Wikipedia - Benutzerbeiträge [de]

Mastzellaktivierungssyndrom

2017-12-08T19:28:43Z

Coldtrack: Reverted 1 edit by Greenanimal (talk): No explanation. (TW)

{{distinguish|Mastocytosis}}
{{Infobox medical condition
| Name = Immune Disorder
| Image =
| Caption =
| Field = [[Immunology]]
| DiseasesDB =
| ICD10 = {{ICD10|D89.8}}
| ICD9 = 757.33/202.60<ref name="cancer">"Surveillance, Epidemiology, and End Results Program Turning Cancer Data Into Discovery." View. National Cancer Institute, 2 July 2014. Web. 12 Oct. 2015.</ref>
| ICDO =
| OMIM =
| MedlinePlus =
| eMedicineSubj =
| eMedicineTopic =
| MeshID =
}}

'''Mast cell activation syndrome''' ('''MCAS'''), also commonly referred to as '''mast cell activation disorder''' ('''MCAD'''), is an immunological condition in which [[mast cell]]s inappropriately and excessively release chemical mediators, resulting in a range of chronic symptoms, sometimes including [[anaphylaxis]] or near-anaphylaxis attacks.<ref name="Valent">{{cite journal | author = Valent P | year = 2013 | title = Mast Cell Activation Syndromes: Definition and Classification | url = | journal = Allergy | volume = 68 | issue = 4| pages = 417–24 | pmid = 23409940 | doi=10.1111/all.12126}}</ref><ref name="Cem">{{cite journal | pmc = 3753019 | pmid=21035176 | doi=10.1016/j.jaci.2010.08.035 | volume=126 | title=Mast cell activation syndrome: Proposed diagnostic criteria | year=2010 | journal=J. Allergy Clin. Immunol. | pages=1099–104.e4 | vauthors=Akin C, Valent P, Metcalfe DD}}</ref><ref name="anaph">{{cite journal | author = Akin C | year = 2015 | title = Mast Cell Activation Syndromes Presenting as Anaphylaxis | url = http://www.sciencedirect.com/science/article/pii/S0889856115000119 | journal = Immunology and Allergy Clinics of North America | volume = 35 | issue = 2| pages = 277–85 | doi=10.1016/j.iac.2015.01.010}}</ref> Primary symptoms include cardiovascular, dermatological, gastrointestinal, neurological and respiratory problems.<ref name=Cem />

Unlike [[mastocytosis]], where patients have an abnormally increased number of mast cells, patients with MCAS have a normal number of mast cells that do not function properly and are defined as "hyperresponsive".<ref name=Cem /> MCAS is still a poorly understood condition and is a current topic of research.<ref name="white">White, Andrew, Dr. "A Tale of Two Syndromes – POTS and MCAS". The Dysautonomia Dispatch. Dysautonomia International, 17 Feb. 2015. Web. 12 Oct. 2015. <http://www.dysautonomiainternational.org/blog/wordpress/a-tale-of-two-syndromes-pots-and-mcas/>.</ref>

MCAS is often found in patients with [[Ehlers–Danlos syndrome]] (EDS) and [[postural orthostatic tachycardia syndrome]] (POTS).<ref name=milner /> It is also found in subset groups of patients with [[common variable immunodeficiency]] (CVID)<ref name="Journal of Allergy">{{cite journal | author = Szczawinska-Poplonyk A | year = | title = An Overlapping Syndrome of Allergy and Immune Deficiency in Children | url = http://www.hindawi.com/journals/ja/2012/658279/ | journal = Journal of Allergy | volume = 2012 | issue = | pages = 1–9| doi = 10.1155/2012/658279 }}</ref> and [[Lyme disease]].<ref name="Lyme">{{cite journal |vauthors=Talkington J, Nickell SP | date = Mar 1999 | title = Borrelia burgdorferi Spirochetes Induce Mast Cell Activation and Cytokine Release | journal = Infect Immun | volume = 67 | issue = 3| pages = 1107–1115 | pmc=96436 | pmid=10024550}}</ref>

