Pulmonary Tuberculosis Reactivation: Triggered by the Descent in Altitude?

Abstract

High altitudes are linked to decreased rates of pulmonary tuberculosis infection, disease and mortality. However, its relevance as a trigger for pulmonary tuberculosis reactivation in immunocompetent patients is not documented. A 28-year-old healthy Nepalese female was admitted in the emergency department with sudden left pleuritic back pain with shortness of breath, two weeks after arriving in Lisbon, having arrived from Kathmandu and undergone a change in altitude of 1400 metres. She also had evening low-grade fever and fatigue since she arrived. Her mother-in-law had died of tuberculosis two years before. Chest radiography and computed tomography scan showed a left upper lobe consolidation. Laboratory analyses were 79 mm/sec. Human immunodeficiency virus serology, blood cultures and urinary antigen testing were negative. Bronchial secretions’ cultures became positive for Mycobacterium tuberculosis complex. The patient was started on anti-tuberculous treatment and made a steady recovery. This case reports a probable reactivation of pulmonary tuberculosis infection that could have been triggered by altitude differences.

Case Report: A Great Mimicker of Neoplasm: Pulmonary Cryptococcosis in an Immunocompetent Host After High-Altitude Descent

“…A recent case report documented a healthy 28-year-old female from Nepal with tuberculosis reactivation after descending 1,400 m, urging researchers to clarify the role that altitude descent may play as a risk factor for diseases susceptible to altitudeassociated reactivation. 11 We speculate that the altitude of Tibet, with elevations ranging from 4,000 to 8,000 m above sea level, may support cryptococcosis latency in the immunocompetent host. 12 Upon this evidence, it may be hypothesized that at higher altitudes, natural selection may yield Cryptococcus resistance to lower oxygen tension, within the immunocompetent host, thus potentiating pathogenicity and symptomatic presentation upon descent.…”