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InfectionsatHighAltitude
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OxfordJournals
Medicine&Health
ClinicalInfectiousDiseases
Volume33,Issue11
Pp.18871891.
ClinicalInfectiousDiseases
cid.oxfordjournals.org
ClinInfectDis.(2001)33(11):18871891.doi:10.1086/324163
InfectionsatHighAltitude
Charles D. Ericsson, Section Editor, Robert Steffen, Section Editor, Buddha Basnyat1,2,
Thomas A. Cumbo3, and Robert Edelman4,5
+
Author Affiliations
Reprints or correspondence: Dr. Buddha Basnyat, Nepal International Clinic, Laldurbar, GPO
Box 3596, Kathmandu, Nepal (NIC@naxal.wlink.com.np).
Abstract
Every year, thousands of outdoor trekkers worldwide visit high-altitude
(>2500 m) destinations. Although high-altitude areas per se do not
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Table 1
microbial infection, but there are few data that systematically examine
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gastric pH [11]. Many high-altitude areas are snowbound; others are more
or less desert communities, such as the Tibetan Plateau, northern
Pakistan, and Afghanistan. A relative lack of water and sewage
most common cause of gastroenteritis in this cohort [12, 13]. In the Indian
subcontinent, the common causes of gastroenteritis are bacteria, Giardia,
and amoebas, in rank order [14]. Cyclospora cayetanensis appears on a
seasonal basis. Campylobacter species may cause a sizable number of
diarrhea cases. Guillain-Barr syndrome, often precipitated by
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NeurologicalInfections
Rabies infection is a serious concern for those venturing into wild parts of
Latin America, Africa, and Asia. Those going to high altitudes are at an
increased risk because they cannot readily avoid rabid animals and cannot
be treated quickly after exposure. Clinical knowledge of rabies prevention
is paramount, and one should have a very low threshold for descent and
diagnosed, probably due to the rarity of the Culex mosquito vector at such
altitudes. In the Indian subcontinent, JE must be differentiated from
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influenza poses a year-round risk, who are part of a large travel group, or
who are visiting the Southern Hemisphere during April through September
[30].
and frostbite are common in the mountain wilderness and predispose the
outdoor trekker to frequent and severe dermatological problems. In the
hypoxic high-altitude environment, wounds may heal slowly, despite
cellulitis and lymphangitis [33]. Descent to lower altitude may be the only
definitive treatment. Exposure to ultraviolet radiation and frigid weather
can reactivate herpes simplex infections. Scabies and lice are endemic. In
situations of trauma, burns, and surgical procedure at high altitude,
impaired immunity and poor hygiene associated with altitude may result in
a festering wound infection [28].
Local inhabitants commonly present with advanced cases of skin infections
that afflict visitors, but less severely. For example, septicemia and
osteomyelitis not uncommonly develop secondary to uncontrolled skin
infections in natives. Suppurative otitis media may predispose local
inhabitants to facial infection, bone infection, hearing loss, and
higher altitudes [35]. It may take weeks for Plasmodium falciparum and
months for P. vivax to manifest as a febrile illness after leaving the
lowlands for the mountains. Diagnosis is presumptive, and medical
evacuation from high altitude to a larger center is the norm. The
mainstays of malaria prevention when visiting endemic areas are mosquito
repellents and chemoprophylaxis.
Dengue fever, with Aedes aegypti mosquito vectors [36, 37], is endemic to
the tropics and subtropics, with transmission occurring between
approximately 25N and 25S latitude. Like malaria, travelers are infected
in the lowlands and become ill after reaching higher altitude. Diagnosis is
presumptive. Treatment is generally supportive and includes descent.
Prevention of mosquito bites should be stressed during pretravel
counseling. Dengue hemorrhagic fever occurs in natives at lower altitudes
and is rarely, if ever, seen in mountain travelers.
Typhus is probably an underdiagnosed cause of fever in mountain
travelers, although like most other infections at higher altitudes, the
prevalence is anecdotal. Typhus is caused by Rickettsia prowazekii, R.
typhi, R. tsutsugamushi vectored by lice, fleas, or mites, depending on
whether it is epidemic, endemic, or scrub typhus [38]. One individual
treated with ciprofloxacin for diarrhea and fever while outdoor trekking
did not improve and was subsequently diagnosed in Bangkok as having
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have increased their frequency of sexual activity, who have acquired new
partners, who have started antibiotic therapy, or who are unable to
maintain usual levels of personal hygiene are prone to sexually
genital herpes, and acute HIV infection may result, among other infections.
Urinary tract infections can be diagnosed in the field via urine dipstick, but
they are most often treated empirically. Descent is usually not necessary
unless severe pain and fever suggest pyelonephritis.
In essence, infections and infectious diseases at high altitude often
Table 2
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