==Symptoms and triggers==
MCAS is a condition that affects multiple systems, generally in an inflammatory manner. Symptoms typically wax and wane over time, varying in severity and duration. Many signs and symptoms are the same as those for [[mastocytosis]], because both conditions result in too many mediators released by mast cells.<ref name="guide">Afrin, Lawrence B. "A Concise, Practical Guide to Diagnostic Assessment for Mast Cell Activation Disease." WJH World Journal of Hematology 3.1 (2014): 155-232. Web. <https://www.novapublishers.com/catalog/product_info.php?products_id=42603>.</ref> It has many overlapping characteristics with recurrent idiopathic anaphylaxis, although there are distinguishing symptoms, specifically hives and angioedema.<ref name=frieri />

'''Common symptoms include:'''<ref name=white /><ref name=presentation /> 
*''Dermatological''
**flushing
**easy bruising
**either a reddish or a pale complexion
**itchiness

*''Cardiovascular''
**lightheadedness, dizziness, presyncope, syncope

*''Gastrointestinal''
**diarrhea, cramping, intestinal discomfort
**nausea, vomiting
**swallowing, throat tightness

*''Psychological & Neurological''
**brain fog, short term memory dysfunction, difficulty with recalling words
**headaches, migraines

*''Respiratory''
**congestion, coughing, wheezing

*''Vision/Eyes''
**ocular discomfort, conjunctivitis

*''Constitutional''
**general fatigue and malaise
**food, drug, and chemical intolerances (especially fragrances)
**sense of being cold all the time

*''Musculoskeletal''
**osteoporosis and osteopenia (including young patients)

*[[Anaphylaxis]] ''If too many mediators are spilt into a patient's system, they may also experience anaphylaxis, which primarily includes: difficulty breathing, itchy hives, flushing or pale skin, feeling of warmth, weak and rapid pulse, nausea, vomiting, diarrhea, dizziness and fainting.''

Symptoms can be caused or worsened by triggers, which vary widely and are patient-specific.
'''Common triggers include:'''<ref name=presentation />
*specific foods and drinks (especially alcohol, and high-histamine content foods)
*temperature extremes
*airborne smells including perfumes or smoke
*exercise or exertion
*emotional stress
*hormonal changes, particularly during adolescence, pregnancy and women's menstrual cycles

==Causes==
There are no known causes, but the condition appears to be inherited in some patients.<ref name=milner /> Symptoms of MCAS are caused by excessive chemical mediators inappropriately released by mast cells. Mediators include leukotrienes and histamines. The condition may be mild until exacerbated by stressful life events, or symptoms may develop and slowly trend worse with time.<ref name=white /><ref name=milner />

==Diagnosis==
MCAS is often difficult to identify due to the heterogeneity of symptoms and the "lack of flagrant acute presentation."<ref name="presentation">Afrin, Lawrence, Dr. "Presentation, Diagnosis, and Management of Mast Cell Activation Syndrome." Mast Cells: Phenotypic Features, Biological Functions and Role in Immunity. Nova Science, 2013. 155-232. Web. <https://www.novapublishers.com/catalog/product_info.php?products_id=42603>.</ref> The condition can also be difficult to diagnose, especially since many of the numerous symptoms may be considered "vague". Patients often see many different specialties due to the inherent multisystem nature of the condition, and do not get diagnosed until a holistic view is taken by a diagnostician.<ref name=guide /> Lack of awareness of MCAS by many medical professionals is currently a hurdle to proper diagnosis.

::"Although different diagnostic criteria are published, a commonly used strategy to diagnose patients is to use all three of the following:

#Symptoms consistent with chronic/recurrent mast cell release: Recurrent abdominal pain, diarrhea, flushing, itching, nasal congestion, coughing, chest tightness, wheezing, lightheadedness (usually a combination of some of these symptoms is present)
#Laboratory evidence of mast cell mediator (elevated serum tryptase, N-methyl histamine, prostaglandin D2 or 11-beta- prostaglandin F2 alpha, leukotriene E4 and others)
#Improvement in symptoms with the use of medications that block or treat elevations in these mediators"<ref name=white />

The World Health Organization has not published diagnostic criteria.

