National athletic trainers' association position statement: skin diseases

Common Skin Infections in High School Athletes and the Role of the School Nurse

Skin infections in high school athletes pose a risk of transmission to other student athletes. Therefore, it is important to promptly identify possible skin infections and refer them to the healthcare provider for treatment so athletes can return to play quickly and with little interruption to the team. Common skin infections include bacterial infections such as Streptococcus and Staphylococcus, viral infections such as herpes simplex and molluscum contagiosum, and fungal infections such as tinea corporis and capitis. The National Federation of State High School Associations provides guidance for the prevention of skin infections as well as return to play guidelines. The school nurse and high school athletic trainer are both healthcare professionals who play a role in preventing, identifying, monitoring, and caring for student athletes who contract skin infections.

Mpox and Monkeypox Virus: Special Considerations for Athletes in Contact Sports

Monkeypox virus infections (mpox) in humans have become increasingly common since the virus was first identified in 1970. Coverage of the ongoing mpox outbreak has emphasized the role of skin-to-skin contact in monkeypox virus transmission and has focused on the community of men who have sex with men. While close contact from sexual activity is currently the main mechanism of monkeypox virus transmission, the potential for contact sports to exacerbate the 2022 outbreak has largely been overlooked. Infectious diseases rapidly spread in sports with significant skin-to-skin contact (i.e., wrestling and other combat sports, American football, and rugby). Mpox has not yet reached the athletic community, but once it does, it may follow a similar pattern of other infectious skin diseases in sports. Thus, it is critical to initiate a discussion of the risk of mpox and potential preventive measures within a sports context. This Current Opinion aims to provide stakeholders within the sports community with a brief review of infectious skin diseases in athletes, an overview of mpox and why it is relevant to athletes, and recommendations to reduce the risk of monkeypox virus transmission within sports settings. Guidelines for sports participation in athletes exposed to mpox and those with suspected, probable, and confirmed cases of monkeypox are provided.

The Identification and Treatment of Common Skin Infections

Skin conditions are a common problem addressed by medical providers. Up to 25% of individuals in the United States will seek attention for these conditions each year. The same problem occurs in the athletic training room, where athletes with infectious skin conditions can be seen. Most conditions are simple and can be treated without concern for spread to susceptible athletes. However, others can be quite serious and spread rapidly through a team and opponents during competition. Knowledge of the different types of skin infections is necessary to help treat these athletes and prevent spread to others. With proper diagnosis and treatment, certified athletic trainers can keep the athlete off the field of play for a minimum period and prevent transmission.

Prevalence of Common Viral Skin Infections in Beach Volleyball Athletes

Viral skin infections often affect the sports community. The aim of this study was to assess the rates, location sites, and seasons of appearance of common viral cutaneous diseases in beach volleyball athletes in Greece. Five hundred and forty-nine beach volleyball athletes participated in this study. The average age was 28.4 years. The viral infections were herpes simplex (type 1), molluscum contagiosum and warts. The measured parameters included: gender, age, the season when athletes may be more susceptible to infections and the location of infection in the body. Practicing information such as the number of training years, number of weekly trainings, and average hours of daily training was also recorded. Incidence rates correlated in relation to age: (a) warts (p < 0.001), molluscum contagiosum (p < 0.001), and herpes simplex (p = 0.001); (b) years of training: warts (p < 0.001), molluscum contagiosum (p < 0.001), and herpes simplex (p = 0.004); (c) average hours of daily training: molluscum contagiosum (p = 0.006) and herpes simplex (p < 0.010). The skin is the largest organ, and the risk of infection should not be underestimated. Prevention, early detection, recognition, and treatment are related to health and athletic performance, but also to the risk of transmission.

Epidemiology of Injuries in National Collegiate Athletic Association Men's Wrestling: 2014-2015 Through 2018-2019

CONTEXT

The first men's wrestling National Collegiate Athletic Association (NCAA) Championship was sponsored in 1928; since then, participation has increased.

BACKGROUND

Continued study of wrestling injury data is essential to identify areas for intervention based on emerging trends.

METHODS

Exposure and injury data collected in the NCAA Injury Surveillance Program during 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios (IRRs) were used to examine differential injury rates.

RESULTS

The overall injury rate was 8.82 per 1000 athlete exposures. The competition injury rate was significantly higher than practice injury rate (IRR = 4.11; 95% CI = 3.72, 4.55). The most commonly injured body parts were the knee (21.4%), shoulder (13.4%), and head/face (13.3%), and the most prevalently reported specific injury was concussion.

