Updated: 10/2/2018

Infectious Diseases in Athletes

Topic
Review Topic
0
0
Questions
13
0
0
Evidence
7
0
0
Videos
1
https://upload.orthobullets.com/topic/3124/images/mrsa.jpg
https://upload.orthobullets.com/topic/3124/images/herpesgladiatorum.jpg
https://upload.orthobullets.com/topic/3124/images/tineacorporis.jpg
https://upload.orthobullets.com/topic/3124/images/acnemechanica.jpg
https://upload.orthobullets.com/topic/3124/images/impetigo.jpg
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
      • 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
 

Please rate topic.

Average 4.1 of 28 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Questions (13)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

You have 100% on this question.
Just skip this one for now.

(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? Review Topic

QID: 3052
FIGURES:
1

Figure A

8%

(209/2679)

2

Figure B

2%

(47/2679)

3

Figure C

3%

(87/2679)

4

Figure D

83%

(2219/2679)

5

Figure E

4%

(104/2679)

L 2

Select Answer to see Preferred Response

SUBMIT RESPONSE 4

You have 100% on this question.
Just skip this one for now.

(SAE07SM.31) An 18-year-old lacrosse player is diagnosed with infectious mononucleosis. What is the recommendation for return to play? Review Topic

QID: 8693
1

Full participation once symptoms resolve

2%

(4/210)

2

Full participation once the splenomegaly resolves

25%

(52/210)

3

Full participation 4 weeks after the onset of symptoms regardless of the size of the spleen

4%

(8/210)

4

Full participation 4 weeks after both the onset of illness and findings of a normal-sized spleen

62%

(131/210)

5

No participation for 8 weeks

7%

(15/210)

L 3

Select Answer to see Preferred Response

SUBMIT RESPONSE 4

You have 100% on this question.
Just skip this one for now.

(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? Review Topic

QID: 923
1

Presence of turf burns

45%

(627/1389)

2

Use of a cold whirlpool

1%

(19/1389)

3

Use of a warm whirlpool

16%

(223/1389)

4

Sharing locker room soap

2%

(26/1389)

5

Sharing locker room towels

35%

(491/1389)

L 4

Select Answer to see Preferred Response

SUBMIT RESPONSE 1

You have 100% on this question.
Just skip this one for now.

(SBQ07SM.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? Review Topic

QID: 1416
1

May return to play now if receives a 4-week course of oral valacyclovir

1%

(9/1399)

2

May return to play now if there is no sign of splenomegaly

60%

(839/1399)

3

May return to play in 4 weeks if receives a 4-week course of oral valacyclovir

1%

(10/1399)

4

May return to play in 4 weeks if there is no sign of splenomegaly

33%

(458/1399)

5

May return to play now if there is no sign of splenomegaly and receives a 4-week course of oral valacyclovir

6%

(78/1399)

L 4

Select Answer to see Preferred Response

SUBMIT RESPONSE 4
ARTICLES (14)
VIDEOS & PODCASTS (1)
Topic COMMENTS (4)
Private Note