts to turn black.

In some cases, a spot may appear brown or gray. Over time, the brown spots can turn black.

Other times, the teeth may develop small dots that appear black. These small dots often appear near the gumline, which is a common occurrence in children who have black teeth.

When tartar is the cause, a person will probably notice black coloration on the outside of the molars or the inside of the front teeth. Tartar will continue to build up the stain unless it is removed. In these cases, holes may appear as the enamel erodes away.

What stains can be avoided?

Coffee and cola may lead to black teeth
Coffee and cola may lead to black teeth.

People concerned about developing black teeth should avoid putting certain things in their mouth.

They should also be sure to practice proper dental hygiene after eating.

Also, they may want to avoid or reduce their use of some of the following:

  • coffee
  • cola
  • black tea
  • red wines
  • tobacco products

Good dental hygiene can often protect against the potential extrinsic causes of black teeth.

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Treatment and prevention

Treating black teeth at home is not usually possible. Several home whitening kits are available that may help with mild discoloration, but black teeth typically require professional treatment.

A dentist will examine the teeth to diagnose the underlying cause and will then determine the right treatment.

What if tartar is the cause?

A dentist will need to remove the buildup when tartar is the cause. This is typically done by scraping the tartar off the teeth. The dentist may need to use ultrasonic instruments that use vibration to break up the tartar and make it easier to remove.

What if decay is the cause?

In cases of decay, it is unlikely that a dentist will be able to improve the black teeth through a simple cleaning. They will instead need to remove the decayed portion of the tooth.

If the decay is in one part of the tooth, the dentist might be able to remove the affected portion and close the hole with a filling. If the decay has reached the second layer of the tooth, however, the dentist will remove all the decay and place a crown over the top of the tooth.

Sometimes, the tooth may be too severely damaged to recover with a crown or filling. The dentist may need to remove the entire tooth instead.

Prevention tips

People can often avoid black teeth with proper dental hygiene. The American Dental Association (ADA) recommend:

  • brushing twice a day with a fluoride toothpaste
  • cleaning or flossing between the teeth at least once a day
  • scheduling regular dental visits
  • avoiding sugary foods


A dentist is the best resource to determine if black teeth are caused by staining, tartar buildup, or decay. A person will need professional help to treat the black teeth, no matter what the cause.

Practicing proper dental hygiene can help prevent black teeth. Once removed, and with proper care, a person may never have black teeth again.

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Medical News Today: What causes a piercing rejection to occur?

Body piercing is not without risk. Sometimes a piercing may be rejected, which can cause discomfort and scarring. Spotting a piercing rejection early can reduce scarring and damage to the skin.

Whenever the skin is broken, there is a risk of infection, scarring, allergies, or other skin problems.

In this article, we look at the causes and symptoms of piercing rejection, and how to stop it from happening.

What causes piercing rejection?

Anti-eyebrow piercing. Image credit: Ralf Roletschek, (2008, August 11).
The body may try to reject a piercing because it is a foreign object.
Image credit: Ralf Roletschek, (2008, August 11).

Sometimes, the body’s immune response sees the jewelry as a foreign object and rejects it.

Piercing rejection can cause discomfort and scarring.

The following can help reduce the risk of piercing rejection:

  • choosing a qualified and experienced piercer
  • using proper jewelry
  • practicing proper piercing aftercare

Anyone who has piercings should keep a careful eye on them while they heal. Catching a piercing rejection early can reduce scarring or damage to the skin.

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Symptoms of piercing rejection

A piercing rejection usually happens gradually. Symptoms tend to appear several days or weeks before the body finally pushes the jewelry out of the skin in a process called migration.

Signs that a piercing is migrating and possibly being rejected include:

  • more of the jewelry becoming visible on the outside of the piercing
  • the piercing remaining sore, red, irritated, or dry after the first few days
  • the jewelry becoming visible under the skin
  • the piercing hole appearing to be getting larger
  • the jewelry looking like it is hanging differently
  • the jewelry moving more freely than it should

Which piercings are more likely to be rejected?

Piercing rejection scar on nape piercing.
Surface piercings, such as nape piercings, are at risk of rejection, which can lead to scarring.

Any piercing has the potential to be rejected. Rejection depends on the person’s immune system and how well the piercing heals. But, the body tends to reject some types of piercings more often than others.

Surface piercings are the most common types of piercing to be rejected by the body. Surface piercings travel along an area of skin, rather than going directly through a body part. The jewelry punctures only a small amount of the skin’s surface.

Examples of surface piercings include eyebrows, neck, hip, and wrist.

Surface piercings may be prone to rejection just because it is easier for the body to push the jewelry out of a small amount of skin.

Non-surface piercings include the earlobe, ear cartilage, lip, or tongue. These types of piercings go all the way through the body tissue — in one side and out the other.

Non-surface piercings may be rejected less often because there is more tissue to hold them in place, making it more difficult for the body to push them out.

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How to prevent piercing rejection

Sometimes, a piercing rejection occurs without an apparent cause. However, the following steps may make a piercing rejection less likely to happen.

Choose the right piercer

It is essential to select a piercer who is familiar with the body’s anatomy, the healing process, and where best to place a piercing. Before getting a piercing, talk to the piercer about:

  • The type of piercing. Ask about the specific kind of piercing desired and their experience with it. Their expertise with specific piercing locations. Ask to see photos of piercings they have done in the past. These should show a variety of piercings that look well-suited to individual body types.
  • Their sterilization and safety measures. The Association of Professional Piercers state that every piercer should use an autoclave for sterilizing equipment. Good hygiene can help lower the risk of infection and trouble with healing, both of which can lead to piercing rejection.
  • Other sanitary and health measures. Ask about single-use needles, gloves, and the cleaning of hands and rooms between each customer.