SUMMARY

These findings provide the most current update to injury incidence and outcomes in NCAA men's wrestling. We identify notable trends that warrant consideration in future research.

Infectious Dermatoses in Sport: A Review of Diagnosis, Management, and Return-to-Play Recommendations

ABSTRACT

Infectious dermatoses represent a significant source of morbidity and missed athletic participation among athletes. Close quarters and skin trauma from contact sports can lead to outbreaks among teams and athletic staff. The National Collegiate Athletic Association and National Federation of State High School Associations have published guidance with recommended management and return-to-play criteria for common fungal, bacterial, viral, and parasitic rashes. In addition to rapidly diagnosing and treating infectious dermatoses, team physicians should counsel athletes and athletic staff on proper equipment care and personal hygiene to reduce infection transmission. Clinicians should always consult sport and athlete governing bodies for sport-specific recommendations.

Outbreak of community-acquired Staphylococcus aureus skin infections in an Australian professional football team

OBJECTIVES

Skin and soft tissue infections commonly affect athletes and can lead to cluster outbreaks if not managed appropriately. We report the findings of an investigation into an outbreak of community-acquired Staphylococcus aureus infection in an Australian professional football team.

DESIGN

Retrospective cross-sectional study.

METHODS

Nose, axilla, groin and throat swab were collected from 47 participants. MRSA and MSSA isolates underwent antibiotic susceptibility testing, binary typing and whole genome sequencing. Infection control practitioners (ICPs) investigated the training grounds for risk factors in the transmission of S. aureus.

RESULTS

Almost half of the participants (n=23, 48.9%) were found to be colonised with MSSA. An outbreak cluster of MRSA ST5 closely related to the fusidic acid-resistant New Zealand NZAK3 clone was identified in a group of four players. MSSA ST15 and MSSA ST291 strains were found to have colonised and spread between two and five players, respectively. All participants were advised to undergo decolonisation treatment consisting of 4% chlorhexidine body wash and mupirocin nasal ointment for ten days. The ICP team identified several unhygienic practices within the club's shared facilities that may have played a role in the transmission of S. aureus.

CONCLUSIONS

We report for the first time a community-associated S. aureus outbreak involving the highly successful fusidic acid-resistant MRSA ST5 clone in a professional football club associated with inadequate hygiene procedures. Management and prevention of S. aureus relies heavily on hygiene education and adherence to personal and environmental hygiene practices and policies.

Methicillin-Resistant Staphylococcus aureus: Risk for General Infection and Endocarditis Among Athletes

The first studies on Staphylococcus aureus (SA) infections in athletes were conducted in the 1980s, and examined athletes that perform in close physical contact, with particular attention to damaged or infected skin. Recent studies have used molecular epidemiology to shed light on the transmission of SA in professional athletes. These studies have shown that contact between athletes is prolonged and constant, and that these factors influence the appearance of infections caused by SA. These results support the need to use sanitary measures designed to prevent the appearance of SA infections. The factors triggering the establishment of SA within professional sports groups are the nasal colonization of SA, contact between athletes and sweating. Hence, there is a need to use the most modern molecular typing methods to evaluate the appearance of cutaneous SA disease. This review aims to summarize both the current SA infections known in athletes and the diagnostic methods employed for recognition, pointing to possible preventive strategies and the factors that can act as a springboard for the appearance of SA and subsequent transmission between athletes.

Coaches' perceptions about food, appetite, and nutrition of adolescent Indian athletes - A qualitative study

Adolescence is a transitional phase of development with the risk of adopting unhealthy behaviours, which is carried on to adulthood. Adolescent athletes tend to resort to unhealthy eating habits resulting in eating disorders and other clinical outcomes. Hence, it forms a crucial age to understand modifiable food habits and provide appropriate counselling. In India, coaches closely monitor the adolescent athletes, even concerning their eating habits due to the lack of multi-disciplinary support staff. Thus, our study aimed to understand the perceptions of coaches towards food, appetite and nutrition of adolescent athletes using In-depth interviews (IDI). Of all 14 coaches at the state-sponsored residential sports centre, 10 consented. The IDI were conducted in a standardized manner and were recorded and transcribed. They were coded manually, using the open and axial coding in the grounded theory approach to determine themes. They considered nutrition as key to performance and consumption of higher animal protein as important. Majority of them considered sprouts, dry fruits, fruits and vegetables as healthy foods, though were unable to define the quantities nor nutrients therein. Coaches considered protein as “important”, while fat as “unhealthy”. They also observed that athletes were avoiding fruits and vegetables, while consuming more rice. Meal timing, fluid and supplement intake were considered essential for international performance, albeit unaware of the specific requirements. Hygiene practices and peer isolation were considered to affect food intake. This lacunae in the nutrition knowledge and the modifiable nutrition practices explored can be targeted by developing a nutrition education and assessment tool for coaches and junior athletes. Further, a long-term engagement of a nutritionist with every sports academy in India is recommended.