==Treatment==
Common pharmacological treatments include:

*[[Mast cell stabilizer]]s,<ref name="frieri">{{cite journal | vauthors = Frieri M | title = Mast Cell Activation Syndrome | journal = Clin Rev Allergy Immunol | volume = | issue = | pages = | year = 2015 | pmid = 25944644 | doi = 10.1007/s12016-015-8487-6 | quote = }}</ref> including cromolyn sodium and [[natural product|natural]] stabilizers such as [[quercetin]]<ref name="MC stabilizers - review">{{cite journal | vauthors = Finn DF, Walsh JJ | title = Twenty-first century mast cell stabilizers | journal = Br. J. Pharmacol. | volume = 170 | issue = 1 | pages = 23–37 | year = 2013 | pmid = 23441583 | pmc = 3764846 | doi = 10.1111/bph.12138 | quote = A diverse range of mast cell stabilizing compounds have been identified in the last decade from; natural, biological and synthetic sources to drugs already in clinical uses for other indications. Although in many cases, the precise mode of action of these molecules is unclear, all of these substances have demonstrated mast cell stabilization activity and therefore may have potential therapeutic use in the treatment of allergic and related diseases where mast cells are intrinsically involved.}}[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3764846/table/tbl1/ Table 1: Naturally occurring mast cell stabilizers]</ref><ref name="Quercetin MC stabilizer - primary supplement">{{cite journal | vauthors = Weng Z, Zhang B, Asadi S, Sismanopoulos N, Butcher A, Fu X, Katsarou-Katsari A, Antoniou C, Theoharides TC | title = Quercetin is more effective than cromolyn in blocking human mast cell cytokine release and inhibits contact dermatitis and photosensitivity in humans | journal = PLoS ONE | volume = 7 | issue = 3 | pages = e33805 | year = 2012 | pmid = 22470478 | pmc = 3314669 | doi = 10.1371/journal.pone.0033805 | url = }}</ref>
*[[Antihistamine#H1-antihistamines|H1-antihistamines]],<ref name="frieri" /> such as [[cetirizine]] or [[ketotifen]]
*[[Antihistamine#H2-antihistamines|H2-antihistamines]],<ref name="frieri" /> such as [[ranitidine]] or [[famotidine]]
*[[Antileukotriene]]s,<ref name="frieri" /> such as [[montelukast]] or [[zileuton]] as well as natural products (e.g., [[curcumin]] or [[St. John's wort]] extracts)
*[[Nonsteroidal anti-inflammatory drug]]s,<ref name=guide /> including [[aspirin]] can be very helpful in reducing inflammation in some patients, while others can have dangerous reactions<ref name=guide />

Fillers, binders and dyes in many medications are often the culprit in causing reactions, not necessarily the active agent, so alternative formulations and compounding pharmacies should be considered.<ref name=guide />

Lifestyle changes may also be needed. Avoidance of triggers is important. It should be emphasized that MCAS patients can potentially react to any new exposure, including food, drink, medication, microbes and smoke via inhalation, ingestion or touch.<ref name=guide />

A low histamine diet and other elimination diets can be useful in identifying foods that trigger or worsen symptoms. Many MCAS patients already have high histamine levels, so ingesting foods with high histamine or histamine liberators can worsen many symptoms such as vasodilation that causes faintness and palpitations.

==Prognosis==
There is no cure for MCAS. For most, symptoms wax and wane, but many can experience a general worsening trend over time. Lifespan for those with MCAS appears to be normal, but quality of life can range from mild discomfort to severely impaired.<ref name=guide /> Some patients are impaired enough to be disabled and unable to work.

==Epidemiology==
MCAS is a relatively new diagnosis, being unnamed until 2007, and is believed to be very under-diagnosed.<ref name=guide /> New findings are revealing that MCAS is much more prevalent than previously thought. It's currently estimated that 4.5% of the general population has tryptasemia, which is associated with mast cell activation syndrome.<ref name="milner">Milner, Joshua, Dr. "Research Update: POTS, EDS, MCAS Genetics." 2015 Dysautonomia International Conference & CME. Washington DC. Dysautonomia International Research Update: POTS, EDS, MCAS Genetics. Web. <https://vimeo.com/142039306>.</ref>

==History==
It has been suggested in the literature for decades; however diagnostic criteria have been proposed only in 2010.<ref name=Cem /> The condition was first recognized in 1991, and finally named in 2007.<ref name=guide />