Also, consider reading online reviews or talking to previous customers. Choosing an experienced, skilled, and hygienic piercer is crucial.

Choose the right jewelry

A qualified piercer should recommend a size and type of jewelry best suited to the indivdual’s body and the location of the piercing.

Using a thicker piece of jewelry might reduce the risk of rejection.

Using materials such as niobium and titanium offer the lowest risk of irritation and allergies. This can also help speed up the healing process and prevent complications. Research the specific piercing beforehand and the best jewelry size and material for it.

Follow aftercare instructions

Keeping a piercing clean is vital for healing and preventing infection. Do not use harsh cleansers such as peroxide, antibacterial soaps, or alcohol, as they can irritate the skin and delay healing.

Ideally, clean the area with a sterile saline solution or a product recommended by a professional piercer.

Take care not to bump piercings, especially while they heal. An injury to the area could cause irritation, rejection, or migration. Ask the piercer about what precautions to take to protect the piercing during contact sports.

How to stop the process of rejection

Ear piercing bar
Having a professional remove jewelry when it seems to be moving towards the surface may prevent rejection.

If the piercing appears to be migrating toward the surface, take the following steps:

  • Remove the jewelry and contact the piercer. Keeping the jewelry in increases the chances of scarring. A large scar can prevent a person having a new piercing in the same location after it heals.
  • Ask the piercer about using a different piece of jewelry. Thicker-gauge jewelry or a different shape or material may help the piercing heal and settle into place better.
  • Do not try to treat the rejection at home with bandages or coverings. This may slow healing and has not been shown to help keep piercings in place.

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Most people who experience a piercing rejection will recover without any lasting health issues. However, there may be scarring, which can range from mild to severe.

Scarring can make it difficult or impossible to get a new piercing in the same location. It may also be a cosmetic concern. People who are prone to raised or keloid scars are generally advised to avoid piercings.

Antibiotics may be needed if an infection occurs. Anyone who suspects a piercing infection should discuss it with a doctor.

Signs of infection include the following at the piercing location:

  • redness
  • hot to the touch
  • swelling
  • discharge

With proper antibiotic treatment, most piercing infections heal without long-term problems.

After a piercing rejection, people should think about what may have caused it. Did they follow proper aftercare instructions? Did the piercer use appropriate equipment, technique, and jewelry?

If the piercing was done correctly and the person looked after it properly, the rejection may just be bad luck. A person can sometimes have one rejection then have no problems with future piercings. People should consider the risk of another piercing rejection before getting pierced again.

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Medical News Today: Can sneezing during pregnancy affect the baby?

Although many people do worry more than usual while pregnant, sneezing during pregnancy should not cause any anxiety. Sneezing can occur more frequently during pregnancy but does not usually mean anything is wrong with baby or mother.

Some causes of sneezing during pregnancy include:

What are the causes of sneezing during pregnancy?

People can sneeze for many reasons while they are pregnant:

Pregnancy rhinitis

Pregnant woman sitting on bed sneezing and blowing her nose.
Pregnancy rhinitis is a common condition that causes nasal congestion.

Pregnancy causes many changes in the body.

These changes can lead to pregnancy rhinitis, a condition that affects 39 percent of women at some point during their pregnancy.

Pregnancy rhinitis often causes extra nasal congestion.

This congestion can last for 6 weeks or longer during pregnancy and can cause many symptoms, including increased sneezing.

During pregnancy, blood flow to the mucous membranes increases. The nose is full of mucous membranes. The extra blood flow causes the nasal passages to swell, which leads to extra watery discharge and congestion.

Both the additional discharge and congestion can lead to increased sneezing.


Pregnant people have weaker immune systems and are more likely to get a cold, flu, or another bug. These illnesses may last longer and be more severe than in someone who is not pregnant.

When a person is not pregnant, their body typically reacts to germs quickly. During pregnancy, the body’s immune system responds more slowly and gently, because it does not want to mistake the baby for something harmful.

Colds are usually harmless during pregnancy, but the flu or any other illness that causes a fever can be dangerous for both mother and baby. Expectant mothers who are sneezing and think they may have the flu or another illness that causes a fever should call a doctor promptly.


People who have allergies that cause sneezing and other upper respiratory symptoms when they are not pregnant, will likely still have allergy symptoms while pregnant. Seasonal allergies, such as hay fever and pollen allergies, as well as indoor allergies can all trigger sneezing.

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Pregnant woman with pain in belly.
Sneezing during pregnancy may cause pain around the belly.

Sneezing during pregnancy does not pose a risk to mother or baby most of the time.

Sneezing can, however, be a symptom of an illness or a more significant problem that may affect the baby.

When sneezing indicates a more severe problem, there may be risks. For example, if someone gets the flu, risks might include miscarriage, low birth weight, and premature birth.

People who are pregnant may also find that sneezing causes pain around the belly. While this radiating pain does cause discomfort, it is not dangerous. This phenomenon is known as round ligament pain and occurs as the ligaments stretch and loosen during pregnancy.

How is it managed?

Many medicines that are safe to take while not pregnant are not recommended during pregnancy.

