Lower Respiratory Tract Infection: An Unrecognised Risk Factor for High Altitude Pulmonary Edema?

Abstract

The case of a 25-year-old expedition doctor who developed high altitude pulmonary oedema (HAPE) while climbing in the Swiss Alps is presented, with reference to the literature. The patient's symptoms of HAPE were typical. Less typical was the fact that the doctor had previously been to similar altitudes uneventfully. The only differentiator is that on this expedition he developed a mild lower respiratory tract infection (LRTI) 2 days prior to travel. There has been limited, conflicting evidence regarding LRTI as a risk factor for HAPE and high quality research has not focused on this area. LRTI is not commonly recognised as being a risk in high altitude environments, which may be resulting in lethal consequences. This report aims to inform, provide a clinical question for future high altitude research expeditions, and encourage consideration by expedition and high altitude doctors. LEARNING POINTS• Lower respiratory tract infection (LRTI) may be a significant risk factor in the development of high altitude pulmonary oedema (HAPE).• The diagnosis of HAPE is clinical as investigations have been shown to be unreliable.• The Lake Louise HAPE criteria provide a reasonable identification framework but may miss the early stages.

Risk factors underlying high-altitude pulmonary edema in the Ecuadorian Andes

“…HAPE is a life-threatening condition [1] produced by a rapid accumulation of extravascular uid ooding the pulmonary alveoli [5,6]. However, the precise pathophysiology of HAPE is not well understood [7][8][9][10][11].…”