Onychomycosis in Athletes

Onychomycosis is a common disorder that is difficult to cure. Prevalence is lower in children (0.7%), but athletes are 2.5-fold more likely to develop the disease, with infections of the toenails seven times more prevalent than those of the fingernails. This is a concern for athletes as it can interfere with their performance. The risk of developing onychomycosis is increased by the warm environment of many sports activities; the use of occlusive footwear; the warm, moist environment associated with socks and sweating; shared, close quarters among athletes; and trauma to the foot and toenail. Once infected, onychomycosis treatment requires a long duration of treatment with strict compliance, a potential problem for younger patients. Treatment carries the risk of significant side effects, and recurrence rates remain high. Avoiding infection can be a potent first line of defense and may circumvent the need for treatment. Preventive recommendations such as keeping toenails short and proper washing of laundry, to name a few, can be effective and are discussed here. Technological improvements such as synthetic, moisture-wicking socks and well-ventilated, mesh shoes have also been shown to reduce moisture and injury. Education about preventing fungal spread and improving hygiene in the locker room, gym, and pool are of critical importance. This overview of onychomycosis focuses primarily on the preventive measures and innovative changes in athletic gear. It also provides a compact step-by-step guide to prevention intended to be useful for both the general public and the professional. It can be reproduced to use as a handout for athletes, trainers, and coaches.

Athletic Trainer Services in the Secondary School Setting: The Athletic Training Locations and Services Project

CONTEXT

Previous research from a sample of US secondary schools (n = 10 553) indicated that 67% of schools had access to an athletic trainer (AT; 35% full time [FT], 30% part time [PT], and 2% per diem). However, the population-based statistic in all secondary schools with athletic programs (n = approximately 20 000) is yet to be determined.

OBJECTIVE

To determine the level of AT services and employment status in US secondary schools with athletics by National Athletic Trainers' Association district.

DESIGN

Cross-sectional study.

SETTING

Public and private secondary schools with athletics.

PATIENTS OR OTHER PARTICIPANTS

Data from all 20 272 US public and private secondary schools were obtained.

MAIN OUTCOME MEASURE(S)

Data were collected from September 2015 to April 2018 by phone or e-mail communication with school administrators or ATs and by online surveys of secondary school ATs. Employment categories were school district, school district with teaching, medical or university facility, and independent contractor. Data are presented as total number and percentage of ATs. Descriptive statistics were calculated for FT, PT, and no AT services data for public, private, public + private, and employment type by state and by National Athletic Trainers' Association district.

RESULTS

Of the 20 272 secondary schools, 66% (n = 13 473) had access to AT services, while 34% (n = 6799) had no access. Of those schools with AT services, 53% (n = 7119) received FT services, while 47% (n = 6354) received PT services. Public schools (n = 16 076) received 37%, 32%, and 31%, whereas private schools (n = 4196) received 27%, 28%, and 45%, for FT, PT, and no AT services, respectively. Most of the Athletic Training Locations and Services Survey participants (n = 6754, 57%) were employed by a medical or university facility, followed by a school district, school district with teaching, and independent contractor. Combined, 38% of AT employment was via the school district.

CONCLUSIONS

The percentages of US schools with AT access and FT and PT services were similar to those noted in previous research. One-third of secondary schools had no access to AT services. The majority of AT employment was via medical or university facilities. These data depict the largest and most updated representation of AT services in secondary schools.

Community-associated Methicillin-Resistant Staphylococcus aureus Infection Rates and Management among Student-Athletes

PURPOSE

Although community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have reduced among inpatient populations, the incidence in athletics continues to range greatly dependent on the sport. Over the 2015 to 2016 and 2016 to 2017 school years, we assessed the annual CA-MRSA incidence, sport risk, referral practices, and management protocols or interventions among high school and intercollegiate athletics.