The American Pregnancy Association recommend that pregnant people limit the amount of over-the-counter (OTC) medications they take during pregnancy. This means that many common cold medications that would reduce sneezing are off limits.

Home remedies

Ways to manage sneezing during pregnancy without using medication include:

  • saline nasal sprays
  • neti pots
  • using a humidifier
  • avoiding known allergens
  • using an air purifier
  • treating asthma as directed by a doctor
  • exercising regularly
  • eating a diet rich in vitamins

People should also talk to their doctor about the best ways to avoid getting ill during pregnancy. Most doctors recommend people have a flu shot to prevent the flu while they are pregnant.

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When to see a doctor

Pregnant patient looking at clipboard with doctor.
A doctor should be consulted if sneezing is accompanied by other symptoms, such as a fever.

People should see their doctor immediately if they suspect that the sneezing is a symptom of a more significant problem, such as the flu or asthma.

A pregnant woman should also seek immediate medical attention if she has any of the following symptoms or concerns along with sneezing:

  • a fever of 102°F or higher
  • trouble breathing
  • chest pain
  • coughing up yellow or green mucus
  • blowing colored mucus from the nose
  • wheezing
  • loss of appetite
  • inability to sleep
  • a severe headache


There are a lot of misconceptions about sneezing during pregnancy. We answer some of the common questions about pregnancy and sneezing below:

Does sneezing affect the baby?

Sneezing during pregnancy will typically not harm the baby.

The baby is well-protected in the uterus, and even a hard sneeze will not affect the baby.

The only time that sneezing may be problematic for the baby is if the sneezing is the symptom of an underlying illness or problem. In these instances, it is the underlying illness that may affect the baby, not the sneezing itself.

Does sneezing while pregnant influence the baby’s sex?

Despite lots of stories, tales, and myths highlighting ways to influence the sex of the baby, sneezing cannot determine or change the sex of the baby.

A baby’s sex is determined at conception by a chromosome from the male’s sperm.

If the man’s sperm has an X chromosome, the baby will be a female; if it has a Y chromosome, the baby will be a male.

Can a pregnant woman sneeze out her baby?

No. A baby will not be born because a pregnant woman sneezes.

While some people may joke about fast childbirth, even those who deliver their babies quickly still go through the labor process. During labor, contractions help guide the baby out of the uterus through the open cervix.

People will still have to push and go through labor or cesarean delivery for a baby to be born.


Sneezing during pregnancy is a frequent occurrence for many.

Most of the time sneezing during pregnancy is harmless. However, if the sneezing is accompanied by other symptoms that might indicate a more significant problem, then it is essential to visit a doctor as soon as possible.

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Medical News Today: Which drugs pose the biggest threat to public health?

A new report compiling data provided by the some of the most recent and reliable sources worldwide aims to answer the big question: which substances and stimulants pose the biggest threat to health and well-being on a global level?
person having a drink and a smoke
Researchers take a look at recent data on substance use to find out how it affects health outcomes on a global level.

The review was put together by specialists from prominent institutions worldwide, spanning six countries and three continents: Australia, Europe, and North America.

Its first author is Amy Peacock, who works with the National Drug and Alcohol Research Centre at the University of New South Wales in Sydney, Australia, as well as with the School of Medicine at the University of Tasmania in Hobart, which is also in Australia.

The authors sourced their information mainly through records held by the World Health Organization (WHO), the United Nations Office on Drugs and Crime, and the Institute for Health Metrics and Evaluation at the University of Washington in Seattle.

“Alcohol, tobacco, and illicit drug use are major global risk factors for disability and premature loss of life,” the researchers write in the report’s introduction.

Estimating the prevalence of use and associated burden of disease and mortality at the country, regional, and global level is critical in quantifying the extent and severity of the burden arising from substance use.”

These are the reasons why the team decided to publicize an up-to-date collection of available statistics — as complete as possible — about the issue of substance use and abuse, and its economic and medical burden around the world.

The report has now been published in the journal Addiction.

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Alcohol, tobacco use ‘far more prevalent’

Citing the Global Burden of Disease study from 2015, the researchers note that tobacco use has led to 170.9 million disability-adjusted life-years worldwide. Second in line comes alcohol consumption, to which 95 million disability-adjusted life-years are attributed.

No less worryingly, illicit drug consumption has caused individuals around the globe to claim 27.8 million disability-adjusted life-years.

Based on the data available to them, the authors note, “Alcohol use and tobacco smoking are far more prevalent than illicit substance use, globally and in most regions.”

About 1 in 5 adults worldwide will have engaged in heavy alcohol consumption on at least one occasion in the past month, which may increase the risk of sustaining injuries.

Also, an estimated 15.2 percent of adults smoke on a daily basis. People who frequently smoke, the researchers warn, are at an increased risk of developing 12 different forms of cancer, respiratory diseases, and cardiovascular diseases, to name but a few related health outcomes.

The data also suggest that the “use of illicit drugs [is] far less common” than the use of alcohol and tobacco worldwide; estimates indicate that “fewer than 1 in 20 people” reported an instance of cannabis use over the past year.

Even fewer people are thought to engage in amphetamine, opioid, or cocaine use. Nevertheless, some regions — including the United States, Canada, and Australasia — have very high rates of illicit drug abuse that warrant concern.

The authors of the report note that Australasia came up as the region with “the highest prevalence of amphetamine dependence,” amounting to 491.5 per 100,000 people. Australasian populations also appeared to use other drugs, such as cannabis, opioids, and cocaine, more frequently.