==See also==
* [[Immunoglobulin E]]
* [[FcεRI]]

==References==
{{Reflist}}

==External links==
Recent medical reviews on MCAS:
* [https://www.ncbi.nlm.nih.gov/pubmed/26194403 The role of mast cells in functional GI disorders]
* [https://link.springer.com/article/10.1007%2Fs12016-015-8487-6 Mast Cell Activation Syndrome] – May 2015
* [http://www.tandfonline.com/doi/full/10.1586/1744666X.2014.906302#.VhcLJ_lVhBc Spectrum of mast cell activation disorders] – 2014
* {{open access}} [http://onlinelibrary.wiley.com/doi/10.1111/all.12126/epdf Mast cell activation syndromes: definition and classification] – 2013
* {{open access}} [http://www.clinicaltherapeutics.com/article/S0149-2918(13)00171-9/fulltext Expanding Spectrum of Mast Cell Activation Disorders: Monoclonal and Idiopathic Mast Cell Activation Syndromes] – 2013

[[Category:Immune system disorders]]
[[Category:Syndromes]]

Hurrikan Maria

2017-09-19T19:02:01Z

Coldtrack: Reverted to revision 801446356 by Master of Time (talk): No reason for removal. (TW)

{{pp-pc1|expiry=01:38, 19 October 2017|small=yes}}
{{Distinguish|Hurricane Marie (2014)}}
{{Other hurricane uses|Tropical Storm Maria|the Atlantic hurricane of 2017}}
{{Notice|heading=Active hurricane disclaimer|For the most up-to-date information on Hurricane Maria, please refer to the [http://www.nhc.noaa.gov/text/refresh/MIATCPAT5+shtml/ latest advisory from the National Hurricane Center]. Wikipedia is not meant to be used to [[WP:RISK|make life or death decisions]], and information on this page may be outdated.}}
{{Current weather event|tropical cyclone|date=September 2017}}

{{Infobox hurricane current
|name=Hurricane Maria
|category=cat5
|type=hurricane
|time=2:15 p.m [[Atlantic Time Zone|AST]] (18:15 [[Coordinated Universal Time|UTC]]) September 19
|image=Maria Geostationary VIS-IR 2017.png
|track=15L 2017 5day.png
|lat=16.6|N|lon=63.6|W
|distance_from=About 110 mi (175 km) [[Points of the compass|SE]] of [[Saint Croix]] About 140 mi (225 km) [[Points of the compass|W]] of [[Guadeloupe]]
|1sustained=145 kn (165 mph; 265 km/h)
|gusts=175 kn (200 mph; 320 km/h)
|pressure=920 [[Bar (unit)|mbar]] ([[Pascal (unit)|hPa]]; 27.17 [[Inches of Mercury|inHg]])
|movement=[[Points of the compass|WNW]] at 9 kn (10 mph; 17 km/h)
}}
'''Hurricane Maria''' is an extremely powerful [[tropical cyclone]] which recently made landfall on [[Dominica]], and is currently threatening the [[Leeward Islands]], [[Puerto Rico]], and the [[Dominican Republic]]. The thirteenth [[tropical cyclone naming|named storm]], seventh [[hurricane]], fourth [[major hurricane]], and second Category 5 hurricane of the unusually active [[2017 Atlantic hurricane season]], Maria formed on September 16 out of a [[tropical wave]] that was monitored by the [[National Hurricane Center]] beginning on September 14. It is the third major hurricane in a row to threaten the Leeward Islands with a direct strike or major impacts within two weeks, after [[Hurricane Irma]] caused catastrophic damage there and [[Hurricane Jose (2017)|Jose]], then a Category 4 hurricane, passed dangerously close just days after. At 23:30 UTC on September 18, Maria strengthened to a Category 5 hurricane, therefore making the [[2017 Atlantic hurricane season]] the first since [[2007 Atlantic hurricane season|2007]] to feature two Category 5 hurricanes, and [[List of Category 5 Atlantic hurricanes#Systems|one of only six Atlantic hurricane seasons]] to feature two or more Category 5 hurricanes, as well as only the second (after 2007) to feature two hurricanes making landfall at Category 5 intensity.

