Infectious Disease

20.1 Acute Febrile Illness

Phy Sportsmed 1996;24:44; Phy Sportsmed 1999;27:47; The Team Physician Handbook. 2nd ed. St. Louis: Mosby 1997;225

Cause: Viral or bacterial causes.

Pathophys: Change in hypothalamic set point to aid in fighting infection; physiologic response includes increased sensible fluid loss, increased resting heart rate, increased basal metabolism, decreased pulmonary gas diffusion, decreased concentration, increased susceptibility to heat illness and injury.

Sx: May or may not be associated with myalgia, pulmonary, upper respiratory, gi, or GU symptoms.

Si: Temp >100.4°; focal or nonfocal signs.

Crs: Usually self-limiting.

Cmplc: Untreated focal infection; sudden death due to myocarditis, infecting fellow competitors.

Diff Dx: Early focal infection (UTI, pyelonephrites, pneumonia, pharyngitis, sinusitis, gastroenteritis), CVD.

Lab: Usually not indicated except for UTI or more severe infections.

Rx:

Acetaminophen (Tylenol) 650-1000 mg qid.
Ibuprofen (Motrin) 400 mg qid to 800 mg tid; beware of gi and renal effects.
Preventing the spread of infection (Phy Sportsmed 2003;31:23):
- Limit exposure (restrict ill athletes).
- Handwashing and daily showering.
- Protect skin (eg, change socks, take care of blisters and abrasions).
- Safeguard water source: safe, clean drinking water; care and cleanliness of water containers; do not share water bottle.
- Clean practice surfaces and uniforms; mat and court care.
- Protect individual immunity: avoid overtraining; slow down when inappropriately fatigued; pay attention to nutrition, hydration, and sleep; immunizations (Td and H. flu; Hep A and Hep B).
- Be prepared for universal precautions to protect from hand and body fluids: use gloves, disposal bags, careful handling of sharps, antiseptic soaps, and cleansers.

Return to Activity:

“Neck check” (Phy Sportsmed 1993;21:125):
- Resolution of below-the-neck symptoms (fever, severe cough, diarrhea/vomiting, myalgias).
- Normal hydration.
- Beware postviral bronchial reactivity—may need bronchodilator (Phy Sportsmed 1993;21:125).
Generally 2 d rest for every d of lost training.
Begin training at 50% intensity and if feeling OK after 5-10 min, train at full intensity.
If recovering from URI, SI or OM nl Valsalva function for altitude and aquatic sports.
If there is a TM perforation, it should be resolved before altitude or aquatic sports.

20.2 Infectious Mononucleosis (IM)

Clin Sports Med 2004;23:485; Am Fam Phys 2004;70:1279; Phy Sportsmed 2002;30:27; Phy Sportsmed 1996;24:49; Clin Sports Med 1997;16:635

Cause: Epstein-Barr virus of the herpes family.

Epidem:

95% infected by 25 y/o; highest prevalence in 15-25 y/o age group, but only 50% are symptomatic.
Affects 25% of college-aged individuals.
Not highly contagious among college roommates.

Pathophys: Infects B cells; transmitted by intimate contact.

Sx: Fever, fatigue, sore throat, ± abdominal pain; possible exposure history to IM.

Si: Tired-appearing; purulent pharyngitis; diffuse adenopathy (esp posterior cervical), signs of hepatosplenomegaly.

Crs: Usually self-limiting, but may have prolonged fatigue.

Cmplc: Loss of training time, school or work performance due to prolonged fatigue; upper airway obstruction; splenic rupture; Guillain-Barré; thrombocytopenia; or hemolytic anemia.

Diff Dx: GABS, CMV, enterovirus, coxsackie, GC, mycoplasma.

Lab: Mild leukocytosis with increased ATL count; elevated transaminases; elevated urine specific gravity or BUN if dehydrated; may have hemolytic anemia or thrombocytopenia; throat culture or rapid strep test.

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