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Europeans score high on heavy drinking

The authors also note that, in stark contrast with the populations of other continents, people across Central, Eastern, and Western Europe tend to indulge much more in alcohol consumption.

Per capita, Central Europeans drink 11.61 liters of alcohol per person, Eastern Europeans drink 11.98 liters per person, and Western Europeans consume 11.09 liters.

Europe was also discovered to contain the highest number of people who smoke tobacco, with 24.2 percent of Eastern Europeans, 23.7 percent of Central Europeans, and 20.9 percent of Western Europeans admitting to this habit.

At the opposite end of the spectrum, countries in North Africa and the Middle East reported the lowest rates of alcohol consumption, as well as the lowest percentage of heavy drinking.

However, the authors caution that the findings detailed in their report may not be complete, seeing that many regions — especially Africa, the Caribbean, South America, and Asia — have incomplete or missing data about substance use and its impact on the population’s health and well-being.

They therefore advise that in the future, public health organizations should develop and apply more rigorous methods of collecting relevant data and make them available to researchers and public policy-makers.

Still, “Regular compilations of global data on geographic variations in prevalence of substance use and disease burden, such as this, may encourage the improvements in data and methods required to produce better future estimates,” they conclude.

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Medical News Today: What does it mean when you have a double ear infection?

A double ear infection is when both ears become infected by bacteria or a virus. Double ear infections are not always more serious than single ear infections, but their symptoms are often more severe.

Early diagnosis and treatment may lead to a quicker recovery and reduce the risk of complications.

Read on to learn more about identifying and treating a double ear infection.

What are the symptoms?

Woman holding head in pain due to double ear infection
Symptoms of double ear infection may include pain in ears, fatigue, a headache, and problems hearing.

The symptoms of a double ear infection are similar to those of a single ear infection, but they may be more severe when both ears are infected.

Symptoms may include:

  • pain in the ear
  • difficulty sleeping
  • drainage from the ears
  • fatigue
  • a headache
  • a fever that lasts for 2 or more days
  • problems hearing

How to spot symptoms in toddlers and infants

Signs in infants and toddlers include:

  • crying more than usual
  • increased irritability, especially when lying down
  • loss of interest in feeding
  • pulling on the ears (this may not be a symptom of an earache in infants who are otherwise well)
  • persistent fever, or a fever that goes away and then returns during the same illness

When to see a doctor

People should see their doctor if symptoms continue for more than 24 hours.

People who have pus or bloody discharge coming from one or both ears will likely require more urgent treatment.

When a parent or carer notices the signs of an ear infection in an infant under 6 months old, they should take the child to a doctor as soon as possible.

Older children should see a doctor if symptoms are severe or last for more than 24 hours, especially if they have a fever or discharge from the ear.

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What are the causes?

Bacteria or viruses in the middle ear cause ear infections.

A person who has, or had, an upper respiratory infection may also develop an ear infection. Ear infections are not contagious. However, the respiratory infections that might accompany an ear infection are.

Enlarged adenoids, which are pads of tissue at the back of the nose, may also contribute to a double ear infection, especially in children.

An infection affecting only one ear may also occasionally develop into a double ear infection.


Man cupping hand to ear due to double ear infection
Recurrent infections may lead to hearing problems.

Hearing difficulties are probably the most common short-term complication of a double ear infection.

A person’s hearing will typically return to normal once the infection clears up.

Persistent or recurrent infections can lead to:

  • Hearing problems: Permanent damage to structures within the ear can cause hearing loss of varying degrees.
  • Ruptured eardrum: A torn eardrum may occur after severe ear infections. It will usually heal within a few weeks.
  • Delays in speech and development: Infants and toddlers who experience a prolonged hearing loss may experience delays in their speech and development.
  • Spread of infection: As with all infections, there is a risk that a double ear infection will spread to other areas of the body.

Long-term complications following ear infections are uncommon.

How is it diagnosed?

A doctor will usually diagnose a double ear infection by checking a person’s medical history and asking about their symptoms.

The doctor will examine both ears using a device called an otoscope. It comprises a light and a magnifying lens. Doctors typically look for redness, swelling, and signs of fluid behind the eardrum, which indicates infection.

A doctor may also use another device, called a pneumatic otoscope, to test how much the eardrum moves in response to pressure. If the eardrum does not respond to this pressure, it suggests fluid buildup behind the ear.

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Many single ear infections clear up on their own. But double infections are more likely to require treatments such as:


A bacterial infection can be treated with antibiotics, such as amoxicillin. A doctor may also prescribe antibiotic eardrops.

Antibiotic medications will not work for a viral infection, so a virus will have to run its course.

Ear tubes

Children with recurrent ear infections may require surgery that involves fitting small ear tubes. The tubes help to ventilate the middle ear and prevent fluid buildup.

Some tubes are designed to remain in the ear for up to 12 months before falling out on their own. Other types of tubes stay in place for longer and must be surgically removed.

Home remedies

Home remedies aim to lessen the pain rather than treat the underlying infection. Home treatments include:

  • Warm compresses: To make a compress, soak a washcloth in warm water. Wring out the excess liquid and place the cloth over the affected ear or ears.
  • Pain medications: Some over-the-counter pain (OTC) relievers may reduce ear pain. Options include acetaminophen (Tylenol) or ibuprofen (Advil, Motrin IB). If giving medication to infants and children, always use age-appropriate doses. Aspirin should not be given to children as it has been linked with a serious condition called Reye’s syndrome.

