Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Is tuberculosis (TB) a problem for outdoor enthusiasts? Usually not, although if one travels abroad, there is an entirely different level of risk. There has been recent publicity about a man with a drug-resistant form of TB who exposed fellow airline passengers. Persons with diseases or taking medications that cause immunosuppression are more vulnerable to many germs, including the ones that cause TB.

TB is caused most commonly by the tubercle bacillus Mycobacterium tuberculosis; related species may also cause tuberculous disease. The germs are spread in tiny droplets and particles by the airborne route, namely, coughing and sneezing. When the bacilli take up residence in the human lung(s), they invade healthy tissue and cause infection. Lung tissue can be destroyed, sometimes to a great extent. Furthermore, the microbes can spread through the blood stream and lymph system to affect virtually every organ system, so a person may become extremely ill and die from the disease.

Typical symptoms of TB lung infection include cough with or without chest pain, fever, chills, sweating at night ("night sweats"), poor appetite and weight loss, and weakness. When TB is diagnosed by examination of sputum coughed up by the victim, sputum or tissue culture, x-rays, and skin testing, the victim is treated with many months of antibiotic therapy.

We live in an age of many drug-resistant germs, presumably because the use of antibiotics has allowed these germs to flourish. To make matters worse, there is a "dormant" form of TB, in which a person is infected but does not show any overt manifestation of the disease. Because so many cases of TB occur in countries other than the United States, the incidence of drug-resistant TB is higher outside North America than within its boundaries. We now even refer to "extensively drug resistant" TB, or EDR TB. So, as with many diseases to which Americans have become relatively unfamiliar, we should consider TB to be very high on the list of infectious concerns for foreign travelers.

Is there a way to limit exposure? In a hospital setting, this is done by isolating patients with known or suspected TB, using face masks, and keeping patients with TB or other communicable respiratory diseases in rooms with special ventilation, such that the air within the room can be removed and vented up to a dozen times a day. However, in the population and world at large, one might only be able to carry a face mask for use in a restricted environment and to avoid persons known or suspected to have TB. There is no particular geography that poses a special risk, but travelers are advised to wear a face mask, such as the N95, around persons with any illness that causes them to cough.

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.