Mileno M D, Bia F J
Department of Medicine, Brown University, Providence, Rhode Island, USA.
Infect Dis Clin North Am. 1998 Jun;12(2):369-412. doi: 10.1016/s0891-5520(05)70010-6.
Compromised travelers represent a diverse and challenging group of individuals. They include HIV-infected patients who are at risk for potentially adverse reactions to immunizations, and new exposures to enteric water-borne opportunistic pathogens associated with chronic infections. Such travelers may encounter unfamiliar opportunistic fungi and classical tropical infections, such as leishmaniasis, whose pathogenesis can be enhanced by the presence of prior HIV infection. Other immunocompromised groups include those who are functionally or anatomically asplenic, and patients who are iatrogenically immunosuppressed from medications utilized for solid organ transplantation, chemotherapy, or treatment of malignancies. This population of travelers also includes those with diabetes mellitus who may require adjustments in their dosing, administration, and possibly even the types of insulin used on their trips. These patients are also at greater risk for acquisition of tuberculosis, severe community-acquired pneumonia, urinary tract infections, and pyomyositis. Older travelers present both the infectious disease and travel medicine specialist with issues such events, malignancy-related infections, myocardial infarction, and other forms of cardiopulmonary compromise, which the authors address in this article.
免疫功能受损的旅行者是一个多样化且具有挑战性的群体。他们包括感染艾滋病毒的患者，这些患者在接种疫苗时可能有发生潜在不良反应的风险，以及新接触与慢性感染相关的肠道水源性机会性病原体。这类旅行者可能会遇到不熟悉的机会性真菌和经典的热带感染，如利什曼病，先前感染艾滋病毒会加剧其发病机制。其他免疫功能受损群体包括功能性或解剖性无脾者，以及因实体器官移植、化疗或恶性肿瘤治疗所用药物而医源性免疫抑制的患者。这类旅行者还包括糖尿病患者，他们在旅行期间可能需要调整胰岛素的剂量、给药方式，甚至可能需要调整胰岛素的类型。这些患者感染结核病、严重社区获得性肺炎、尿路感染和脓性肌炎的风险也更高。年长的旅行者给传染病和旅行医学专家带来了诸如此类事件、恶性肿瘤相关感染、心肌梗死和其他形式的心肺功能损害等问题，作者将在本文中对此进行探讨。
