Infectious diseases are often a serious issue for athletes, and those in the care of athletes must often be alert to the possibility of getting an infectious disease for the following reasons:
There is the chance, or even the expectation, of contact or collision with another player, or the playing surface, which may be a mat or artificial turf. The opportunities for skin breaks, obvious or subtle, are present and compromise skin defenses. Young people congregate in dormitories, locker rooms, showers, etc. There is the possibility of sharing personal toilet articles. Equipment, gloves and pads and protective gear, is difficult to sanitize and can become contaminated. However, in many cases, the chance of infection can be reduced by relatively simple measures.
Herpes gladiatorum Wrestlers use mats which are abrasive and the potential for a true contagion (Latin contagion-, contagio, from contingere to have contact with) is very real. The herpes simplex virus, type I, is very infectious and large outbreaks have been documented. A major epidemic threatened the 2007 Minnesota high school wrestling season, but was largely contained by instituting an eight-day isolation period during which time competition was suspended. Practices, such as 'weight cutting', which can at least theoretically reduce immunity, might potentiate the risk. In non-epidemic circumstances, herpes gladiatorum affects about 3% of high school wrestlers and 8% of collegiate wrestlers. There is the potential for prevention of infection, or at least containment, with antiviral agents which are effective in reducing the spread to other athletes when given to those who are herpes positive, or who have recurrent herpes gladiatorum. The NCAA specifies that a wrestler must: - be free of systemic symptoms (fever, malaise, etc.). - have developed no new blisters for 72 hours before the examination. - have no moist lesions; all lesions must be dried and have progressed to a FIRM ADHERENT CRUST. - have been on appropriate systemic antiviral therapy for at least 120 hours before and at the time of the meet or tournament. Active herpetic infections shall not be covered to allow participation.
Impetigo
This superficial intra-dermal infection spreads by contact. A red, tender 'spot' quickly develops blisters or vesicles which rupture to develop a golden crust. Over the past 20 years, the pathogen has changed from being overwhelmingly hemolytic streptococcal to staphylococcus aureus (80%), streptococcal (10%), and the remainder due to a combination of the two. The lesions appear most frequently on the face, around the mouth or nose, but there are often multiple sites that may include the buttocks and trunk. There is a seasonal predilection for summer and fall and contact sport is a definite risk factor. Amongst other regulations, the NCAA require an absence of new lesions for 48 hours before a meet or tournament, and at least 72 hours of completed antibiotic therapy. The NCAA specifies that a wrestler must: - not have developed any new skin lesion for 48 hours before a meet or tournament - have no moist or exudative lesions at meet or tournament time Gram stain of exudate from questionable lesions (if available) should be performed. Active purulent(pus discharging) lesions shall not be covered to allow participation.
Ringworm
Ringworm, more properly called Tinea, presents as a reddish/brown raised or bumpy patch which may be lighter in the center, giving the appearance of a ring. It is caused by one of three parasitic fungi and is named after the body site involved. Consequently, the name does not indicate the fungal type, for example, Tinea corporis (body) and Tinea manum (hand). Ringworm spreads readily by direct skin-to-skin contact, and by using a contaminated hairbrush or other source. Some studies have indicated that spread may be reduced by prophylaxis with anti-fungal agents applied to the skin. Again, there are NCAA prohibitions on participation unless lesions are completely and securely covered in wrestling, or that one week of treatment has been completed in case of extensive involvement. The NCAA specifies that to participate: - at least 72 hours of topical therapy is required for skin lesions. - at least two weeks of systemic antifungal therapy is required for scalp lesions. - wrestlers with extensive and active lesions will be disqualified and those with localized lesions will be disqualified if such lesions cannot be "properly covered". - the disposition of tinea cases will be decided on an individual basis as determined by the examining physician and/or certified athletic trainer.
Infectious mononucleosis
This was recognized as a clinical syndrome in the 1800s consisting of fever, pharyngitis and adenopathy. The term glandular fever was first used in 1889 and the association with Epstein-Barr virus infection in the late 1960s. Sprunt and Evans described the characteristics of Epstein-Barr virus infectious mononucleosis in 1920. It is primarily transmitted by oropharyngeal secretions. A study demonstrated that 13% of susceptible university freshmen developed antibodies to Epstein-Barr virus within nine months of enrollment. Seventy-four percent of those developed the clinical syndrome recognized as infectious mononucleosis. Of most importance in the care of the athlete is the enlargement of the spleen, which may extend beyond the protection normally offered by the lower ribs, and also be softer and consequently more vulnerable to rupture. Most patients do not have a palpable spleen on examination and the sensitivity of physical examination for splenic enlargement has been estimated at about 6%, (94% undetected). The risk of rupture during infectious mononucleosis has been estimated at one per thousand and one review indicated that almost all ruptures occurred in the first three weeks. This has led to the suggestion that athletes be withheld from exertion for a minimum of four weeks from the onset of illness. Others have suggested ultrasound examination at three weeks to assist with decision making concerning return to activity.
Methicillin-resistant Staphylococcus aureus
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