==Meteorological history==
{{Storm path|Maria 2017 track.png}}
The [[National Hurricane Center]] (NHC) began monitoring two [[tropical wave]]s on September 13.<ref>{{cite web|url=http://www.nhc.noaa.gov/archive/xgtwo/gtwo_archive.php?current_issuance=201709140241&basin=atl&fdays=5|title=Graphical Tropical Weather Outlook|work=National Hurricane Center|first1=Michael|last1=Brennan|date=September 13, 2017|accessdate=September 17, 2017}}</ref> The easternmost one quickly spun up into what would become [[2017 Atlantic hurricane season#Tropical Storm Lee|Tropical Storm Lee]], while the western one continued moving generally to the west. With generally favorable conditions in the disturbance's path, development into a tropical cyclone seemed likely.<ref>{{cite web|url=http://www.nhc.noaa.gov/archive/xgtwo/gtwo_archive.php?current_issuance=201709142033&basin=atl&fdays=5|title=Graphical Tropical Weather Outlook|work=National Hurricane Center|first1=Eric|last1=Blake|date=September 14, 2017|accessdate=September 17, 2017}}</ref> The disturbance became better organized throughout the two days,<ref>{{cite web|url=http://www.nhc.noaa.gov/archive/xgtwo/gtwo_archive.php?current_issuance=201709152035&basin=atl&fdays=5|title=Graphical Tropical Weather Outlook|work=National Hurricane Center|first1=Eric|last1=Blake|date=September 15, 2017|accessdate=September 17, 2017}}</ref> and by 15:00 UTC on September 16, the rate of organization was enough to classify the system as a potential tropical cyclone.<ref>{{cite web|url=http://www.nhc.noaa.gov/archive/2017/al15/al152017.discus.001.shtml?|title=Potential Tropical Cyclone Fifteen Discussion Number 1|first1=John|last1=Cangialosi|work=National Hurricane Center|date=September 16, 2017|accessdate=September 17, 2017}}</ref> As the disturbance continued to grow increasingly well-defined throughout the course of the day, it was later upgraded to a moderate-range tropical storm – based on satellite estimates – at 21:00 UTC that day, receiving the name ''Maria''.<ref>{{cite web|url=http://www.nhc.noaa.gov/archive/2017/al15/al152017.discus.002.shtml?|title=Tropical Storm Maria Discussion Number 2|first1=John|last1=Cangialosi|work=National Hurricane Center|date=September 16, 2017|accessdate=September 17, 2017}}</ref> A [[central dense overcast]] (CDO) developed atop the center of circulation, which enabled Maria to become further organized throughout the early morning hours of September 17.<ref>{{cite web|url=http://www.nhc.noaa.gov/archive/2017/al15/al152017.discus.004.shtml?|title=Tropical Storm Maria Discussion Number 4|first1=Richard|last1=Pasch|work=National Hurricane Center|date=September 17, 2017|accessdate=September 17, 2017}}</ref> Later that day, it was upgraded to a hurricane, based on reports from [[Hurricane Hunters]] that were investigating the storm.<ref>{{cite web|url=http://www.nhc.noaa.gov/archive/2017/al15/al152017.discus.005.shtml?|title=Hurricane Maria Discussion Number 6|first1=John|last1=Cangialosi|work=National Hurricane Center|date=September 17, 2017|accessdate=September 17, 2017}}</ref><ref name="usa today 1">{{cite web|last1=Stanglin|first1=Doug|title=Hurricane Jose ambles off U.S. coast as new Tropical Storm Maria tracks Irma's early path|url=https://www.usatoday.com/story/news/2017/09/16/hurricane-season-roars-tropical-storm-lee-forms-jose-threatens-east-coast/673482001/|website=[[USA Today]]|publisher=[[Gannett Company]]|accessdate=September 16, 2017|archiveurl=https://web.archive.org/web/20170916223638/https://www.usatoday.com/story/news/2017/09/16/hurricane-season-roars-tropical-storm-lee-forms-jose-threatens-east-coast/673482001/|archivedate=September 16, 2017|date=September 16, 2017}}</ref><ref name="weather channel 1">{{cite web|last1=Lam|first1=Linda|last2=Belles|first2=Jonathan|title=Tropical Storm Maria Expected to Rapidly Intensify On Approach to the Lesser Antilles; Hurricane Watches Issued|url=https://weather.com/storms/hurricane/news/tropical-storm-hurricane-maria-lesser-antilles|website=[[The Weather Channel]]|publisher=[[Landmark Media Enterprises]]|accessdate=September 16, 2017|archiveurl=https://web.archive.org/web/20170916223858/https://weather.com/storms/hurricane/news/tropical-storm-hurricane-maria-lesser-antilles|archivedate=September 16, 2017|date=September 16, 2017}}</ref> Shortly thereafter, Maria [[rapid deepening|explosively intensified]], with winds doubling from 80 mph (130 km/h) to 160 mph (260 km/h) in a 24-hour period, and the pressure decreasing from 982 mbar (hPa; 29.00 inHg) to 925 mbar (hPa; 28.23 inHg).<ref>{{Cite web|url=http://www.nhc.noaa.gov/archive/2017/al15/al152017.discus.011.shtml?|title=Hurricane MARIA|website=www.nhc.noaa.gov|access-date=2017-09-18}}</ref> About an hour later, Maria made landfall on [[Dominica]], becoming the first hurricane on record to make landfall on the island at Category 5 intensity.<ref name="Masters Cat 5 landfall">{{Cite web |url=https://www.wunderground.com/cat6/category-5-hurricane-maria-hits-dominica |title=Category 5 Hurricane Maria Hits Dominica |last=Masters |first=Date |date=September 18, 2017 |publisher=[[Weather Underground]] |access-date=September 18, 2017}}</ref> Land interaction caused Maria to slightly weaken to a high-end Category 4 hurricane,<ref>{{cite web|url=http://www.nhc.noaa.gov/archive/2017/al15/al152017.discus.013.shtml?|title=Hurricane Maria Discussion Number 13|first1=Richard|last1=Pasch|work=National Hurricane Center|date=September 19, 2017|accessdate=September 19, 2017}}</ref> but Maria regained Category 5 status shortly after its eyewall moved over Dominica.<ref>{{cite web|url=http://www.nhc.noaa.gov/archive/2017/al15/al152017.update.09190905.shtml?|title=Hurricane Maria Tropical Cyclone Update|first1=Richard|last1=Pasch|work=National Hurricane Center|date=September 19, 2017|accessdate=September 19, 2017}}</ref>

