Institute of Occupational and Social Medicine, RWTH Aachen University, Aachen, Germany.
Travel Med Infect Dis. 2010 Jan;8(1):22-8. doi: 10.1016/j.tmaid.2009.11.001. Epub 2009 Dec 14.
This case highlights the difficulties associated with the differential diagnosis of pulmonary symptoms in patients with pre-existing diseases in extreme environmental conditions. A 58-year-old man with child-onset allergic asthma developed dyspnoea and an acute non-productive cough during a trekking expedition on Mt. Kilimanjaro (5895m) in Tanzania. The symptoms were believed initially to be linked to the high altitude exposure (high altitude pulmonary oedema (HAPE) or high altitude cough) or his pre-existing asthma. However, he was later diagnosed correctly with a reinfection of Bordetella pertussis. Pertussis is a highly communicable disease with potentially serious medical consequences that could have affected all of the expedition members. The effectiveness of a pertussis vaccine declines 4-12 years after the vaccination. Thus, it is suggested that the status of immunisation against pertussis should be checked along with those of other infections prior to travel.
本病例强调了在极端环境条件下，患有基础疾病的患者出现肺部症状时进行鉴别诊断的困难。一名 58 岁男子，自幼患有过敏性哮喘，在坦桑尼亚乞力马扎罗山（海拔 5895 米）徒步旅行时出现呼吸困难和急性干咳。最初，人们认为这些症状与高海拔暴露有关（高原肺水肿（HAPE）或高原咳嗽）或他的基础哮喘。然而，后来他被正确诊断为百日咳博德特氏菌的再感染。百日咳是一种高度传染性疾病，可能会导致严重的医疗后果，这可能会影响到所有的探险成员。百日咳疫苗接种后的 4-12 年内，其有效性会下降。因此，建议在旅行前，应与其他感染一样，检查针对百日咳的免疫接种情况。
