Unwell Athlete Flashcards
Tall young men can have
Spontaneous pneumothorax
Intense training is associated with
higher level of infection
The J Curve
Theory that regular moderate exercise decreased risk of URTI, while strenuous exercise increased it
Infection may compromise athletic performance by
Affecting muscle enzyme activity and muscle strength
Exercise that is performed during illness requires more
Cardiorespiratory effort
athletes with symptoms restricted to one system vs. generalised symptoms
One system affected (e.g. URTI or skin) vs generalised symptoms affecting more than one system should be considered separately when deciding whether or not to train or compete
Athlete with URTI symptoms of sore throat, runny nose, but otherwise afebrile
Can be allowed to continue with mild-moderate training
Such exercise in people who are moderately fit and active is not thought to prolong or intensify the llness
Symptoms that mean athlete should avoid athletic activity
Systemic symptoms of generalised malaise
Muscle pains
Temperature in excess of 38
Raised HR more than 10 beats above normal
–> until both systemic symptoms and signs have returned to normal
–> should then gradually resume activity, opposed to going straight back into previous leel
Athletes who engage in intense exercise during such infections have an increased risk of
Heat exhaustion
Post-viral fatigue
Viral myocarditis
Infections which are common in athletes but do not cause them to become severely unwell
Herpes simplex virus
Fungal infections
Skin warts on hands + feet caused by HPV
Herpes simplex virus
Wrestlers- herpes gladiatorum
Rugby forwards- scrum pox
Fungal skin infections
Tinea pedis (athletes foot) Tinea cruris (jock itch)
Influenza
Common viral infection- winter
Number of strains varies yet to year
Can be debilitating with systemic symptoms causing fever, malaise and myalgia
Elderly + chronic illnesses susceptible- immunisation
Athletes may wish to be immunised to stop spread in team
Some of symptomatic treatment options such as pseudoephedrine banned by WADA
Infectious Mononucleosis caused by
Epstein-Barr Virus (EBV)
Causes ‘glandular fever’
Infectious Mononucleosis severity
Appears to increase with age
Children infected by EBV
Typically develop a flu-like illness
Young adults and adolescents infected by EBV
Fatigue Sore throat Malaise Headache Myalgia
EBV clinical examination
Exudative pharyngitis
Swollen, tender cervical lymph notes
High fever 39-40 common
Splenomegaly and EBV
Lymphocytic infiltration within spleen gives rise to splenomegaly in about half the cases
EBV has similarities with clinical picture with
Cytomegalovirus
Toxoplasmosis
Primary HIV infection
Treating Infectious Mononucleosis
Ampicillin or amoxycillin
Infectious mononucleosis treatment SE (ampicillin or amoxycillin)
Defuse macular rash
Older patients in addition can also develop complications such as hepatitis or thrombocytopoenia (decreased platelet count)
Infectious mononucleosis incubation period
30-50 days after exposure
Illness lasting for up to 15 days
Infectious mononucleosis treatment athletes
Systemic treatment to reduce fever and sore throat
Not particularly contagious and no need for isolation of athlete who has it
Many people already have adequate antibody levels because of previous childhood exposure
Rest from all sporting activity until all acute symptoms have resolved
Infectious mononucleosis contact and collision
Should be avoided whilst spleen is enlarged
Risk of splenic rupture increased (from 0.1 to 0.2%) and can be fatal
Infectious mononucleosis cases tend to occur
During first 3 weeks of illness
Acute gastroenteritis causes
Common
Often caused by Norovirus (RNA virus)
Causes approximately 90% of epidemic non-bacterial outbreaks of gastroenteritis world-wide
Acute gastroenteritis transmission
Virus transmitted via contaminated food, water surfaces, or person to person
Can quickly spread amongst sports teams where athletes are in close contact
Acute gastroenteritis symptoms
Usually between 12 to 48 hours after initial infection
Nausea initially
Projectile vomiting
Watery diarrhoea
Acute gastroenteritis how long do symptoms last
Tend to last 12 to 60 hours
How can norovirus be deactivated
Sufficient heating or chlorine-based disinfectant
Acute gastroenteritis treatment
Adequate hydration
Paracetamol for high temp
Hand hygiene
Isolation of the unwell until he/she has been symptom-free for at least 48 hours
Travellers’ diarrhoea infective agents
E-Coli Campylobacter Rotavirus Salmonella Shigella Giardia
High incidence of travellers’ diarrhoea thought to arise due to
Changes in normal bacteria in flora, food and water in foreign countries
Travellers’ diarrhoea is mostly
Bacterial in nature
Travelling athlete is exposed to different bacteria to which he or she is not already immune
Travellers’ diarrhoea symptoms
Mild fever Abdo pain Malaise Onset within first week of arrival Often last between 24-48 hours