====Current storm information====
As of 2:15 p.m [[Atlantic Time Zone|AST]] (18:15 [[Coordinated Universal Time|UTC]]) September 19, Hurricane Maria was located near {{Coord|16.6|-63.6|name=Maria}}, about 110 miles (175 km) southeast of [[Saint Croix]], and about 140 miles (225 km) [[Points of the compass|west]] of [[Guadeloupe]]. Maximum sustained winds are 145 knots (165 mph; 265 km/h), a Category 5 on the [[Saffir–Simpson scale]], with gusts to 175 knots (200 mph; 320 km/h). The minimum barometric pressure is 920 millibars (hPa; 27.17 inHg). The system is moving west-northwest at 9 knots (10 mph; 17 km/h). Hurricane-force winds extend outward up to 35 miles (55 km) from the center of Maria, and tropical storm-force winds extended outward up to 140 miles (220 km) from the center.

For latest official information, see:
* The NHC's [http://www.nhc.noaa.gov/text/refresh/MIATCPAT5+shtml/ latest public advisory on Hurricane Maria]
* The NHC's [http://www.nhc.noaa.gov/text/refresh/MIATCMAT5+shtml/ latest forecast advisory on Hurricane Maria]
* The NHC's [http://www.nhc.noaa.gov/text/refresh/MIATCDAT5+shtml/ latest forecast discussion on Hurricane Maria]

