Chapter 15 : Infectious Diseases at High Altitude

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Many host and environmental factors enhance susceptibility to infectious diseases, such as altered immune responses, hypoxia, physiological adaptation or lack of such adaptation, environmental stressors, increased UV radiation, cramped quarters, inability to maintain personal hygiene, and isolation from adequate medical care. The risk of contracting an infection varies depending on location, length of exposure, and nature of the high-altitude activity. There are few published data on this topic, and as a result, portions of this chapter are anecdotal and based on personal medical experience. Cysticercosis of the brain is one of the most common causes of epilepsy in Nepal. Respiratory problems are common at high altitudes. Arthropod-borne infections are extremely common in travel to developing countries, but arthropod vectors are less common at higher altitudes. Sexually transmitted diseases, fungal vaginitis, and urinary tract infections are usually present in typical fashion at high altitude. Physicians counseling patients who travel with cancer, human immunodeficiency virus, chronic steroid or other immunosuppressive medication use, functional or anatomic asplenia, and renal insufficiency should familiarize themselves and their patients with the travel risks associated with these conditions. The differential diagnosis of illness at high altitude includes other conditions that may be misdiagnosed as an infection. Physicians who may treat infectious diseases at high altitude should carry appropriate chemotherapy and supportive equipment. In essence, infections and infectious diseases at high altitude often parallel those in adjacent lowland environments.

Citation: Basnyat B, Cumbo T, Edelman R. 2009. Infectious Diseases at High Altitude, p 349-357. In Schlossberg D (ed), Infections of Leisure, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815950.ch15

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Upper Respiratory Tract Infections
Infectious Diseases
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High-altitude evacuation of an ill Nepalese woman in the Himalayas during the Hindu festival of Janai Purnima in August 2000 near Lake Gosainkunda, Lang-Tang Region, Nepal. Photo by Paul Joseph Cumbo.

