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Infectious Diseases at High Altitude

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  • Authors: Buddha Basnyat1, Jennifer M. Starling2
  • Editor: David Schlossberg3
  • VIEW AFFILIATIONS HIDE AFFILIATIONS
    Affiliations: 1: Oxford University Clinical Research Unit-Nepal, Nepal International Clinic, Lal Durbar Marg, Kathmandu, Nepal; 2: University of Colorado School of Medicine, Department of Emergency Medicine, Denver, CO 80045; 3: Philadelphia Health Department, Philadelphia, PA
  • Source: microbiolspec August 2015 vol. 3 no. 4 doi:10.1128/microbiolspec.IOL5-0006-2015
  • Received 22 February 2015 Accepted 30 March 2015 Published 13 August 2015
  • Buddha Basnyat, Buddhabasnyat@gmail.com
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  • Abstract:

    Travel to elevations above 2,500 m is an increasingly common activity undertaken by a diverse population of individuals. These may be trekkers, climbers, miners in high-altitude sites in South America, and more recently, soldiers deployed for high-altitude duty in remote areas of the world. What is also being increasingly recognized is the plight of the millions of pilgrims, many with comorbidities, who annually ascend to high-altitude sacred areas. There are also 400 million people who reside permanently in high mountain ranges, which cover one-fifth of the Earth’s surface. Many of these high-altitude areas are in developing countries, for example, the Himalayan range in South Asia. Although high-altitude areas may not harbor any specific infectious disease agents, it is important to know about the pathogens encountered in the mountains to be better able to help both the ill sojourner and the native high-altitude dweller. Often the same pathogens prevalent in the surrounding lowlands are found at high altitude, but various factors such as immunomodulation, hypoxia, poor physiological adaptation, and harsh environmental stressors at high altitude may enhance susceptibility to these pathogens. Against this background, various gastrointestinal, respiratory, dermatological, neurological, and other infections encountered at high altitude are discussed.

  • Citation: Basnyat B, Starling J. 2015. Infectious Diseases at High Altitude. Microbiol Spectrum 3(4):IOL5-0006-2015. doi:10.1128/microbiolspec.IOL5-0006-2015.

Key Concept Ranking

Upper Respiratory Tract Infections
0.48952478
Infection and Immunity
0.47019675
Infectious Diseases
0.42775202
0.48952478

References

1. Basnyat B. 2014. High altitude pilgrimage medicine. High Alt Med Biol 15:434–439. [PubMed][CrossRef]
2. Basnyat B, Cumbo TA, Edelman TA. 2001. Infections at high altitude. Clin Infect Dis 33:1887–1991. [PubMed][CrossRef]
3. Basnyat B, Tabin G. 2015. Altitude illness, p e476. In Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J (ed), Harrison’s Principles of Internal Medicine, 19th ed. McGraw Hill, New York, NY.
4. Brunette GW (ed). 2014. CDC Health Information for International Travel 2014: The Yellow Book. Oxford University Press, New York, NY.
5. Hackett PH, Roach RC. 2011. High-altitude medicine, p 2–33. In Auerbach PS (ed), Wilderness Medicine. C. V. Mosby, St. Louis, MO.
6. Kleessen B, Schroedl W, Stueck M, Richter A, Richter O, Rieck O, Krueger M. 2005. Microbial and immunological responses relative to high-altitude exposure in mountaineers. Med Sci Sports Exerc 37:1313–1318. [PubMed][CrossRef]
7. Mazzeo RS, Swenson ER. 2014. Immune system, p 271–284. In Swenson ER, Bartsch P (ed), High Altitude: Human Adaptation to Hypoxia. Springer, New York, NY. [CrossRef]
8. Mishra KP, Ganju L. 2010. Influence of high altitude exposure on the immune system: a review. Immunol Invest 39:219–234. [PubMed][CrossRef]
9. Pandey P, Bodhidatta L, Lewis M, Murphy H, Shlim DR, Cave W, Rajah R, Springer M, Batchelor T, Sornsakrin S, Mason CJ. 2011. Travelers’ diarrhea in Nepal: an update on the pathogens and antibiotic resistance. J Travel Med 18:102–108. [PubMed][CrossRef]
10. Thompson CN, Blacksell SD, Paris DH, Arjyal A, Karkey A, Dongol S, Giri A, Dolecek C, Day N, Baker S, Thwaites G, Farrar J, Basnyat B. 2015. Undifferentiated febrile illness in Kathmandu, Nepal. Am J Trop Med Hyg 9:875–878. [PubMed][CrossRef]
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/content/journal/microbiolspec/10.1128/microbiolspec.IOL5-0006-2015
2015-08-13
2017-11-23

Abstract:

Travel to elevations above 2,500 m is an increasingly common activity undertaken by a diverse population of individuals. These may be trekkers, climbers, miners in high-altitude sites in South America, and more recently, soldiers deployed for high-altitude duty in remote areas of the world. What is also being increasingly recognized is the plight of the millions of pilgrims, many with comorbidities, who annually ascend to high-altitude sacred areas. There are also 400 million people who reside permanently in high mountain ranges, which cover one-fifth of the Earth’s surface. Many of these high-altitude areas are in developing countries, for example, the Himalayan range in South Asia. Although high-altitude areas may not harbor any specific infectious disease agents, it is important to know about the pathogens encountered in the mountains to be better able to help both the ill sojourner and the native high-altitude dweller. Often the same pathogens prevalent in the surrounding lowlands are found at high altitude, but various factors such as immunomodulation, hypoxia, poor physiological adaptation, and harsh environmental stressors at high altitude may enhance susceptibility to these pathogens. Against this background, various gastrointestinal, respiratory, dermatological, neurological, and other infections encountered at high altitude are discussed.

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Figures

Image of FIGURE 1
FIGURE 1

High-altitude evacuation of an ill Nepalese woman in the Himalayas from Dingboche to Kathmandu, Nepal. Photo by Jennifer M. Starling. doi:10.1128/microbiolspec.IOL5-0006-2015.f1

Source: microbiolspec August 2015 vol. 3 no. 4 doi:10.1128/microbiolspec.IOL5-0006-2015
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Image of FIGURE 2A
FIGURE 2A

High-altitude evacuation of a Nepalese porter in the Himalayas by the Himalayan Rescue Association in Pheriche, Nepal. This patient was diagnosed with pneumonia complicated by HAPE. He was febrile, tachycardic to 149, and his oxygen saturation was 67% without supplemental oxygen. Photos by Jennifer M. Starling. doi:10.1128/microbiolspec.IOL5-0006-2015.f2a

Source: microbiolspec August 2015 vol. 3 no. 4 doi:10.1128/microbiolspec.IOL5-0006-2015
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Image of FIGURE 2B
FIGURE 2B

High-altitude evacuation of a Nepalese porter in the Himalayas by the Himalayan Rescue Association in Pheriche, Nepal. This patient was diagnosed with pneumonia complicated by HAPE. He was febrile, tachycardic to 149, and his oxygen saturation was 67% without supplemental oxygen. Photos by Jennifer M. Starling. doi:10.1128/microbiolspec.IOL5-0006-2015.f2b

Source: microbiolspec August 2015 vol. 3 no. 4 doi:10.1128/microbiolspec.IOL5-0006-2015
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Tables

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TABLE 1

Infectious risks at high altitude

Source: microbiolspec August 2015 vol. 3 no. 4 doi:10.1128/microbiolspec.IOL5-0006-2015

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