====Watches and warnings====
{{HurricaneWarningsTable
|HUW=
* '''[[British Overseas Territories]]'''
** [[British Virgin Islands]]
** [[Montserrat]]
* '''[[Dominica]]'''
* '''[[Dominican Republic]]'''
** [[Cape Engaño (Dominican Republic)|Cabo Engaño]] to [[Puerto Plata, Dominican Republic|Puerto Plata]]
* '''[[France]]'''
** [[Guadeloupe]]
** [[Martinique]]
* '''[[Saint Kitts and Nevis]]'''
* '''[[United States]]'''
** [[United States Virgin Islands]]
** [[Puerto Rico]], including [[Culebra, Puerto Rico|Culebra]] and [[Vieques, Puerto Rico|Vieques]]
| HUA=
* '''[[British Overseas Territories]]'''
** [[Anguilla]]
* '''Dominican Republic'''
** [[Isla Saona]] to Cabo Engaño
* '''France'''
** [[Collectivity of Saint Martin|Saint Martin]]
** [[Saint Barthélemy]]
* '''[[Netherlands]]'''
** [[Saba]]
** [[Sint Eustatius]]
** [[Sint Maarten]]
|TRW=
* '''[[Antigua and Barbuda]]'''
* '''[[British Overseas Territories]]'''
** [[Anguilla]]
* '''Dominican Republic'''
** West of Puerto Plata to the northern border of the Dominican Republic and [[Haiti]]
** West of Cabo Engaño to Punta Palenque
* '''France'''
** [[Guadeloupe]]
* '''Netherlands'''
** Saba
** Sint Eustatius
** Sint Maarten
}}
{{clear}}

==Preparations==
Upon the initiation of the [[National Hurricane Center]] (NHC)'s first advisories for the system that would become Tropical Storm Maria on the morning of September 16, the government of [[France]] issued tropical storm watches for the islands of [[Martinique]] and [[Guadeloupe]], while [[St. Lucia]] issued a tropical storm watch for its citizens, and the government of [[Barbados]] issued a similar watch for [[Dominica]].<ref name="public advisory 1">{{cite web|last1=Cangialosi|first1=John|title=Potential Tropical Cyclone Fifteen Advisory Number 1|url=http://www.nhc.noaa.gov/archive/2017/al15/al152017.public.001.shtml?|website=[[National Hurricane Center]]|publisher=[[National Oceanic and Atmospheric Administration]] and [[National Weather Service]]|accessdate=September 16, 2017|archiveurl=https://web.archive.org/web/20170916215721/http://www.nhc.noaa.gov/archive/2017/al15/al152017.public.001.shtml|archivedate=September 16, 2017|date=September 16, 2017}}</ref> Barbados would later that day declare a tropical storm watch for its citizens and [[Saint Vincent and the Grenadines]].<ref name="public advisory 1a">{{cite web|last1=Cangialosi|first1=John|title=Tropical Depression Fifteen Intermediate Advisory Number 1A|url=http://www.nhc.noaa.gov/archive/2017/al15/al152017.public_a.001.shtml|website=[[National Hurricane Center]]|publisher=[[National Oceanic and Atmospheric Administration]] and [[National Weather Service]]|accessdate=September 16, 2017|archiveurl=https://web.archive.org/web/20170916220110/http://www.nhc.noaa.gov/archive/2017/al15/al152017.public_a.001.shtml|archivedate=September 16, 2017|date=September 16, 2017}}</ref> The government of [[Antigua and Barbuda]] issued Hurricane watches for the islands of [[Antigua]], [[Barbuda]], [[St. Kitts]], [[Nevis]], and [[Montserrat]] by the time of the NHC's second advisory which declared Maria a tropical storm.<ref name="public advisory 2">{{cite web|last1=Cangialosi|first1=John|title=Tropical Storm Maria Advisory Number 2|url=http://www.nhc.noaa.gov/archive/2017/al15/al152017.public.002.shtml|website=[[National Hurricane Center]]|publisher=[[National Oceanic and Atmospheric Administration]] and [[National Weather Service]]|accessdate=September 16, 2017|archiveurl=https://web.archive.org/web/20170916220327/http://www.nhc.noaa.gov/archive/2017/al15/al152017.public.002.shtml|archivedate=September 16, 2017|date=September 16, 2017}}</ref><ref name="washington post 1">{{cite web|last1=Porter|first1=Greg|title=Hurricane Jose lurks off the East Coast, Tropical Storm Maria threatens the Caribbean|url=https://www.washingtonpost.com/news/capital-weather-gang/wp/2017/09/16/hurricane-jose-lurks-off-the-east-coast-and-the-caribbean-faces-a-new-threat-as-tropics-remain-active/?utm_term=.e470cf551ff7|website=[[The Washington Post]]|publisher=[[Jeff Bezos|WP Company LLC]]|accessdate=September 16, 2017|archiveurl=https://web.archive.org/web/20170917000012/https://www.washingtonpost.com/news/capital-weather-gang/wp/2017/09/16/hurricane-jose-lurks-off-the-east-coast-and-the-caribbean-faces-a-new-threat-as-tropics-remain-active/?utm_term=.eca462e843ec|archivedate=September 16, 2017|date=September 16, 2017}}</ref> Evacuation orders were issued in Puerto Rico in advance of Maria, and officials announced that 450 shelters would be opened beginning during the afternoon of September 18.<ref>{{Cite news|title=Hurricane Maria upgraded to 'extremely dangerous' Category 4, islands including Puerto Rico brace for impact|last1=Shapiro|first1=Emily|last2=Hoyos|first2=Joshua|last3=Golembo|first3=Max|last4=Allen|first4=Karma|publisher=ABC News|date=September 18, 2017|accessdate=September 18, 2017}}</ref>
==Impact==
===Dominica===
Striking [[Dominica]] as a Category 5 hurricane, Maria caused severe damage. Roofs were blown off houses, including that of [[Prime Minister of Dominica|Prime Minister]] [[Roosevelt Skerrit]] who required rescue.<ref name="IBtimes PM roof">{{Cite web |url=http://www.ibtimes.com/hurricane-maria-now-category-5-blows-away-roof-dominica-pms-house-2591299 |title=Hurricane Maria, Now Category 5, Blows Away Roof Of Dominica PM's House |last=Paul |first=Pritha |date=September 19, 2017 |publisher=[[International Business Times]] |access-date=September 18, 2017}}</ref> Most of the island was left without cellular, radio, or internet service. Skerrit called the devastation "mind boggling" and indicated immediate priority was to rescue survivors rather than assess damage.<ref>{{cite news|author=Austin Ramzy|newspaper=New York Times|date=September 19, 2017|accessdate=September 19, 2017|title=Hurricane Maria Does ‘Mind Boggling’ Damage to Dominica, Leader Says|url=https://www.nytimes.com/2017/09/19/world/americas/hurricane-maria-caribbean.html}}</ref>

