Bitten by the Sports Bug
ARTICLE COPIED from Minnesota HealthCare News- April
2003- written by Kevin Smith R.N., C.N.P., M.S.N. “BITTEN
BY THE SPORTS BUG”
As parents, coaches, and fans, we enjoy watching our
young athletes have a greater time competing on the field, at the
rink, in the pool, the gym or wherever their sports takes them.
We marvel at the fitness and the picture of health that these elementary
and high school athletes represent. Sports participation provides
a wonderful opportunity for fun, friendship, and healthy physical
activity, yet even for the young, healthy athlete, there are certain
risk factors for illness related to sports participation. Fortunately,
there are things we all can do to minimize these risks.
Youth participation in sports remains popular throughout
the United States. When we think of health problems related to sports
activities, we often think of injuries such as sprains, strains
and broken bones. However, young athletes can also develop health
problems by being exposed to various infectious diseases and illnesses
through contact with other athletes. (Has your child ever shared
a water bottle?)
Transmission of infectious diseases
Most infectious diseases or illnesses that can be
transmitted among athletes are not serious and respond well to treatment.
On the other hand, the illness can sometimes serious and there is
potential for outbreaks. It is important for athletes, coaches and
parents to be aware of ways to prevent transmission of illnesses
between athletes, and to know how to manage infectious
illnesses when to manage infectious illnesses when
they occur.
The most common of the many conditions caused by person-to-person,
athlete-to-athlete contact is the transmission of herpes simplex
virus (cold sores) among wrestlers and rugby players. One report
described an outbreak of herpes simplex in 60 out of 175 high school
wrestlers attending a training camp. Other outbreaks spread by person-to-person
contact include Staphylococcus skin infection, group A strep infection,
hepatitis B, and several types of fungus infections. The athletes
affected by these outbreaks were involved in wrestling, basketball,
football, rugby and orienteering (hiking).
Another mode of illness transmission is associated
with contamination of shared water sources, drinking containers
and shared food. Infectious agents include various types of viruses
that cause aseptic meningitis and pleurodynia (chest pain) among
football and soccer teams. One such outbreak occurred when players
ate ice cubes from the other team’s ice chest, and drank water
from the team’s cooler and from a hose near the playing field.
Although uncommon, exposures to or outbreaks of measles have occurred
during sporting events. For example, in 1991 three gymnasts had
onset of measles during an international competition, potentially
exposing thousands of people. The local health department provided
1,300 people with post-exposure vaccinations against measles.
Common illnesses and infections
As mentioned above, Herpes simplex virus
occurs in sports activities involving close contact among athletes,
such as wrestling. The infection typically is located around the
mouth or eyes. The blister-type lesions may be limited or widespread,
and the symptoms range from mild itching to severe pain. Lesions
around the eyes are of greatest concern. In addition, a secondary
bacterial infection can occur that often looks like impetigo. In
these cases, the athlete should receive early medical treatment
to avoid complications. The lesions should be health to the point
of being dry scabs before the athlete returns to activity. Avoiding
contact with the blisters is the primary method of prevention.
Impetigo is a common skin infection caused by bacteria
such as staph and strep. Like the herpes simplex infection, this
highly contagious infection is spread though skin-to-skin contact.
The small blisters that form are usually itchy; they typically become
larger, have honey-colored drainage and eventually crust over. Treatment
may include topical or oral antibiotics. The lesions should be limited
to completely dry scabs before the athlete returns to contact sports.
Fungal-type infections are common in most sport activities
and are associated with sweating, moisture, shared towels, and shower
and locker room floors. The most common body parts affected are
the feet (“athlete’s foot”) and the groin (“jock
itch”). However, the scalp and other body parts can also be
affected with a round-type lesion commonly known as ringworm. Most
of these infections will respond to over-the-counter topical medications.
Difficult cases may require prescription oral medications. Unfortunately,
relapses of these infections are common. Preventative measures include
antifungal powders, loose absorbent clothing, shoes that “breathe”
when away from the sports activity, and shower sandals. A tip for
athletes with athlete’s foot is to put socks on before underwear
to prevent jock itch.
Otitis externa (“swimmer’s ear”
or “surfer’s ear”), an infection of the external
ear canal, is more common in hot and humid weather. Typically, water
is trapped in the ear canal, causing itching, irritation and pain.