How can they be prevented?

Frequent hand washing can help to prevent infections
Washing hands frequently may help to prevent colds and flu.

It is difficult to prevent ear infections in young children completely.

Steps to reduce the frequency or severity of infections include the following simple tips and habits:

  • washing hands frequently to help prevent colds and flu
  • avoiding people who are sick
  • keeping children away from childcare settings when they are ill
  • teaching children to avoid sharing their utensils with others
  • avoiding exposure to cigarette smoke
  • staying up to date on all immunizations, including the flu shot

Where possible, breast-feed infants, as breast milk provides additional protection from ear infections. Try to hold the infant in an upright position when feeding.

Also, avoid prolonged bottle-feeding at bedtime, as research suggests it can increase ear and sinus infections, acid reflux, and cough.

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A double ear infection should begin to heal within a few days of treatment. But symptoms may not fully resolve until a person has completed the full course of antibiotics, which can take up to 10 days.

Home remedies can reduce pain and discomfort in the meantime.

Anyone who notices the symptoms of an ear infection should seek prompt medical treatment for the best outlook.

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Medical News Today: Cholesterol found to play a role in Alzheimer’s

A new study, led by researchers at the University of Cambridge in the United Kingdom, concludes that cholesterol may play a significant role in the development of Alzheimer’s disease.
Cholesterol buildup in arteries
Cholesterol builds up in arteries, but it may play a role in Alzheimer’s, as well.

Cholesterol is a waxy substance that can build up on the walls of arteries, potentially causing health problems.

Approximately 71 million people in the United States live with high levels of low-density lipoprotein (LDL), or “bad cholesterol.”

It is more commonly implicated as a contributing factor in cardiovascular conditions such as heart disease and stroke, but cholesterol is also one of the main constituents of the cell wall.

A new study, published in the journal Nature Chemistry, suggests that this cholesterol could also act as a catalyst for clusters of a protein called amyloid-beta to form in the brain.

Amyloid-beta is well known to be a key contributing factor to Alzheimer’s disease, which currently affects around 5.4 million people in the U.S. When amyloid-beta aggregates, it forms into plaques that are toxic to brain function and kills off brain cells.

However, scientists have struggled to identify how the clusters of amyloid-beta form in the first place.

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Cholesterol speeds up aggregation

What scientists do know is that amyloid-beta molecules do not normally stick together in the brain because they are only present in low levels, and they are spread out across the brain.

The Cambridge team joined forces with researchers at Lund University in Sweden to investigate how amyloid-beta manages to form into clusters in Alzheimer’s disease.

They revealed that amyloid-beta can stick to lipids, a type of insoluble molecule that includes fats, steroids, phospholipids, and waxes. In particular, amyloid-beta was found to stick very well to lipid cell membranes containing cholesterol.

Then, once amyloid-beta molecules become stuck to cholesterol-containing lipid cell membranes in the vicinity of other “stuck” amyloid-beta molecules, there is a greater chance that these molecules will encounter each other, causing clusters to begin forming.

The team calculates that the presence of cholesterol caused amyloid-beta clusters to develop 20 times faster than they would have otherwise.

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Will eating less cholesterol reduce risk?

Earlier studies have mapped a link between cholesterol and Alzheimer’s; for instance, scientists know that some of the same genes that process cholesterol in the brain are also implicated in Alzheimer’s. However, it is unclear how they are linked.

The authors of the recent study are not sure if dietary cholesterol plays a role in Alzheimer’s, as this kind of cholesterol does not cross into the brain from the bloodstream.

So, although it is generally good for your health to eat a balanced diet without too much LDL cholesterol, how much cholesterol you consume in your diet is not thought to be an issue in regards to your risk of developing Alzheimer’s.

In fact, study co-author Prof. Michele Vendruscolo — of the Centre for Misfolding Diseases at the University of Cambridge — says that it is not the cholesterol in itself that is the problem.

“The question for us now,” he says, “is not how to eliminate cholesterol from the brain, but about how to control cholesterol’s role in Alzheimer’s disease through the regulation of its interaction with amyloid-beta. We’re not saying that cholesterol is the only trigger for the aggregation process, but it’s certainly one of them.”

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Prof. Vendruscolo explains that cholesterol is moved around the body by dedicated “protein carriers” such as ApoE, which, in its mutated form, has also been studied as a risk factor for Alzheimer’s.

In older people, protein carriers are less effective, interrupting the movement of cholesterol around the body. So, it may be possible for scientists in the future to design drugs that target this process, helping to control the balance of cholesterol and amyloid-beta in the brain.

“This work has helped us narrow down a specific question in the field of Alzheimer’s research,” concludes Prof. Vendruscolo.

“We now need to understand in more detail how the balance of cholesterol is maintained in the brain in order to find ways to inactivate a trigger of amyloid-beta aggregation.”

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Medical News Today: What are the symptoms of citrus allergy?

A person with a citrus allergy experiences a reaction when they come into contact with fruits such as oranges, lemons, and limes.

While this allergy is uncommon, reactions can trigger severe symptoms. An individual with an allergy to grass may be more likely to develop an allergy to citrus.

In this article, we describe ways to identify and treat a citrus allergy.

What are the symptoms?

Woman with a citrus allergy holding her mouth
Symptoms of a citrus allergy may include redness, swelling, and tingling sensations on the lips.

Symptoms may appear immediately after touching a citrus fruit, its juice, or products containing either. In other cases, symptoms can take hours to develop.

