Infectious Disease & Wilderness Medicine

The recognition, treatment, and management of infectious processes is critical for individuals traveling into the wilderness. Particularly in a resource- limited environment, individuals exposed to infectious disease in the wilderness can experience sequalae not commonly observed in the hospital-based urban clinical environment. In the United States, several infectious pathogens are well known to contribute to the development of infection in the wilderness setting. The purpose of this review is to discuss the treatable infectious diseases encountered by individuals venturing into the wilderness of the United States of America. Diligent preparation stands as the cornerstone for safe and rewarding outdoor adventures. By performing critical analysis of current literature, we seek to offer a comprehensive guide on the identification and management of infectious agents that pose a risk to the outdoors people of the United States.

Current literature regarding infectious disease in the wilderness consistently highlights the diversity of pathogens encountered in the wild. However, the most common clinical manifestation acquired in the wilderness is diarrhea (Auerbach in Wilderness Medicine (7th ed.). Elsevier, 2017 [1], Victora et al. in Bull. World Health Organ. 78:(10), 1246, 2000 [2]). Frequently transmitted through fecal–oral route, contaminated water sources are frequently implicated in these cases (Auerbach in Wilderness Medicine (5th ed). Elsevier, 2018 [3], https://www.cdc.gov/healthywater/drinking/travel/backcountry_water_treatment.html, www.cdc.gov/eid). Tick-borne illnesses also represent a major avenue by which wilderness explorers become infected (Openshaw et al. in Am J Trop Med Hyg. 83(1), 174–182, 2010 [5]). Lyme disease and Rocky Mountain Spotted Fever are two of the most common diseases wilderness travelers face (Rosenberg et al. in Morbidity and Mortality Weekly Report, 68(9), 1–11, 2019 [6], https://www.cdc.gov/rmsf/index.html). Zoonotic infections are spread when an infectious pathogen is introduced to a human via an animal host. Individuals can become infected by direct contact with the animal host, their bodily fluids, or their environment. Some ticks and mosquitoes are considered “vectors” and directly transmit the infectious agent (Auerbach in Wilderness Medicine (7th ed.). Elsevier, 2017 [1], Harms et al. in J Infect. 82(1), 98–104, 2021 [7], https://www.cdc.gov/rmsf/index.html, Openshaw et al. in Am J Trop Med Hyg. 83(1), 174–182, 2010 [5]).

Certain infections are prevalent in people travelling to rural United States. This review concentrates on the management of common treatable infections acquired in wilderness areas within the United States.