General Medical Concerns

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1 General Medical Concerns General Medical Concerns Fred Reifsteck MD Head Team Physician University of Georgia Missed Time: school, work, practice, games Decreased Performance Physical/ Mental stress: New injuries Contagious State Fever Impairs coordination Impairs concentration Impairs muscle strength Impairs aerobic power Alters temperature regulation Sore Throat Pharyngitis: Inflammation of the pharynx Tonsillitis: Inflammation of the tonsils Sore throat, fever, exudates, adenopathy, other URI symptoms Exudative Tonsillitis Pharyngitis Viral-majority Streptococcus- Group A,B,C,G Mononucleosis- Epstein Barr (EBV) 1

2 Viral Pharyngitis Sore throat, fever, lymphadenopathy, URI symptoms, Rhinorrhea Diagnosis: Clinical, Throat culture Streptococcus (Strep) Found in 20 to 30 percent of children Found in 5 to 15 percent of adults Most serious complication- Rheumatic Fever 0.1-3% untreated Treatment: Supportive, fever control, comfort measures, rest, push fluids, time Strep Painful to swallow sore throat +/-exudates Lymphadenopathy, typically anterior NOTa cough, runny nose Centor score: fever, tonsiliar exudates, cervical lymphadenopathy, cough, age (modified). Used to help determine likelihood of Strep Infectious Mononucleosis Incidence peaks age More than 90 % of adults worldwide are seropositive for EBV antibodies by age 35 Incubation period 30 to 50 days PCN still first line treatment, Cephalexin, Azithromycin (resistance) Antibiotics reduce proportion of people with symptoms at 3 days post treatment. Mono Mono 3-5 day prodrome, fatigue, headache, loss of appetite and myalgias Sore throat, lymphadenopathy especially posterior cervical, fever, fatigue (98%) Heterophile antibody (monospot), quick in office test. 25 % false negative in the first week. Atypical Lymphocytes (>10 %) on CBC differential EBV specific antibodies (IgM acute, IgG chronic) 97% sensitivity and 94% specificity. IgM disappears in 4-6 weeks, IgG should persist for life Wide spectrum of clinic severity Complications: splenic rupture ( %). Contact/ collision sports Spleen ultrasound/ CT scan generally not reliable with no baseline and the significant variation of size in the general population Potential enlargement for 21 days Treatment: Supportive care, rest, fluids, fever control. Steroids for mild to severe IM, significant decrease in sore throat symptoms within 12 hours of illness, but the effect did not last beyond that. 2

3 Neck Check Used for return to play with symptoms above the neck, may exercise at low intensity for 10 minutes. If symptoms worsen, stop. If symptoms do not worsen can continue at 50 %. Symptoms below the neck, no exercise until symptoms resolve. Upper Respiratory Tract Infection Common cold, > 50% of acute illnesses Average adult 1-6 episodes per year Usually viral: Rhinovirus (10-40%); coronavirus (20%); Respiratory Syncytial virus (10%). > 200 virus strains Symptoms: Nasal congestion/ drainage, sore throat, cough, fatigue, fever usually < Incubation period:1-3 days, symptoms 3-7 days Treatment: Supportive, symptomatic, nothing works for everyone Influenza Sudden onset of symptoms, mylagias, headache, fever, cough, sore throat, nasal congestion/ drainage Complications: Worry with underlying pulmonary disease, pneumonia, ARDS. The young, the old, the immunocompromised. There are deaths from the flu. Influenza A Wild birds can be the host. Divided into subtypes H N Treatment: supportive, fluids, fever control (can be very high); Oseltamivir 75 mg BID x 5 days. Start early, mild relief. A lot of side effects. Advertised on TV, direct to consumer Influenza B Seasonal influenza. Respiratory and GI symptoms (nausea, vomiting, loss of appetite) Treatment: Supportive, hand washing, cover mouth and nose, antiviral meds. COVER YOUR MOUTH! Both strains of the flu, isolation of the sick 3

4 Influenza Bronchitis Flu vaccine has efficiency of 70-90% in population under the age of 65. It is a killed virus. You CAN NOT get the flu from the vaccine. 4 weeks to obtain full immunity. Best given in the fall. Flumist (nasal spray) live virus, give with care around the immunocompromised Cough from inflammation of the bronchial tree lasting up to 3 weeks or greater with or without sputum Viruses cause 90%, may get secondary bacterial infection Mycoplasma pneumonia, Bordetella pertussis, Chlamydia pneumonia (not what you re thinking) Diagnosis: clinical,? CXR Treatment: supportive treat fever and cough. Antibiotics or not??? Potentially after 10 to 14 days. Bronchodilator for wheeze, SOB. Inhaled corticosteroids second line therapy, oral steroids Isolated case of pertussis consider teammate prophylaxis Pneumonia Lower respiratory tract 30-50% viral, rest bacterial Productive cough, fever, malaise, myalgias Wheeze, SOB, chest tightness Diagnosis: clinical, CXR may show infiltrate; CBC elevated WBC, left shift Admit or not admit, hypoxia Macrolide antibiotics, Tetracyclines walking pneumonia Second most common infection in adolescents and young adults Most common cause viral (Rotavirus, Norwalk) Bacterial, Protozoa Diarrhea, nausea/ vomiting, abdominal cramping, myalgias Red Flag: Bloody Diarrhea Diagnosis: clinical, stool culture, bacterial, O & P Infections vs. food borne vs. traveler s Infectious: seasonal, community acquired. E. coli and Salmonella; Protozoa Giardia Food Borne: comes from preformed toxins. Incubation period 1-6 hours, usually resolves in less than 1 day. Multiple people eating the same thing. Usually storage and preparation issues Traveler s: 90 % E. coli spread by food and water. Also, Salmonella, Shigella, Vibrio, Campylobacter Treatment: rehydration oral if possible, if not IV rehydration. Loperamide for comfort, be careful with overuse Antibiotics: AVOID. They areneeded for Shigella. NOfor campylobacter, Salmonella, E. coli. Usually ineffective and can increase risk of hemolytic uremic syndrome. Pseudomembranous colitis. Treat Protozoa with antiprotozoal drugs. Traveler s diarrhea bismuth (Black Stool), or antibiotics, Fluroquinolones. Check black box warning. Return to play: Well hydrated, manageable stools 4

5 Conclusions References Young people in congested settings, schools, dormitories, etc. get sick. They love to pass it to each other. Early recognition, diagnosis and treatment key in keeping the illness confined and the athlete available for play. Harris MD and Harris TM. Infectious Disease and the Athlete. In O Connor FG Sr. editor. ACSM s Sports Medicine A Comprehensive review. Philadelphia: Wolters Kluwer/ Lippincott Williams & Wilkins p. Luzuriaga K, Sullivan JL. Infectious mononucleosis. NEJM. 2010; 362: Boggess BR. Gastrointestinal infections in the traveling athlete. Curr Sports Med Rep. 2007; 6: Womack J, Jimenez M. Common questions about infectious mononucleosis. Am Fam Physician. 2015;91(6): THANK YOU! 5