Citation: Basnyat B, Cumbo T, Edelman R. 2009. Infectious Diseases at High Altitude, p 349-357. In Schlossberg D (ed), Infections of Leisure, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815950.ch15
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1. Abramowicz, M. 2006. Advice to travelers 2006, p. 25–34. In Treatment Guidelines, vol. 4. Medical Letter Inc., New York, NY.
2. Albrecht, C.,, T. A. Cumbo, and, S. Gambert. 2003. Health issues, travel, and the elderly. Clin. Geriatr. 11:2433.
3. Bailey,, D. M.,, B. Davies, L. M. Castell,, D. J. Collier,, J. S. Milledge,, D. A. Hullin,, P. S. Seddon, and, I. S. Young. 2003. Symptoms of infection and acute mountain sickness; associated metabolic sequelae and problems in differential diagnosis. High Alt. Med. Biol. 4:319331.
4. Basnyat, B., and, D. Murdoch. 2003. High altitude illness: an update of pathophysiology, prevention, and treatment. Lancet 361:19671974.
5. Basnyat, B.,, T. A. Cumbo, and, R. Edelman. 2000. Acute medical problems in the Himalayas outside the setting of altitude illness. High Alt. Med. Biol. 1:167174.
6. Basnyat, B.,, T. A. Cumbo, and, R. Edelman. 2001. Infections at high altitude. Clin. Infect. Dis. 33:18871891.
7. Basnyat, B.,, J. Lemaster, and, J. A. Litch. 1999. Everest or bust: a cross sectional epidemiological study in the Himalayas at 4300 meters. Aviat. Space Environ. Med. 70:867873.
8. Basnyat, B., and, J. A. Litch. 1997. Medical problems of porters and trekkers in the Nepal Himalaya. Wilderness Environ. Med. 8:7881.
9. Basnyat, B.,, A. P. Maskey,, M. D. Zimmerman, and, D. R. Murdoch. 2005. Enteric (typhoid) fever in travellers. Clin. Infect. Dis. 41:14671472.
10. Basnyat,, B.,, D. Subedi,, J. Sleggs,, G. Bhasyal,, B. Aryal, and, N. Subedi. 2000. Disoriented and ataxic pilgrims: an epidemiological study of acute mountain sickness and high-altitude cerebral edema at a sacred lake at 4300 meters in the Nepal Himalayas. Wilderness Environ. Med. 11:8993.
11. Reference deleted.
12. Biselli, R.,, S. Le Moli,, P. M. Matricardi,, S. Farrace,, A. Fattorossi,, R. Nisini, and, R. D’Amelio. 1991. The effects of hypobaric hypoxia on specific B cell responses following immunization in mice and humans. Aviat. Space Environ. Med. 62:870874.
13. Bishop, R. A., and, J. A. Litch. 2000. Malaria at high altitude. J. Travel Med. 7:157158.
14. Carpenter, R. C.,, J. T. Reeves, and, A. G. Durmowicz. 1998. Viral respiratory infection increases susceptibility of young rats to hypoxiainduced pulmonary edema. J. Appl. Physiol. 84:10481054.
15. Epstein,, P. R.,, H. F. Diaz,, S. Elias,, G. Grabherr,, N. E. Graham,, W. J. M. Martens,, E. Mosley-Thompson, and, E. J. Susskind. 1998. Biological and physical signs of climate change: focus on mosquito-borne disease. Bull. Am. Meteorol. Soc. 78:409417.
16. Giesbrecht, G. G. 1995. The respiratory system in a cold environment. Aviat. Space Environ. Med. 66:890902.
17. Hackett, P. H., and, R. C. Roach. 2007. High-altitude medicine, p. 2–36. In P. S. Auerbach (ed.), Wilderness Medicine. C. V. Mosby, St. Louis, MO.
18. Harris, M. D.,, J. Terrio,, W. F. Miser, and, J. F. Yetter III. 1998. High-altitude medicine. Am. Fam. Physician 57:19071914, 19241926.
19. Hartmann,, G.,, M. Tschop,, R. Fischer,, C. Bidlingmaier,, R. Riepl,, K. Tschop,, H. Hautmann,, S. Endres, and, M. Toepfer. 2000. High altitude increases circulating interleukin-6, interleukin-1 receptor antagonist and C-reactive protein. Cytokine 12:246252.
20. Heap, B. J. 1990. Cerebral cysticercosis as a common cause of epilepsy in Gurkhas in Hong Kong. J. R. Army Med. Corps 136:146149.
21. Houston, R., and, E. Schwartz. 1990. Helminthic infections among Peace Corps volunteers in Nepal. JAMA 263:373374.
22. Hug,, D. H.,, J. K. Hunter, and, D. D. Dunkerson. 2001. Malnutrition, urocanic acid, and sun may interact to suppress immunity in sojourners to high altitude. Aviat. Space Environ. Med. 72:136145.
23. Junkett, G. 1999. Prevention and treatment of traveler’s diarrhea. Am. Fam. Physician 60:119124, 135136.
24. Leader, R. A., and, V. N. Low. 1995. Tuberculosis of the abdomen. Radiol. Clin. N. Am. 33:691.
25. Magill, A. J. 1998. Fever in the returned traveler. Infect. Dis. Clin. N. Am. 12:445469.
26. Mason, N. P., and, P. W. Barry. 2007. Altitude-related cough. Pulm. Pharmacol. Ther. 20:388395.
27. Maquina, C., and, E. Gotuzzo. 2000. Bartonellosis: new and old. Infect. Dis. Clin. N. Am. 14:122.
28. McFadden,, E. R. 1987. The lower airway, p. 234–245. In J. R. Sutton,, C. S. Houston, and, G. Coates (ed.), Hypoxia and Cold. Praeger, New York, NY.
29. Meehan,, R.,, U. Duncan,, L. Neale,, G. Taylor,, H. Muchmore,, N. Scott,, K. Ramsey,, E. Smith,, P. Rock,, R. Goldblum, and, C. Houstan. 1988. Operation Everest II: alterations in the immune system at high altitudes. J. Clin. Immunol. 8:397406.
30. Meehan, R. T. 1987. Immune suppression at high altitude. Ann. Emerg. Med. 16:974979.
31. Murdoch, D. R. 1995. Symptoms of infection and altitude illness among hikers in the Mount Everest region of Nepal. Aviat. Space Environ. Med. 66:148151.
32. Murphy, G. S., and, E. C. Oldfield III. 1996. Falciparum malaria. Infect. Dis. Clin. N. Am. 10:747775.
33. Olender,, S.,, S. Mayuko,, J. Apgar,, K. Gillenwater,, C. T. Bautista,, A. G. Lescano,, P. Moro,, L. Caviedes,, E. J. Hsieh, and, R. H. Gilman. 2003. Low prevalence and increased household clustering of Mycobacterium tuberculosis infection in high altitude villages in Peru. Am. J. Trop. Med. Hyg. 68:721727.
34. Pandey, M. R.,, B. Basnayt, and, R. P. Neupane. 1988. Chronic bronchitis and cor pulmonale in Nepal. J. Inst. Med. 10:263270.
35. Sarnquist, F. H. 1983. Physicians on Mount Everest: a clinical account of the 1981 American medical research expedition to Everest. West. J. Med. 139:480485.
36. Schwartz, E.,, E. Mendelson, and, Y. Sidi. 1996. Dengue fever among travelers. Am. J. Med. 101:516520.
37. Shlim, D. R., and, B. L. Innis. 2000. Hepatitis E vaccine for travelers. J. Travel Med. 7:167169.
38. Shlim, D. R. 1999. Traveler’s diarrhea. Wilderness Environ. Med. 10:165170.
39. Taylor, R. R.,, B. Basnyat, and, R. M. Scott. 2008. A diplomatic disease. J. Travel Med. 15:200201.
40. Tiollier,, E.,, L. Schmitt,, P. Burnat,, J. P. Fouillot,, P. Robach,, E. Filaire,, C. Y. Guezennec, and, J. P. Richalet. 2005. Living hightraining low altitude training: effects on mucosal immunity. Eur. J. Appl. Physiol. 94:298304.
41. Wainwright, M.,, N. C. Wickramasinghe,, J. V. Narlikar, and, P. Rajaratnam. 2003. Microorganisms cultured from stratospheric air samples obtained at 41km. FEMS Microbiol. Lett. 218:161165.
42. West, J. B. 1998. High Life: a History of High Altitude Physiology and Medicine, p. 160. Oxford University Press, Oxford, United Kingdom.
43. Zafren, K.,, B. Basnyat, and, G. Basnyat. 2009. Clinical images: a pneumonic confusion. Wilderness Environ. Med. 20:8182.


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Infectious risks at high altitude

Citation: Basnyat B, Cumbo T, Edelman R. 2009. Infectious Diseases at High Altitude, p 349-357. In Schlossberg D (ed), Infections of Leisure, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815950.ch15

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