Infectious Disease in Athletics

1. Infectious Disease in Athletics

2. Role of the Immune System • Collection of disease fighting cells that neutralizes foreign substances • Illness results when immune system does not neutralize foreign substances (antigens) • Cell-mediated response, humoral immune response (B-cells that produce antibodies), or nonspecific immune response (inflammation) • Auto-immune response against the body leads to damage of body’s own tissues

3. Viral Infections • Rhinovirus (Common Cold) • Etiology • Over 100 different rhinoviruses • Transmitted by either direct or indirect contact (cough, sneeze, speaking, touching contaminated article)

4. Sign and Symptoms • Begins w/ scratchy, sore throat, stopped-up nose, watery discharge and sneezing • Second batch may produce thick yellow nasal discharge, watering eyes, mild fever, sore throat, headache, malaise, myalgia, dry cough • Secondary - laryngitis, tracheitis, acute bronchitis, sinusitis, and otis media • Management • Symptomatic treatment (may last 5-10 days) • Non-prescription cold medications • Eat a balanced diet, consume 64 oz. of water • Avoid emotional stress and extreme fatigue

5. Influenza (Flu) • Etiology • Caused by myoviruses (A, B, C) • Type A is most common • Virus enters through cell genetic material • Sign and Symptoms • Fever (102-103 degrees F), chills, cough, headache, malaise, and inflamed respiratory mucous membrane w/ coryza • General aches and pains, headache becomes worse • Weakness, sweating, fatigue may persist for many days • Management • Bed rest and supportive care • Symptomatic care should be avoided by those under age 18 ( Reye’s syndrome) • Steam inhalation, cough medicines, and gargles

6. Infectious Mononucleosis • Etiology • Epstein-Barr virus (member of herpes group) that has incubation period of 4-6 weeks • Transmitted through saliva • Sign and Symptoms • First 3-5 days -severe fatigue, headache, loss of appetite and myalgia • Days 5-15 - fever, swollen lymph nodes and sore throat (50% will experience enlarged spleen) • Possible jaundice, skin rash, puffy eyelids • Management • Supportive symptomatic treatment • Acetaminophen for headache, fever and malaise • Resume training after 3 weeks after onset if spleen not markedly enlarged/painful, athlete is afebrile, liver function is normal, and pharyngitis is resolved

7. Rubella (German Measles) • Etiology • Highly contagious viral disease (childhood disease) • Results 13-24 days after exposure • May cause developmental difficulties for fetus in pregnant females • Sign and Symptoms • Temperature elevation, sore throat, drowsiness, swollen lymph glands and red spots on palate • Rash • Management • Prevent by early childhood immunization • Measles, mumps, rubella vaccine (MMR)

8. Rubeola (Measles) • Etiology • Childhood disease • Incubation time of 10 days following exposure • Sign and Symptoms • Sneezing, nasal congestion, coughing, malaise, photophobia, spots in mouth, conjunctivitis, and elevated fever (rash appears - causes itching) • Management • Inoculation w/ MMR vaccine at 12-15 months and 4-6 years of age • Bed rest, isolation in dark room and use of antipyretic and anti-itching medication

9. Mumps (Parotitis) • Etiology • Contagious viral disease that results in inflammation of parotid and salivary glands • Appear in 12-25 days following exposure • Sign and Symptoms • Malaise, headache, chills and moderate fever • Pain in neck - swelling of glands may last up to 7 days • Pain w/ jaw motion and swallowing; increased or decreased saliva production • Management • Varicella-zoster immune globulin w/in 96 hours of exposure will prevent clinical symptoms in normal healthy children • Acyclovir meds should be administered to adolescents and adults w/ in 24 hours of exposure • Anti-itching medications to prevent scratching

10. Respiratory Conditions • Sinusitis • Etiology • Stems from upper respiratory infection caused by a variety of bacteria • Sign and Symptoms • Nasal mucous swell and block ostium of paranasal sinus • Painful pressure occurring from accumulation of mucus • Skin over sinus may be swollen and painful to the touch • Headache and malaise; purulent nasal discharge • Management • If infection is purulent, antibiotics may be warranted • Steam inhalation and other nasal topical sprays w/ oxymetazalone can produce vasoconstriction and drainage

11. Tonsillitis • Etiology • Acute inflammation and bacterial infection of tonsil epithelium • Sign and Symptoms • Tonsil appear red, swollen, w/ yellow exudate in pits • Pain w/ swallowing, high fever and chills, headache and neck pain • Sinusitis, otitis media, tonsillar abscesses may also develop • Management • Culture to check for streptococcal bacteria and antibiotics for 10 days • Gargling w/ saline water, liquid diet, and antipyretic medication • Frequent bouts of tonsillitis may necessitate removal

