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Infectious Diseases in Athletes

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Topic updated on 03/22/16 8:25am
Methicillin-Resistant Staph Aureus (MRSA)
  • MRSA is a bacterium which causes infection in humans
  • Epidemiology
    • community acquired MRSA increasing in sports 
  • Pathophysiology
    • transmission is via direct contact with skin 
    • exposed skin from abrasions ( "turf burns" ) significantly increases the risk of infection  
    • sharing of razors, towels, soaps and personal hygiene products also increases risk  
    • chances of prevention increased by
      • avoiding exposure of compromised skin
      • good hygiene 
  • Presentation
    • manifests on the skin as a boil or pimple type lesion 
    • can produce "spider-bite" type lesions 
    • described as "pustules on a erythematous base"
  • Treatment 
    • nonoperative
      • mupirocin
        • indications
          • initial treatment of small lesions
    • operative
      • irrigation & debridement with oral trimethoprim/sulfa and rifampin
        • indications
          • larger lesions
      • irrigation & debridement and IV antibiotics
        • indications
          • more severe infections
Herpes Gladiatorum
  • Herpes infections are a group of viral infections which manifest on the skin and/or in the nervous system  
  • Epidemiology
    • common in wrestlers and rugby players
    • occurs in approximately 2% to 7% of wrestlers  
  • Pathophysiology
    • caused by herpes simplex type 1 virus 
    • transmitted via direct skin to skin contact 
    • incubation 2-14 days
    • head, neck and shoulders primary areas of infection
    • if contacts the eye herpetic conjunctivitis can develop
  • Presentation
    • physical exam
      • clusters of  fluid-filled blisters
      • rash
  • Treatment
    • nonoperative
      • acyclovir, valacyclovir, and no wrestling until lesions have scabbed over 
        • indications
          • any active lesions
        • return to play
          • when no new lesions within the preceding 72 hours and
          • at least 5 days of anti-viral medications
Tinea Infections
  • A common fungal infection of the skin
    • include tinea pedis, corporis, capitis, and cruris (describes areas of body affected)
  • Epidemiology
    • common in wrestlers
  • Pathophysiology
    • tinea infections are caused by dermatophytes
    • transmitted by direct contact of fungus with skin 
    • broken areas of skin can facilitate infection
  • Presentation  
    • physical exam
      • scaly red patches in circular formation
      • example of tinea corporis (body) aka "ringworm" 
  • Studies
    • diagnosis
      • scrapings from lesions are examined under microscope after preparation with potassium hydroxide
      • positive for tinea if hyphae are found
  • Treatment
    • nonoperative
      • topical antifungals
        • indications
          • tinea cruris, pedis and corporis
      • systemic antifungals
        • indications
          • tinea capitis 
          • more severe cases of all forms tinea
      • no sports participation
        • indications
          • active infection
        • can return to play when
          • 48 hours of treatment  
          • must be screened prior to competition
Acne Mechanica / Folliculitis
  • Skin condition that causes pimple like lesions 
  • Epidemiology
    • occurs in athletes who are required to wear protective padding 
      • hockey, football
  • Pathophysiology
    • primarily caused by mechanical friction and heat on exposed skin
    • occlusion of skin also a cause
  • Physical exam 
    • red papules on skin 
    • inflammation of follicles 
  • Treatment
    • nonoperative
      • observation
        • indications
          • first line of treatment
          • most cases will resolve spontaneously after the season ends
      • keratinolytics such as tretinoin
        • indications
          • severe cases
    • prevention
      • wash immediately after play  
      • athletic clothing that wicks away moisture  
Impetigo
  • A highly contagious bacterial infection of the skin
  • Epidemiology
    • common in wrestlers
  • Pathophysiology
    • common pathogens include
      • streptococcus pyogenes
      • staphylococcus aureus 
  • Presentation
    • initially present as fluid filled blister-like lesions
    • crusting noted after a few days
  • Treatment
    • erythromycin, topical bactroban
      • first line of treatment
    • no sports participation
      • indications
        • active infection
      • return to play
        • may return to play when all lesions are clear of crusting
Mononucleosis
  • A viral infectious condition characterized by fatigue and splenomegaly  
  • Pathophysiology
    • caused by Epstein-Barr Virus (a herpes virus)
    • incubation period of 30-50 days
    • spread through saliva (kissing, sharing cups)
  • Presentation
    • symptoms
      • resolve in 4-8 weeks
      • 3-5 day prodromal period includes
        • malaise
        • myalgia
        • nausea
        • headache
      • Hoagland's triad
        • fever
        • pharyngitis (in 30%)
          • Group A streptococcus is responsible
          • exudative (white/grey pseudomembrane) in 50%
        • lymphadenopathy
          • posterior cervical chain
          • lasts 2-3 weeks
      • rash
        •  
          • petechial/maculopapular/urticarial
          • common if treated with ampicillin/amoxicillin
    • physical exam
      • splenomegaly 
      • pharyngitis
  • Studies
    • heterophile Ab test (Mono-spot test)
      • 87% sensitive, 91% specific
    • viral capsid antigen (VCA) IgG and IgM
      • 97% sensitive, 94% specific
    • lab tests
      • absolute and relative lymphocytosis with >10% atypical lymphocytes
  • Imaging
    • generally unnecessary
    • ultrasound 
      • if imaging is obtained, order ultrasound
      • noninvasive, reliable, has no radiation
    • CT
      • to exclude rupture
  • Treatment
    • nonoperative
      • fluids, hydration, acetaminophen, rest
        • isolation is unnecessary as transmissibility is low
      • no contact sports for 3-5 weeks  
        • some take up to 3 months
        • indications
          • indicated in athletes until splenomegaly is completely resolved  
          • most splenic rupture occurs in first 3 weeks
      • IM penicillin (one time) or PO penicillin (10 days)
        • erythromycin if allergic to PCN
        • indications
          • for strep pharyngitis
        • do NOT use amoxicillin
      • corticosteroids 
        • decrease tonsillar size if there is difficulting swallowing/dehydration
      • advanced airway management
        • if there is respiratory distress
      • stool softener
        • decreases straining/Valsalva during bowel movements
  • Complications
    • splenic rupture
      • risk is 0.1-0.5%
      • most common in first 3 weeks
      • due to sudden increase in portal venous pressure 
        • 50% atraumatic from Valsalva maneuver (rowing, weightlifting)
        • 50% from external trauma
    • aplastic anemia
    • Guillain-Barre syndrome
    • meningitis/encephalitis
    • neuritis
    • lymphoma
    • hemolytic uremic syndrome
    • disseminated intravascular coagulation
HIV and AIDS
  • AIDS is an immune deficiency condition caused by infection with the Human Immunodeficiency Virus (HIV)
  • Epidemiology
    • HIV can occur in any population
      • increased prevalence in hemophiliacs, IV drug abusers, and homosexual men
  • Pathophysiology
    • the CD4 cells (T-helper cells) are affected 
  • Diagnosis
    • the diagnosis of AIDS requires an HIV positive test plus one of the following
      • CD4 count less than 200
      • diagnosis of an opportunistic infection
  • Treatment
    • no difference in treatment as compared to other athletes
      • use of universal precautions at all times
      • wound care
        • in the event of bleeding, compressive dressings should be used 
        • participation in sport is restricted until all bleeding has ceased
      • participation in sports
        • HIV infection alone is insufficient grounds to prohibit an athlete from competition