Some people experience symptoms after inhaling airborne citrus particles.

However, symptoms are usually confined to the areas of skin that have touched citrus products. These often include the:

  • gums
  • lips
  • throat
  • tongue

Common symptoms include:

  • tingling sensations
  • itching
  • redness
  • swelling

Touching the peels of citrus fruits can cause a skin reaction called contact dermatitis. This may lead to:

  • a burning sensation on the skin
  • blisters
  • dry and flaky skin
  • extreme itching
  • hives
  • redness
  • swelling

Citrus allergies can also cause digestive and respiratory problems, including:

  • coughing
  • diarrhea
  • nausea
  • a runny or stuffy nose
  • sneezing
  • stomach pain
  • vomiting
  • wheezing

In rare cases, a citrus allergy may induce anaphylaxis, a potentially fatal condition that should be treated as a medical emergency.

Anaphylaxis symptoms include:

  • confusion
  • difficulty breathing
  • flushed skin
  • a loss of consciousness
  • nausea, vomiting, and diarrhea
  • a sharp drop in blood pressure
  • swelling of the mouth and throat
  • a weak or rapid pulse


Allergic reactions occur when the immune system misidentifies a usually harmless substance as a threat. This substance is known as an allergen.

Some individuals with pollen allergies may also react to citrus fruits. This is caused by cross-reactivity, which occurs when the proteins in one substance resemble those of an allergen and provoke a similar reaction.

Results of a study from 2013 suggest that people with grass pollen allergies may be vulnerable to citrus allergies. When given a skin prick test, 39 percent of participants with grass pollen allergies showed similar reactions to citrus. However, it is possible for a person to react to a test but have no allergy symptoms otherwise.

The citrus varieties tested were clementines, lemons, and oranges.

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Foods to avoid

A variety of citrus fruits
Citrus fruits include limes, lemons, and oranges.

A person with a citrus allergy should refrain from touching the fruits and eliminate them from the diet.

Citrus fruits include:

  • kumquats
  • lemons
  • limes
  • mandarins
  • grapefruits
  • oranges

A surprising number of processed and prepared foods contain citrus. Carefully check the labels on products such as:

  • juices, lemonades, and other beverages
  • ice creams
  • flavored yogurts
  • jellies
  • herbal teas
  • sauces and dressings, including mayonnaise and sweet and sour sauces
  • seafood and meat dishes, including prawn cocktails, baked fish, and duck dishes
  • marinades
  • pickles and chutneys
  • alcoholic and non-alcoholic cocktails
  • vitamin C supplements and bioflavonoid supplements
  • candies and confectionary, including candied peels, cheesecakes, and cookies

Citrus can also be found in personal care products such as toothpaste. Cosmetics and perfumes often contain limonene, a compound in citrus peels that can cause contact dermatitis.

Alternative foods

Some people can tolerate cooked citrus fruit because heat can deactivate the proteins that trigger an allergic reaction.

For those who cannot tolerate citrus but want to add a tart flavor to meals, popular citrus substitutes include:

  • herbs such as lemon verbena and sumac
  • vinegar
  • white wine

Citric acid is commonly used as a preservative or firming agent, as well as for flavor. It can cause skin and oral irritation, but it rarely triggers an allergic reaction. However, some people with allergies choose to use a substitute.

Citrus fruits are a popular source of vitamin C, but plenty of other fruits and vegetables can help a person with an allergy meet their daily requirement.

Other foods rich in vitamin C include:

  • bell peppers
  • broccoli
  • cauliflower
  • kiwis
  • mangoes
  • papayas
  • strawberries

When to see a doctor

Anyone who experiences an allergic reaction should see a doctor for treatment recommendations. Further testing may be needed.

Seek emergency medical attention if symptoms of anaphylaxis occur.


blood tests and analysis sheet
A blood test may be ordered to diagnose a citrus allergy.

A doctor will ask about a person’s diet and symptoms, and they may also perform a physical examination.

The doctor may request that a person record their meals and symptoms in a food diary. This will help to identify triggers.

A doctor may also perform an allergy test, but these often show false positive or negative results.

Common allergy tests include:

Skin tests

A skin prick test involves using a needle to apply a diluted allergen to the skin.

If within 15 minutes the skin becomes red and itchy or a bump appears, a person is likely to have an allergy to the substance.

An intradermal test may be used to confirm results. In this test, the diluted allergen is injected just below the surface of the skin. A visible reaction indicates an allergy.

Blood tests

When diagnosing a citrus allergy, a doctor may order a blood test.

This will determine the amount of immunoglobulin E antibodies in the bloodstream. A person with a high number of antibodies is likely to have an allergy to the substance tested.

Blood tests are more expensive than skin tests. Also, results take longer, and blood tests are often less accurate.

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What are the treatment options?

There is no cure for a citrus allergy, though symptoms may diminish over time. If a person can eliminate contact with the fruits, symptoms should disappear.

When it is impossible to avoid contact with citrus completely, the following treatments can reduce allergy symptoms:


Several types of prescription and over-the-counter (OTC) medication can treat allergic reactions. Depending on the symptoms, a doctor may recommend:

  • antihistamines
  • inhalers
  • ointments or lotions


Immunotherapy can be used to treat severe allergies.

People receiving immunotherapy receive injections of the allergen, with the aim of decreasing the immune response and sensitivity over time.

Some pollen allergies are treated with another form of immunotherapy, which involves tablets placed under the tongue, rather than shots.

