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 an 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 antivirals (acyclovir, valacyclovir, famciclovir) indications any active lesions may return to play after no new lesions have formed within the preceding 3 days received at least 5 days of anti-viral medications lesions have crusted over 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 Differential diagnosis Pitted keratolysis presents with small pits over the weight-bearing portion of the foot red fluorescence under Wood's lamp when caused by Corynebacterium 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 72 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 common if treated with ampicillin/amoxicillin petechial/maculopapular/urticarial 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