 

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Qbank (4 Questions)

TAG
(SBQ07.31) A 20-year-old collegiate football player was diagnosed with infectious mononucleosis 4 weeks ago. He is now asymptomatic. How should you counsel the patient in regards to return to play decisions? Topic Review Topic

1. May return to play now if receives a 4-week course of oral valacyclovir
2. May return to play now if there is no sign of splenomegaly
3. May return to play in 4 weeks if receives a 4-week course of oral valacyclovir
4. May return to play in 4 weeks if there is no sign of splenomegaly
5. May return to play now if there is no sign of splenomegaly and receives a 4-week course of oral valacyclovir

PREFERRED RESPONSE ▶
TAG
(OBQ09.239) Which of the following dermatologic conditions represented in Figures A-E is commonly seen in athletes and is most appropriately treated with topical mupirocin for small lesions and incision with drainage and administration of trimethoprim/sulfa for larger lesions? Topic Review Topic
FIGURES: A   B   C   D   E  

1. Figure A
2. Figure B
3. Figure C
4. Figure D
5. Figure E

PREFERRED RESPONSE ▶
TAG
(OBQ07.262) If a team experiences an outbreak of community acquired methicillin-resistant staph aureus (MRSA), which of the following factors is most likely to be the etiology? Topic Review Topic

1. Presence of turf burns
2. Use of a cold whirlpool
3. Use of a warm whirlpool
4. Sharing locker room soap
5. Sharing locker room towels

PREFERRED RESPONSE ▶
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