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Chapter 15 : Infectious Diseases at High Altitude
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.