METHODS

This study targeted high school and intercollegiate athletic programs across the United States. For the 2015 to 2016 study, 269 athletic trainers completed a one-time questionnaire. In the 2016 to 2017 study, 217 athletic trainers reported data bimonthly during the academic year. Each questionnaire targeted demographic information, physician-confirmed CA-MRSA infection occurrence, and management of CA-MRSA infections and bacterial skin lesions.

RESULTS

The CA-MRSA infection incidence was 26.8 per 10,000 athletes (95% confidence interval [CI], 24-30) in 2015-2016 and 20.3 per 10,000 athletes (95% CI, 18-23) in 2016-2017. The CA-MRSA infection incidence was high in wrestling and football compared to the general student-athlete population. During the 2015 to 2016 study, the wrestling incidence rate was 248.3 per 10,000 (95% CI, 204-302); the football incidence rate was 71.0 per 10,000 (95% CI, 60-85). In the 2016 to 2017 study, the wrestling incidence rate was 100.0 per 10,000 (95% CI, 66-151); the football incidence rate was 81.8 per 10,000 (95% CI, 68-99). At least 23% of respondents denoted at least one physician-confirmed CA-MRSA infection within their populations (2015-2016, 39%, n = 105; 2016-2017, 23.5%, n = 51). In the 2015 to 2016 survey, respondents indicated that athlete education and environmental decontamination were the most used management steps (51.8%, n = 582).

CONCLUSIONS

Despite increased awareness of CA-MRSA, more educational efforts focusing on best practices and education are needed, especially with athletes and the medical community involved in their care.

Increasing the Post-Use Cleaning of Gym Equipment Using Prompts and Increased Access to Cleaning Materials

A multiple treatment reversal design was used to evaluate the effects of three different antecedent-based interventions on the post-use cleaning of gym equipment. Unidentified students, faculty, staff, and community members participated in this study. An announcement, signs, and signs together with increased accessibility to cleaning materials were evaluated. The highest level of post-use cleaning was observed under the signs plus accessibility condition. These results indicate that the use of antecedent-based interventions may be a viable option for increasing cleaning behavior.

Infectious Disease in Contact Sports

CONTEXT:

Infections are common in contact sports. This review aims to describe the epidemiology, presenting signs and symptoms, treatment guidelines, and regulations for several common infections seen in contact sport athletes. The conditions discussed include bacterial skin infections, herpes simplex virus, molluscum contagiosum, common warts, tinea, scabies, head lice, conjunctivitis, human immunodeficiency virus, hepatitis C virus, and vaccine-preventable illnesses.

EVIDENCE ACQUISITION:

Searches were performed across PubMed and MEDLINE research databases. In addition, general internet search engine results and reviews of reference lists of relevant papers were used to identify additional sources of evidence.

STUDY DESIGN:

Clinical review.

LEVEL OF EVIDENCE:

Level 4.

RESULTS:

The most common infections seen in contact sport athletes include bacterial skin infections, herpes simplex virus, molluscum contagiosum, common warts, tinea, scabies, head lice, conjunctivitis, and vaccine-preventable illnesses. Other infections, including human immunodeficiency virus and hepatitis C, are uncommon but potentially life threatening.

CONCLUSION:

Infections are common in contact sport athletes. The provider who cares for these athletes should be aware of the most common infections and their appropriate management. Early diagnosis and appropriate clinical management are important for treating the infected athlete, minimizing risk of transmission, minimizing time lost from competition, and preventing large outbreaks.

Infectious Diseases Associated With Organized Sports and Outbreak Control

Participation in organized sports has a variety of health benefits but also has the potential to expose the athlete to a variety of infectious diseases, some of which may produce outbreaks. Major risk factors for infection include skin-to-skin contact with athletes who have active skin infections, environmental exposures and physical trauma, and sharing of equipment and contact with contaminated fomites. Close contact that is intrinsic to team sports and psychosocial factors associated with adolescence are additional risks. Minimizing risk requires leadership by the organized sports community (including the athlete's primary care provider) and depends on outlining key hygiene behaviors, recognition, diagnosis, and treatment of common sports-related infections, and the implementation of preventive interventions.

CA-MRSA Infection Incidence and Care in High School and Intercollegiate Athletics

PURPOSE

Position papers offer solutions to manage community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), yet few studies establish the infection rate, management protocols, and referral practices among student-athletes. Over the 2012-2013 and 2013-2014 school years, we assessed the annual CA-MRSA infection incidence, sport risk, referral practices, and management steps among high school and intercollegiate athletics.

