INFECTIONS - Medicine for Mountaineering and Other Wilderness Activities - page 311

Leptospirosis is an infection acquired from fresh water or soil contaminated by urine
from infected animals. Outbreaks have been associated with adventure travel, particularly
water sports such as kayaking, white water rafting, and swimming in tropical rivers. The
illness is biphasic. The first phase is characterized by a flulike illness typified by fever,
chills, headache, muscle pains, and nausea. It usually lasts four to seven days. Conjunctiv-
itis with red eyes and muscle tenderness help confirm the diagnosis.
The second phase is immune mediated and characterized by uveitis (redness of the eye,
blurred vision, sensitivity to light or photophobia, and eye pain), a rash, and rarely car-
diovascular collapse. Jaundice, renal failure, severe respiratory distress, and hemorrhagic
phenomena such as bleeding into the skin may develop. Pulmonary involvement occurs in
20 to 70 percent of infected individuals. Approximately 5 to 10 percent of such severe in-
fections are fatal.
Doxycycline is the preferred therapy for early disease. Intravenous penicillin and hos-
pitalization in an intensive care unit often are required for severe infections. Doxycycline
provides effective chemoprophylaxis.
More information is available at www.cdc.gov/ncidod/dbmd/diseaseinfo/leptospiros-
is_g.htm .
Tuberculosis
Tuberculosis is a slowly progressive, chronic infection that is a huge health burden and
a major cause of death worldwide. Much of the tuberculosis in developing countries has
become resistant to the drugs available for treatment. Few individuals with an active infec-
tion would feel well enough to take part in a wilderness expedition, and such an infection
would almost always be detected by a physician before the outing began. The major prob-
lem for travelers is avoiding being infected by individuals with active infection.
Two features characterize active infection and should help travelers recognize individu-
als harboring them. First, pulmonary tuberculosis is the most common form of infection
and the type that is most often spread. Individuals with active pulmonary tuberculosis have
achroniccough,andmaterial isusuallycoughedup.Thesputumtypically isthickandyel-
low and may be bloody, but if the person swallows the material that is coughed up no one
can see it.
The second typical feature results from the long-standing nature of the infection and the
debilitation that accompanies it. Infected individuals appear chronically ill. Most have lost
a significant amount of weight. They look sick.
Not everyone with active tuberculosis presents these features, and such individuals are
much more difficult to recognize. However, travelers should avoid close proximity to indi-
viduals with typical features.
Avoiding contact with infected individuals may be easier said than done. On city streets
of developing countries discerning travelers can give people that appear to have active in-