==See also==
{{Portal|Tropical cyclones}}
* [[List of Category 5 Atlantic hurricanes]]
**[[1928 Okeechobee hurricane|1928 San Felipe Segundo hurricane]] – The strongest and most destructive cyclone to affect Puerto Rico in modern times, the only recorded Category 5 hurricane to make landfall on the island
**[[Hurricane David]]
**[[Hurricane Irma]]
* [[1932 San Ciprian hurricane]] – the last major hurricane to strike Puerto Rico
* [[Hurricane Jose (2017)]]
* [[Hurricane Luis]]
* [[Hurricane Hortense]]
* [[Hurricane Marilyn]]
*[[Tropical cyclone#Climate change]]
*[[Tropical Storm Erika]] – devastated the island of Dominica with severe flooding
{{clear}}

==References==
{{Reflist|30em}}

==External links==
{{Commons category|Hurricane Maria (2017)|Hurricane Maria}}
* The National Hurricane Center (NHC)'s [http://www.nhc.noaa.gov/archive/2017/MARIA.shtml? advisory archive on Tropical Storm Maria]
* [https://weather.com/storms/hurricane-central/AL152017 Track and wind speed history] from [[The Weather Channel]]
{{Category 5 Atlantic hurricanes}}
{{2017 Atlantic hurricane season buttons}}

{{DEFAULTSORT:Maria}}
[[Category:2017 Atlantic hurricane season]]
[[Category:2017 in Dominica]]
[[Category:2017 in Martinique]]
[[Category:Category 5 Atlantic hurricanes]]
[[Category:Hurricanes in Dominica]]
[[Category:Hurricanes in Martinique]]
[[Category:September 2017 events in North America]]