12. Seasonal Atopic (Allergic) Rhinitis • Hay fever, pollinosis from airborne pollens • Etiology • Reaction to pollen - airborne fungal spores (allergens) resulting in allergic antibodies causing the release of histamine • Sign and Symptoms • Eyes, throat, mouth and nose begin to itch, followed by watering eyes, sneezing and clear watery discharge • Sinus type headache, emotional irritability, difficulty sleeping, red & swollen eyes and nasal mucus membranes, and wheezing cough • Management • Oral antihistamines and decongestants

13. Pharyngitis (sore throat) • Etiology • Caused by virus or streptococcus bacteria • Transmitted by direct contact of infected person or one who is a carrier • Sign and Symptoms • Pain w/ swallowing, fever, inflamed and swollen glands, malaise, weakness and anorexia • Mucus membrane may be inflamed and covered w/ purulent matter • Management • Throat culture • Topical gargles and rest • Antibiotic therapy for streptococcal infection

14. Acute Bronchitis • Etiology • Infectious winter disease that follows common cold or viral infection • Fatigue, malnutrition or becoming chilled could be predisposing factors • Sign and Symptoms • Upper respiratory infection, nasal inflammation and profuse discharge, slight fever, sore throat and back muscle pains • Fever lasts 3-5 days while cough can last 2-3 weeks • Yellow mucus indicates infection • Pneumonia can complicate condition • Management • Avoid sleeping in cold environment, avoid exercise in extreme cold w/ protection • Rest until fever subsides, drink 3-4 quarts of water daily, ingest antipyretic analgesic, cough suppressant, and antibiotic

15. Pneumonia • Etiology • Infection of alveoli and bronchioles from viral, bacterial or fungal microorganisms • Irritation from chemicals, aspiration of vomitus • Alveoli fill w/ exudate, inflammatory cells and fibrin • Sign and Symptoms • Bacterial will cause rapid onset • High fever, chills, pain on inspiration, decreased breath sounds, rhonchi on auscultation, coughing of purulent, yellowish sputum • Management • Treat w/ antibiotics; perform deep breathing exercises to removal of sputum through heavy coughing • Analgesics and antipyretics may be useful for controlling pain and fever

16. Cystic Fibrosis (Not infectious) • Etiology • Genetic disorder that can manifest as obstructive pulmonary disease, pancreatic deficiency, urogential dysfunction and increased electrolyte sweating • Cause of severe lung disease w/ life expectancy of about 30 years • Sign and Symptoms • Bronchitis, pneumonia, respiratory failure,gall bladder disease, pancreatitis, diabetes and nutritional deficiencies • High production of mucus • Management • Drug therapy to slow progress of disease (ibuprofen) • Antibiotics to control pulmonary disease • Consistent postural drainage to mobilize secretions • High fluid intake to thin secretions and use of humidifier

17. Sexually Transmitted Diseases The Love Bugs

18. SC ranks among the top 10 states for highest rates of gonorrhea and syphilis Chlamydia is the most common STD. In SC the highest rates of infection are among women ages 15-19 (16%) STDs/HIV primarily affect teenagers and young people 50% of gonorrhea and syphilis cases are among persons 15-29 years of age 37% of HIV infections are among this age group SC ranks 10th in the country for the highest rate of AIDS The highest rate for HIV infection in SC is in Richland County 1 in 4 teenagers will acquire an STD Just the Facts

19. Risk Assessment • Person who has multiple sex partners • Unprotected sex (even once) • History of STD or has a current STD • Drug user • Sex partner of drug user • Person who has sex for drugs/money • Sex partner of person who has sex for drugs/money • Between the ages of 12-26 • Sexual practices/ Exposure sites

20. Bacterial STDs Gonorrhea Chlamydial Infections Syphilis

21. Gonorrhea • Transmitted- vaginal/oral/rectal sex • Symptoms- 3-10 days following exposure • Milky discharge from penis/vagina/rectum • Burning/itching on urination • If untreated can cause PID/ectopic pregancy in women • Sterility in both sexes • Joints, heart valves, brain

22. Gonorrhea (clap) • Etiology • Caused by organism infection - gonococcal bacteria which is spread through intercourse • Sign and Symptoms • In men - experience tingling of urethra followed by 2-3 hours of greenish yellow discharge and painful urination • 60% of women are asymptomatic • Females will experience vaginal discharge • May result in sterility if not treated or arthritis • Management • Penicillin • Avoid sexual contact until it is known that the disease is no longer active

24. Chlamydia • Most prevelant STD worldwide • Transmitted thru vaginal/anal sex • Symptoms- up to 75% of women and 15% of men are asymptomatic • In men & women abnormal discharge and burning on urination. • Swelling of the testicles in men and abdominal pain and painful intercourse in women

25. Chlamydia cont…. • Possible consequences for infected persons: • If untreated in women 30% will experience PID, infertility and chronic pelvic pain • In men epididymitis, inflammation of the testicle and sterility

