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Infections at High Altitude PDF
Infections at High Altitude PDF
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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,
Reprints or correspondence: Dr. Buddha Basnyat, Nepal International Clinic, Laldurbar, GPO
Box 3596, Kathmandu, Nepal (NIC@naxal.wlink.com.np).
Abstract
Background
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climb to alpine and tundra zones at higher elevations.
Table 1
Infectious risks at high altitude.
GastrointestinalInfections
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elevations, decreased prevalence of flies (the result of cold weather) and
hypoxic stress may decrease risk of transmission. A recent study in the
Himalayas found that 14% of a cohort of foreign outdoor trekkers
developed gastroenteritis [10]. This incidence of gastrointestinal
symptoms is half that seen at lower altitudes. Nevertheless, risk factors do
exist at altitude. Factors that promote the spread of enteric pathogens at
high altitude include cramped sleeping arrangements, poor hygiene, and
concurrent illness and medications such as ranitidine that increase the
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
management facilities in such locales exacerbates the risk of diarrhea.
HepatitisAAndHepatitisE
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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
evacuation for rabies immunoglobulin and postexposure immunization in
the event of a dog or monkey bite in the mountains. Those considering
long wilderness trips should be strongly encouraged to receive rabies
immunization.
RespiratoryInfections
Respiratory problems are common at high altitude [10, 24, 25]. Symptoms
are exacerbated by hypoxic conditions, crowding into tents and huts,
smoky wood stoves, and cold, dry air [26]. Common manifestations
include sinusitis, pharyngitis, bronchitis, and pneumonia. Sore throat and
cough are common above 4000 m. Just like the ubiquitous Khumbu cough
in the Nepal Himalayas, bronchitis in Aconcagua climbers was seen in 13
of 19 climbers at 4300 m [27]. The cough can be purulent or dry, and it
can be severe enough to cause rib fractures. Nasal congestion may worsen
hypoxemia, especially at night when excessive oxygen desaturation is
common during episodes of periodic breathing. Respiratory infections may
predispose the outdoor trekker to acute mountain sickness [10, 24, 25]. In
fact, if acute altitude sickness develops after a respiratory infection,
further ascent up the mountain may need to be postponed because life-
threatening high-altitude cerebral edema or pulmonary edema may result.
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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].
DermatologicalInfections
InsectborneInfections
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.
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typhus; treatment with doxycycline resulted in rapid improvement
(unpublished data).
OtherInfections
Table 2
Infection and preventive measures at high altitude.
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