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 login to view 2 more bullets operative irrigation & debridement with oral trimethoprim/sulfa and rifampin login to view 2 more bullets irrigation & debridement and IV antibiotics login to view 2 more bullets 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) login to view 6 more bullets 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 login to view 2 more bullets systemic antifungals login to view 3 more bullets no sports participation login to view 5 more bullets 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 login to view 3 more bullets keratinolytics such as tretinoin login to view 2 more bullets 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 login to view 1 more bullet return to play login to view 1 more bullet 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 login to view 4 more bullets Hoagland's triad login to view 7 more bullets rash login to view 2 more bullets 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 login to view 1 more bullet no contact sports for 3-5 weeks login to view 4 more bullets IM penicillin (one time) or PO penicillin (10 days) login to view 4 more bullets corticosteroids login to view 1 more bullet advanced airway management login to view 1 more bullet stool softener login to view 1 more bullet Complications splenic rupture risk is 0.1-0.5% most common in first 3 weeks due to sudden increase in portal venous pressure login to view 2 more bullets 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 login to view 2 more bullets participation in sports login to view 1 more bullet