Travellers’ diarrhoea antibiotic prophylaxis
Antibiotic prophylaxis debatable
Various regimes include ciprofloxacin or norfloxacin which should commence on arrival in foreign country + should continue until athlete has returned home for 48 hours
Antibiotics for treatment can shorten symptoms but are only indicated if diarrhoea is bloody and severe
Local antibiotic resistance should be kept in mind
Traveller’s diarrhoea treatment
Adequate fluid + electrolyte replacement
Anti-diarrhoea meds such as loperamide (imodium) can also be used
Loperamide
Immodium
Anti-diarrhoea
Viral agents which can cause inflammation of liver
Hep A-E EBV CMV Herpes Simplex Adenovirus
Faeco-oral route virus
Hep A
Needle or sexual transmission
Hep B + C
Consider prophylactic immunisations for
Hep A + B
Zika Virus
Most people don’t have any symptoms
If symptoms do occur, usually mild and last around 2-7 days
Zika Virus symptoms
Rash Itching all over body Fever Headache Joint pain (with possible swelling, mainly in smaller joints of hands + feet) Muscle pain Conjunctivitis (red eyes) Lower back pain Pain behind eyes
How do you catch Zika
Infected mosquitoes biting humans Affected mosquitoes (the Aedes mosquito) mostly active during day, especially during mid-morning, then late afternoon to dusk Small no. of reports that passed on through sex
Zika virus treatment
No specific treatment for symptoms
Drink plenty of water
Paracetamol
Seek help if coming back from country that also has active malaria if feeling unwell, to rule it out
Overtraining syndrome is also known as
Underperformance or unexplained underperformance syndrome (UUPS)
Overtraining syndrome
Common cause of persistent tiredness in athletes
Reflects accumulative fatigue periods of excessive training with inadequate recovery
Develops when failed adaptation to overload training due to inadequate regeneration
Overtraining
Process of excessive training in athletes that can lead to persistent fatigue, poor performance, neuroendocrine changes, changes to mood states and frequent illness such as URTIs
Overtraining syndrome manifestation
Several ways, including impaired performance
Athletes make mistake by reacting to impaired performance by trying to increase intensity of training
Viscous cycle
Other causes of fatigue in athletes
Viral Illness Inadequate carbs, protein or iron Dehydration Nutritional deficiencies- vit d, b, zinc, mag) Medications- BB, insulin, antihistamines Hypothyroidism Anxiety + depression Anaemia Insufficient sleep Jet lag Chronic fatigue
Physiological variables which can indicate over training
- Performance decline despite continued training
- Decreased work rate and lactate threshold
- Cardiovascular changes (E.g. Increased early morning heart rate, increased resting BP)
- Decreased serum ferritin
- Hormonal changes (decreased catecholamine production, changes in serum free testosterone to cortisol ratio)
- Frequent illness (E.g. URTI)
- Persistent muscle soreness
- Decrease in body mass
Physiological changes that may be associated with over training
- Mood state changes (utilising the Profile of Mood States Questionnaire (PoMS)
- Apathy
- Lack of motivation
- Loss of appetite
- Sleep disturbance
- Increased stress levels
- Irritability
- Depression
Overtraining syndrome management
History + exam
Training diary
Baseline investigations to exclude other conditions
Monitor physiological + psychological parameters
Advice as doctor
Complete rest in short term Sleep Nutrition Adequate fluid + hydration Psychological support Sports massage to aid muscle relaxation Cross training after few days Speak to fam if confidentiality allows
How long does complete recovery from overtraining take
Few weeks
Sometimes longer
Polyarthralgia
Multiple painful joints
Polyarthritis
Multiple painful joints with synovitis
History between polyarthralgia and polyarthritis
o Must distinguish between polyarthritis with joint pain, stiffness and swelling from polyarthralgia alone.
o Joint inflammation characterised by night pain, prominent morning stiffness (at least 60 mins but often hours), swelling, warmth and loss of function.
o Key diagnostic is the onset of joint involvement.
rheumatoid arthritis
Onset occurs in weeks or months and has symmetrical involvement of small joint
Reactive arthritis
Follows genitourinary or gastrointestinal infection
More rapid onset
Asymmetrical involvement of large joints, enthesitis or dactylitis
Duration of symptoms should be recorded
Parvovirus B19 Polyarthritis
Common in young women who care for small kids who develop parvovirus B19 infection
Can be indistinguishable from early rheumatoid arthritis
Symptoms usually settle within 6 weeks
Rheumatoid arthritis often has a chronic and progressive course.
The pattern of joint involved in polyarticular pseudogout or psoriatic arthritis often resembles rheumatoid arthritis but WITHOUT nodulosis, vasculitis, or other systemic features seen in rheumatoid arthritis
