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1、INVITEDARTICLETRAVELMEDICINECharlesD.EricssonandRobertSteffen,SectionEditorsInfectionsatHighAltitudeBuddhaBasnyat,1,2ThomasA.Cumbo,3andRobertEdelman4,51NepalInternationalClinic/HimalayaRescueAssociation,DepartmentofHumanPhysiology,TribhuvanUniversity,and2PatanHospital,Kathm
2、andu,Nepal;3JohnsHopkinsUniversity/SinaiHospitalofBaltimorePrograminInternal,Medicine,4DivisionofGeographicMedicine,DepartmentofMedicine,DivisionofInfectiousDiseasesandTropicalPediatrics,DepartmentofPediatrics,andTravelers’HealthClinic,UniversityofMarylandFacultyPractice,an
3、d5ClinicalResearch,CenterforVaccineDevelopment,UniversityofMarylandSchoolofMedicine,BaltimoreEveryyear,thousandsofoutdoortrekkersworldwidevisithigh-altitude(12500m)destinations.Althoughhigh-altitudeareaspersedonotharboranyspecificagents,itisimportanttoknowthepathogensencount
4、eredinthemountainstobebetterabletohelptheillsojournerathighaltitude.Thesearethesamepathogensprevalentinthesurroundinglowlands,butvariousfactorssuchasimmunomodulation,hypoxia,physiologicaladaptation,andharshenvironmentalstressorsathighaltitudemayenhancesusceptibilitytothesep
5、athogens.Againstthisbackground,variousgastrointestinal,respiratory,der-matological,neurological,andotherinfectionsencounteredathighaltitudearediscussed.Becausetherearefewpublisheddataoninfectionsathighaltitude,thisreviewislargelyanecdotalandbasedonpersonalexperience.Inthisr
6、eview,weidentifyanddiscussinfectionscommonlyrangesindevelopingcountriesattracttravelersfromdevelopedencounteredathighaltitude.Becausetherearefewpublishedcountrieswhohavehadnopreviousexposuretothearea’sdataoninfectionsataltitude,thisreviewismoreanecdotalinindigenouspathogens
7、.Thetravelertohighaltitudestypicallynatureandlargelybasedonourpersonalexperience.Althoughtreksorclimbsthroughseveralecosystemsenroute,fromtrop-2ofus(B.B.andT.A.C.)havemedicalexperienceinmosticaljungleordesertatthebaseoftheclimbtoalpineandpopularmountainranges,mostofourtimei
8、sspentinthetundrazonesathigherelevations.Himalayas,andweemphasizetheHimalayasinthi