The infection usually is due to multiple forms of bacteria. The
ear canal can become quite swollen and painful. Most cases respond
well to eardrops, but some require oral antibiotics. Recurrence
can be reduced by using earplugs or preventive eardrops.
Intestinal infections usually occur in athletes who
are involved in freshwater sports such as kayaking, orienteering
and other paddle sports. However, such infections can occur from
contamination in swimming pools. Any athlete with persistent abdominal
symptoms such as bloating, loss of appetite, weight loss or diarrhea
should be evaluated to determine the cause of the infection.
In the United States, viral upper respiratory infections
are the most common reason for clinic visits, both by the general
population and among athletes. The incidence of colds is highest
from late August to April or May. Over-training can increase the
risk of these infections and exertion can increase the severity.
Over-training can make an athlete more vulnerable
to a variety of illnesses, according to David Wang, M.D., sports
medicine specialist at the University of Minnesota Boynton Health
Services. “When you use all of your energy to train, you have
less reserve to fight off infections,” he says. Athletes experiencing
systematic symptoms such as fever, chills, and sweats should avoid
activity, Dr. Wang says. However, he adds, “exceptions can
be made when the symptoms are above the neck, such as nasal congestion,
sore throat and ear pain.”
Influenza A and Influenza B are also more common in
winter with indoor sports such as basketball and wrestling. The
fatigue symptoms can be significant for athletes, and outbreaks
among teams can occur. Complications include bronchitis, pneumonia
and sinus infections. In rare instances, influenza can lead to other
more serious infections. Some newer medications are available to
treat Influenza A and Influenza B. The medications reduce the duration
of the illness but are effective only if they are started within
the first 48 hours of the illness. The best prevention is a flu
shot.
Human Immunodeficiency Virus (HIV) transmission between
athletes has received much public attention, particularly in relation
to two well-known HIV-positive athletes, Magic Johnson and Greg
Louganis. However, at this time there is no confirmed transmission
of HIV attributed to sports contact. Although the risk of transmission
of disease through blood on the athletic field is remote, precautions
should be taken with all body fluids. Any athlete who suffers an
injury causing bleeding should leave the field and not return until
the bleeding is controlled. Open lesions should be covered.
Preventing transmission
Pre-participating physical examination. A pre-participating
physical examination is required for participation in most organized
sports. These visits are a good opportunity to stay up to date on
the well-child health evaluation issues; to review and update immunizations
status; and to address issues such as allergies and asthma.
Immunizations.
According to the Minnesota Department of Health, carious
laws require immunizations for those in institutional settings.
Children in kindergarten through grade 12 should be up to date on
all childhood immunizations. Exemptions are allowed for those with
certain medical conditions or if the student or parent/guardian
conscientiously opposes immunizations.
Good hygiene.
According to Gloria Peterson, M.D., family physician
and medical director of QuickMedx, “Sports teams, especially
high school teams, usually have several individual water bottles
that are used by any member of the team regardless of who used it
previously. There are documented cases of meningitis that were fatal-
spread by soda pop cans. The mouth is a great reservoir of bacteria
and viruses. Mono and herpes cold sores are two examples of easily
transmissible viral diseases. Upper respiratory infections could
be spread this way.” Dr. Peterson recommends that parents
look at how their children get water and other liquids during school
sports. Each child needs his or her own water bottle with the child’s
name on it. Coaches and parents should teach athletes that they
should not share bottles or glasses. Probably the best way to avoid
sharing is to provide single-use only disposable paper cups. The
children can serve themselves from another, larger container.
Quick identification and treatment of athletes with
infectious illnesses.
Athletes who are at risk for various types of skin
infections should be examined routinely. Athletes in contact sports
such as wrestling and rugby are particularly susceptible to such
infections. Self-reporting of skin lesions may be unreliable, as
many athletes would be reluctant to report a problem that may affect
their participation. Skin wounds that are potentially infectious
should be covered to prevent exposure to others. When an athlete
sustains a bloody injury, the blood on the injured athlete and other
participants should be washed with soap and water or a moist towelette.
Trainers or coaches should wear disposable examination gloves when
they come in contact with blood.
Basic education
Coaches, athletes, and parents should be aware of
basic hygiene, first aid, and prevention of infections. Attentiveness
to those basics will help keep your young athletes healthy.
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