Emergency epinephrine

People with severe citrus allergies are at risk of anaphylaxis. They will likely need to keep an emergency epinephrine injector, such as an EpiPen or Auvi-Q, with them at all times.


A citrus allergy is a rare and potentially severe condition. A person can reduce or eliminate symptoms by cutting citrus fruits out of their diet and avoiding products that contain the fruits or extracts.

While there is no cure, medications and immunotherapy can help to alleviate symptoms. Those with severe citrus allergies should carry emergency epinephrine pens to treat anaphylaxis, a potentially fatal event.

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Medical News Today: What does a maculopapular rash look like?

A maculopapular rash causes flat and raised lesions on the skin. Maculopapular rashes usually suggest an infection or allergic reaction to something.

This type of rash is a symptom of another ailment, rather than being a condition itself. People with a maculopapular rash should see their doctor, especially if they experience other symptoms, as it could signal a serious illness.

Keep reading to learn more about this type of rash and what treatments are available.

What does it look like?

The most distinctive feature of a maculopapular rash is the pattern of macules and papules. A macule is a small, flat, red area of discoloration, and a papule is a small, red, raised lesion.

As a result, a maculopapular rash appears as red bumps against a red background. People with darker skin may not notice the flat, red patch.

A maculopapular rash can appear on any part of the body depending on the underlying cause. It may also spread to other areas. The rash usually lasts from 2 to 21 days.

Chronic maculopapular rashes may last for more than 8 weeks.

Other symptoms

A maculopapular rash may cause itching at the site of the bumps.

It can also cause other symptoms associated with infections and immune reactions, such as:

  • breathing difficulties
  • dry skin
  • fever
  • a headache
  • muscle pain
  • vomiting

Anyone who experiences other symptoms should see a doctor promptly because the infections that cause a maculopapular rash can be dangerous and may spread to other people.

What are the causes?

The following may cause a maculopapular rash:


Several bacterial and viral infections are known to cause maculopapular rashes. People will experience other symptoms too, including those listed above.

Some infections associated with a maculopapular rash are:

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Allergic reaction

Woman having trouble breathing holding throat
Maculopapular rash may be a symptom of an allergic reaction. Other symptoms may include difficulty breathing and hives.

An allergic reaction occurs when the body mistakenly identifies a substance (allergen) as a threat to the body. A maculopapular rash can be a symptom of an allergic reaction.

Other allergy symptoms include:

  • difficulty breathing
  • dizziness
  • hives
  • increased heart rate
  • stomach pain
  • swelling

Reaction to medication

Some people experience an allergic reaction to a prescribed or over-the-counter (OTC) medication. The rash usually occurs within 7 to 28 days of taking the drug.

Some research reports that the antibiotic amoxicillin caused a maculopapular rash in up to 70 percent of people being treated for a viral infection, most notably for the Epstein–Barr virus.

Other medications that have been associated with maculopapular rashes include:

  • allopurinol (Zyloprim)
  • angiotensin-converting enzyme inhibitors
  • anticonvulsants
  • beta-lactam antibiotics
  • hypoglycemic medications
  • non-steroidal anti-inflammatory drugs (NSAIDs)
  • sulphonamides
  • thiazide diuretics

The reaction can, however, occur in response to almost any medication.


The underlying cause may result in complications.

For example, complications associated with an allergic or drug reaction include the risk of anaphylaxis, a medical emergency that can be fatal.

Various viral and bacterial infections can cause complications. The Zika virus, for example, can lead to:

How is it diagnosed?

To diagnose the cause of a maculopapular rash, a doctor will ask a person about their general health and any history of illness and allergies. They will ask where the rash started on the body and when it began.

A doctor will also ask about:

  • any medications the person is taking
  • the presence of other symptoms
  • recent travel to areas where viral infections are common

The doctor will then carry out a physical examination. They may order blood tests or urine tests to check for infection. Sometimes, they may take a small sample of the rash (a biopsy) to examine it under the microscope.

If the rash gets worse or does not resolve with treatment, a doctor will likely refer a person to a dermatologist (a skin doctor).


The treatment for a maculopapular rash depends on the underlying cause:

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Doctor and patient with clipboard
Antibiotics may be prescribed if an infection is the cause of the rash.

A doctor will likely prescribe antibiotics for a bacterial infection. But antibiotics do not work for viral infections.

Sometimes, the virus will have to run its course. People can manage symptoms with rest, fluids, and OTC pain relievers.

However, more severe viruses, such as HIV, will require a treatment program that might include antiviral drugs.

Allergic reaction

The best way to treat an allergy is by discovering and avoiding the allergen. Antihistamines, topical creams, and cold compresses can alleviate symptoms in cases of allergen exposure.

Reaction to medication

If a drug reaction causes the rash, it may be necessary to stop taking the medication. A doctor may be able to offer alternative treatments.

People should not discontinue use of a medication without speaking to their doctor first.

Relief from itching

To reduce the itching caused by a maculopapular rash, a doctor may recommend OTC antihistamines or hydrocortisone cream. Stronger versions of these medications are available by prescription.

It is essential to see a doctor before treating a maculopapular rash at home so that they can determine the underlying cause.

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The outlook for people with a maculopapular rash depends on the underlying cause. Sometimes, the rash is a symptom of a drug reaction or allergic reaction. Avoiding the trigger can clear up the rash and prevent recurrence.