26. Chlamydia • Etiology • Caused by bacterial organism • Sign and Symptoms • May result in pelvic inflammation and is important cause of infertility and ectopic pregnancy in females • In males, inflammation occurs along with purulent discharge 7-28 days after intercourse • Painful urination and traces of blood in urine, vaginal discharge • Can cause conjunctivitis and pneumonia in newborns • Management • Identify infection and exact organism present • Treat with antibiotics

27. Syphilis • Transmitted through vaginal/anal/oral sex • Infection can occur by non-sexual contact if sores, rashes or mucous patches come in contact with broken skin • Symptoms- Stage 1- painless sores (chancres) appear on genitals or any other part of the body

29. Primary Lesion in Female

30. Syphilis cont…. • Chancre heals with several weeks • Secondary syphilis-if chancre is not treated, organism enters the bloodstream causing rash, sore throat, fever, swollen glands and mucous patches

32. Syphilis cont…. • Symptoms from secondary syphilis disappear after several weeks • Tertiary syphilis occurs years later after spirochete has damaged major organs • Damage to heart and vessels • Brain damage resulting in mental illness • Damage to spinal cord causing paralysis • Deafness/blindess

33. Syphilis • Etiology • A spirochete bacteria is the organism related to syphilis and enters body through mucous membranes or skin lesions • Sign and Symptoms • 4 stages • Incubation is usually 3-4 weeks but could be anywhere from 1-13 weeks; painless chancre or ulcer forms that heal w/in 4-8 weeks (can occur on penis, urethra, vagina, cervix, mouth, hand, foot or around eye) • Secondary stage occurs 6-12 weeks after initial infection and is characterized by a rash, lymph swelling, body aches, mild flu-like symptoms and possible hair loss • Latent syphilis is characterized by no or few symptoms - but if untreated it may result in tertiary syphilis

34. Sign and Symptoms • Late stage is characterized by deep penetration of spirochetes that damage skin, bone, cardiovascular system and nervous system • Late stage may develop w/in 3-10 years of infection and cause neurosyphilis - muscle weakness, paralysis and various types of psychoses • Management • Penicillin is used for all stages • Other drugs may be required due to increased resistance

35. Treatments for Bacterial STDs • Gonorrhea and chlamydia can be cured with antibiotic medication however, it cannot undo the damage done prior to treatment • Syphilis is treated with penicillin and other 3rd generation antibiotics but these medications are only effective in primary and secondary syphilis. There is no cure for tertiary syphilis.

36. Viral STDs Genital Herpes Human Papillomavirus (genital warts) HIV Hepatitis B

37. Genital Herpes • Spread by direct sexual skin to skin contact with infected site during vaginal/anal/oral sex • Symptoms include itching and burning sensation in buttocks, • Blisters or painful open sores in the genital area, anus, buttocks and thighs • Sores heal after several weeks but often recur • No cure-

39. Genital Herpes • Etiology • Caused by type 2 herpes simplex virus • Sign and Symptoms • Develops 4-7 days following sexual contact • Begins to crust 14-17 days in primary genital herpes and 10 days in secondary • Females may be asymptomatic while males will experience itching and soreness • Development of lesions • Management • Herpes and pregnancy • No cure just systemic medication (antiviral medications) to lessen early symptoms or the disease

40. Genital Warts • Cause by HPV • Occur 1-3 months after exposure • Emerging as a common STD • No Cure- treatment is aimed at surgical removal • Associated with increased risk of anal cancer

42. Genital Candidiasis • Etiology • Transmitted through sexual activity and appear as warts on the glans penis, vulva or anus • Sign and Symptoms • Cauliflower-like wart or can be singular • Soft, moist pink or red swellings that develop cauliflower-like head • May be mistaken as secondary syphilis or carcinoma • Management • When moist - 20-25% polophyllin • Dry warts - may be frozen with liquid nitrogen

44. Trichomonas Vaginalis • Sexually transmitted • Often secondary to existing STD • Called NGU (nongonoccocal urethritis) in men • Causitive agent is protazoa • Symtoms are foul, whitish discharge, itching, vulvular irritation

45. Trichomoniasis • Etiology • Caused by the flagellate protozoan trichomonas vaginalis • Sign and Symptoms • Vaginal discharge that is greenish yellow and frothy • Causes irritation of the vulva, perineum and thighs • Painful urination • Males tend to by asymptomatic but may experience purulent urethral discharge • Management • 2 grams of metronidazole cures up to 95% of cases in women • Males require 500mg twice daily for 7 days • Complete cure is required before engaging in intercourse

46. Pubic Lice • Sexually transmitted • Also by contaminated linens, clothing or other articles • Parasite is the causative agent • Symptoms include: intense itching of perineal area

47. Play safe- protect yourself • Abstinence is 100% effective • Have sex with only one uninfected partner • Talk to your partner • Consider all potential sex partners as infected • Use condoms, birth control foams, creams or jelly. These kill many STD germs • Get checked for STDs • Know the signs and symptoms of STD • If you have an STD, your partner must get treated as well