Unwell Athlete Flashcards
What causes a higher level of infection
Intense training
What is the J curve
Graph showing the relationship between the risk of URTI and the amount and intensity of exercise
Regular moderate exercise => below average risk
Sedentary => Average risk
Strenuous exercise => above average risk
How does infection affect athletic performance
Compromise
affects the activity of muscle enzymes and muscle strength
greater CR effort
What are the guidelines for exercise during infection?
- Symptoms restricted to one system vs Generalised symptoms
- Sore throat but afebrile => mild-moderate training
- Systemic Sx of generalised malaise, muscle pain, T >38 degrees, HR raised by >10 above normal => avoid any activity until recovered; gradually re-introduced
- Those engaged in intense activity while ill => increased risk of heat exhaustion, post-vital fatigue and viral myocarditis
Which diseases are common in athletes but do not lead to being severely unwell?
HSV - wrestlers (herpes gladitorum), rugby forwards (scum pox)
HPW - skin warts on hands and feet
Fungal skin infections - tinea pedis (athletes foot), tinea curdis (jock itch)
Influenza
Viral infection with a variety of strain
people in team sports at higher risk of being infected
susceptible population get annual vaccination
young children are super spreaders and are now starting to get vaccinated
Debilitating illness with systemic Sx (malaise, fever, myalgia)
Symptomatic treatment like pseudoephedrine banned by WADA
Infectious Mononucleosis
EBV
Causes glandular fever
malaise, high fever (39-40), splenomegaly, fatigue, sore throat, malaise, headache, myalgia
cervical lymph nodes enlarged, tender
Severity of illness increases with age and exudative pharyngitis
Incubation period 30-50d, disease lasting <=15d
Similar clinical picture to toxoplasmosis, CMV and primary HIV
Treatment
- Systemic Rx for fever and sore throat; no need for isolation
- Amoxicillin or Ampicillin
- Rest from all sporting activity until fully recovered esp contact and collision sports (high risk of splenic rupture; from 0.1% to 0.2%) and can be fatal; most cases during first 3 weeks of illness)
Acute Gatroenteritis by Norovirus
RNA Virus
Spread by contaminated food, water surfaces and person to person
Most common cause of gastroenteritis; 90% of epidemic cases worldwide
Quick spread
Sx start at 12-48hrs and last 12-60hrs
Initially nausea then projectile vomiting and watery diarrhoea
Prevention by heating or chlorine-based disinfectanct
Rx
Paracetamol for high temp
Adequate hydration
Hand hygiene; alcohol gel not effective against virus
Isolation of athlete until Sx-free for at least 48hrs
Traveller’s diarrhoea infective organisms
E.coli, salmonella, campylobacter, rotavirus, shigella, giardia
Traveller’s diarrhoea
High incidence due to change in bacteria gut flora upon arrival to new country
Mostly bacterial; exposed to bacteria not already immune to
Sx - mild fever, malaise, diarrhoea , abdo pain
Onset within 1st week of arrival and lasts 12-48hours
Rx
- Abx prophylaxis debatable; Ciprofloxacin or Norfloxacin - started upon arrival until 48hrs after leaving
- Abx treatment can shorten symptoms but only indicated in bloody and severe diarrhoea
- Adequate fluid and electrolyte replacement
- Imodium/ Loperamide (anti-diarrhoeal)
Fit for Travel Guide
General Rules
Personal hygiene
Hand hygiene - carry hand sanitiser
use clean utensils, cups and dishes; clean with alcohol wipes
Eat food which is thoroughly cooked and served immediately
Food Precautions
Cheese and ice cream; from trusted sources only
Meat ; freshly prepared and thoroughly cooked
Veg; should be cooked
Fruit; eat peeled incl tomatoes
AVOID - shellfish, fish, green salads, leftovers or food exposed to air
Water and Liquid Precautions
Water; only ingested when sure of purity
Unsafe water needs to be boiled/ chemically purified or using a reliable filter
Bottled water, coffee, hot tea, beer and wine; safe
Milk; boiled unless pasteurised
Viral Hepatitis
Infective organisms - Hep A-E, EBV, CMV, HSV, Adenovirus
Transmission
- Hep A: faecal-oral
- Hep B&C: needle use or sexual
Prophylactic transmission for Hep A and B
Zika Virus
Infected mosquitos (Aeries) - active during mid-morning and late-afternoon [DISTINGUISHING POINT WITH MALARIA] Rarely transmitted through sex
Most dont have symptoms; usually mild and lasts 2-7d
Sx - rash, joint pain +/- swelling (mainly small joints), fever, headache, myalgia, conjuctivitis, LBP, pain behind eye
No specific treatment
Adequate hydration
Paracetamol
Urgent medical advice if returning from country active with both zika and malaria
What is a ciprofloxacin side effect? (MSK related)
Increased risk for achilles tendonitis and subsequent rupture
Overtraining Syndrome
aka Underperformance Syndrome, Unexplained Unexplained Underperformance Syndrome
Accumulative fatigue with periods of excessive training with inadequate recovery; failed adaptation to overload due to inadequate regeneration
Poor performance, neuroendocrine changes, changes to mood states and frequent illness
Athletes incorrectly react to underperformance by training harder; leads to vicious cycle
Physiological changes of Overtraining Syndrome
Performance decline despite continued training
CVS changes e.g. incr resting BP, higher morning HR
Decreased work rate and lactate threshold
Decr serum ferritin
Hormonal changes e.g. decr catecholamine production
Frequent illness
Persistent muscle soreness
Decr body mass
Psychological changes of Overtraining Syndrome
Mood state changes (utilised PoMS) Apathy Lack of motivation Lack of appetite Sleep disturbances Increased stress levels Irritability Depression Lack of insight
DDx of Overtraining Syndrome (i.e. persistent fatigue)
Viral illness
Inadequate protein intake
Inadequate iron stores
Nutritional deficiencies e.g. vit D, Zn, Mg
Depression and anxiety
Dehydration
Medication e.g. b-blockers, anti-histamines, insulin
Hypothyroidism
Anaemia
Jet lag
Chronic fatigue syndrome (Dx of exclusion)
Red Flag conditions - malignancy, HF, diabetes, renal fail
Management of Overtraining Syndrome & Advise
History and examination, incl. training diary
baseline Ix
monitor physiological and psychological parameters
Advise:
- Complete rest in short term, incl sleep catch up
- Nutritional advice + Adequate hydration
- Psychological support + reduce stressors
- Sports massage
- Cross-training after a few days to maintain fitness
- Develop a routine
- Complete recovery may take a few weeks, sometimes longer
Polyarthritis
Joint inflammation
Night pain, morning stiffness (>=60mins), swelling, warmth, loss of function
key diagnostic is the onset of joint involvement
Useful Ix:
- FBC
- Inflammatory factors: CRP, ESR
- HLA B27
- Anti CCP Ab
- RhF
- ANA
- Serum uric acid
- Joint aspiration: MC&S, Crystals
- XR
Rheumatoid Arthritis
Onset in weeks or months; chronic and progressive
Symmetrical
small joints
Ix - RhF, Anti-CCP, ANA
Reactive arthritis
Follows GU or GI infection more rapid onset Asymmetrical large joints enthesitis or dactylitis duration of Sx should be recorded
Ix - HLA B27
Parvovirus B19 Polyarthritis
Young women who care for infected children
can be indistinguishable from early RA
Settles within 6wks
Polyarticular Pseudogout or Psoriatic Arthritis
Pattern of joint joints involved resembles RA –> W/O nodulosis, vasculitis, or other systemic features of RA