A maculopapular rash caused by a virus will usually resolve once the infection goes away. However, some diseases are more serious than others and can cause severe complications. Some, like HIV, have no cure but can be managed with appropriate treatments.

People with a rash should see their doctor who can provide a more accurate outlook based on their diagnosis.

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Medical News Today: Scientists halt flesh-eating disease in mice

The bacterium that is the main cause of necrotizing fasciitis, or flesh-eating disease, causes widespread, deadly infection by getting the nervous system to stop the immune system from attacking it.
bacteria on orange background
Researchers investigate the bacterial infection that causes necrotizing fasciitis.

A team that was led by scientists from Harvard Medical School in Boston, MA, made the surprising discovery while studying the disease-promoting tactics of Streptococcus pyogenes in mice with necrotizing fasciitis.

You can read about the study in a paper shortly to be published in the journal Cell, where the researchers also suggest two potential treatments.

Should they succeed in animal and human trials, the treatments could be of immense value in containing “highly invasive bacterial infections.”

“Necrotizing fasciitis,” explains senior study author Isaac M. Chiu, who is an assistant professor of microbiology and immunobiology at Harvard Medical School, “is a devastating condition that remains extremely challenging to treat and has a mortality rate that’s unacceptably high.”

Flesh-eating disease

The flesh-eating disease is caused by serious bacterial infection of subcutaneous tissue, the tissue that lies just below the skin, and the fascia, the tissue that covers the organs that lie inside the body.

The disease is very rare; each year, it affects approximately 200,000 people worldwide, which includes around 1,200 individuals in the United States.

The infection — which can be caused by several types of bacteria — is not easy to diagnose, and it can develop suddenly and spread rapidly. If not treated promptly, it can result in “multiple organ failure and death,” which occurs in around 30 percent of cases.

Following an injury, the nervous system sends one signal to the brain and another to the immune system. The first signal triggers pain sensations, and the second tells the immune system to hold back.

Scientists suggest that neurons, or nerve cells, have this ability to instruct the immune system to hold back in order to prevent “over-deployment” of immune cells that might cause “collateral” damage to healthy tissue.

Prof. Chiu became interested in how this nervous system and immune system interaction might work in flesh-eating disease when he discovered that affected patients often experienced an excessive level of pain that occurred before symptoms developed.

Could it be that the bacterium was somehow exploiting this natural dual response to injury to repress the immune system for its own advantage?

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Bacterial toxin triggers immune silencing

To investigate this further, he and his colleagues developed a mouse model of flesh-eating disease by injecting the animals with the bacterium S. pyogenes sampled from infected human patients.

Using the mouse model, they discovered that a toxin produced by the bacterium — known as streptolysin S — was a trigger for pain and the subsequent silencing of the immune system.

In further tests, they injected mice with bacteria that had been genetically engineered so that they could not produce the toxin. Though they became infected, the mice did not show the usual pain and neither did the infection become invasive.

The researchers confirmed the role of streptolysin S by “re-engineering” the toxin-producing ability back into the modified bacteria and then introducing them into the same mice. The infection developed into “full-blown” flesh-eating disease.

The team then gave the mice an antibody that blocked the toxin. The mice’s pain symptoms were much reduced, confirming that bacterial streptolysin S was the trigger.

Underlying molecular mechanisms

The researchers carried out further experiments in which they explored the underlying molecular mechanisms of the interaction between the nervous system and the immune system.

In these, they discovered that streptolysin S triggers neurons to send a pain signal to the brain. This also triggers another signal to the immune system that causes it to secrete a neurotransmitter, or chemical messenger, called calcitonin gene-related peptide (CGRP), which then holds back the immune response.

They also found that CGRP does this by both halting the despatch of neutrophils and by blocking their ability to kill bacteria at the wound site.

“Effectively,” notes Prof. Chiu, “this neuronal signal silences the alarm system that normally calls on the body’s infection fighters to curb infection.”

He goes on to explain that such a response is appropriate when a wound is clean and not infected — you don’t want the immune system coming in and inflaming healthy tissue in an attempt to deal with an infection that is not there.

But, the strep bacterium takes advantage of this and invokes the same strategy when the wound is infected, allowing the disease to develop unhindered.

Patients in the early stage of necrotizing fasciitis often feel an enormous amount of pain but do not show the symptoms that one might expect to accompany it — such as redness, swelling, and inflammation.

Prof. Chiu and colleagues suggest, however, that this is what you would expect if, for some reason, the neutrophils that bring on the inflammation and get rid of the bacteria were not summoned.

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Two possible ways to halt the disease

The scientists then ran another set of experiments, wherein they introduced the bacteria into two groups of mice: one in which they had stopped the ability of the nerve fibers to carry pain signals, and another in which they had not.

These demonstrated that blocking the pain nerves improved the body’s control of the infection.

Various experiments in which mice were injected with botulinum neurotoxin A — a nerve-blocker that is present in facial anti-wrinkling cosmetic treatments — showed that such an approach may work as a treatment for flesh-eating disease.

Injections of the nerve blocker even 2 days after the mice were first infected and already had wounds stopped the disease causing more tissue damage.

The researchers also tested another possible way of tackling the disease. They showed that CGRP-blockers removed the brakes on the immune system by stopping the nerve cells from sending the halt signals. They also stopped necrotizing fasciitis from spreading in mice.

Our findings reveal a surprising new role of neurons in the development of this disease and point to promising countermeasures that warrant further exploration.”

Prof. Isaac M. Chiu

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