METHODS

This study targeted high school and intercollegiate athletic programs in the Northeastern United States. For the 2012-2013 study, 156 athletic trainers completed a one-time questionnaire. In the 2013-2014 study, 87 athletic trainers reported data bimonthly during the academic year. Each questionnaire targeted demographic information, physician-confirmed CA-MRSA infection occurrence, and management of CA-MRSA infections and bacterial skin lesions.

RESULTS

The CA-MRSA infection incidence was 15.5 per 10,000 athletes (95% confidence interval [CI], 13-19) in 2012-2013 and 16.3 per 10,000 athletes (95% CI, 13-21) in 2013-2014. The CA-MRSA infection incidence was higher in wrestling and football compared to the general student-athlete population. During the 2012-2013 study, the wrestling incidence rate was 90.2 per 10,000 (95% CI, 62-132); the football incidence rate was 42.3 per 10,000 (95% CI, 31-59). In the 2013-2014 study, the wrestling incidence rate was 89.0 per 10,000 (95% CI, 50-158); the football incidence rate was 61.4 per 10,000 (95% CI, 42-90). In both studies, primary care and general physicians received over 60% (2012-2013: 60.5%, n = 133; 2013-2014: 66.5%, n = 125) of referrals. In the 2012-2013 study, respondents indicated that student-athlete isolation and setting decontamination were common management steps used (58.1%, n = 306).

CONCLUSIONS

The incidence of CA-MRSA infections among student-athletes remains high. Therefore, it is critical that sports medicine providers continually reassess management protocols and best practices.

Staphylococcus Aureus Carriage in French Athletes at Risk of CA-MRSA Infection: a Prospective, Cross-sectional Study

Background

Staphylococcus aureus (SA) is a leading cause of infectious diseases in sports teams. In recent decades, community-associated SA (CA-SA) strains have emerged worldwide and have been responsible for outbreaks in sports teams. There are very few data on the prevalence of these strains in France, and none on the carriage among athletes.

Methods

We conducted a cross-sectional study to determine the SA carriage proportion among athletes practicing sports at risk for CA-SA infection in a French county, and determined the methicillin-resistant and/or CA-SA proportion. We also analyzed SA carriage according to risks factors and studied the SA clonality in a sample of our population.

Results

We included 300 athletes; SA carriage proportion was 61% (n = 183) and one was MRSA carrier (0.33%). The MRSA strain belonged to the clonal complex ST5. None of the strain produced Panton Valentine Leucocidin, and we did not find clonal distribution within the teams. Interestingly, we found a high throat-only carriage (n = 57), 31.1% of the SA carriers.

Conclusion

We found a high SA carriage with a local epidemiology quite different than that reported in a similar population in the USA. Further studies on SA carriage should include throat sampling.

Trial registration

The approved protocol was registered on ClinicalTrial.gov, NCT01148485.

Epidemiology of Skin Infections in Men's Wrestling: Analysis of 2009-2010 Through 2013-2014 National Collegiate Athletic Association Surveillance Data

CONTEXT

  Our knowledge of the current epidemiology of skin infections among wrestlers is limited.

OBJECTIVE

  To analyze and report the epidemiology of skin infections among National Collegiate Athletic Association (NCAA) men's wrestling student-athletes during the 2009-2010 through 2013-2014 academic years.

DESIGN

  Descriptive epidemiology study.

SETTING

  Aggregate skin infection and exposure data collected by the NCAA Injury Surveillance Program.

PATIENTS OR OTHER PARTICIPANTS

  Collegiate men's wrestling student-athletes.

MAIN OUTCOME MEASURE(S)

  All viral, bacterial, or fungal skin infections reported by athletic trainers at 17 NCAA programs were analyzed, providing 35 team-seasons of data. Skin infection rates per 10 000 athlete-exposures (AEs), rate ratios, skin infection proportions, and skin infection proportion ratios were calculated.

RESULTS

  The athletic trainers reported 112 skin infections contracted by 87 student-athletes across 78 720 AEs. The overall skin infection rate was 14.23/10 000 AEs (95% confidence interval [CI] = 11.59, 16.86). Of the skin infections identified, 22.3% (n = 25) were recurrent skin infections. Most skin infections (65.2%) were attributable to 5 team-seasons (range, 11-19 infections). Most skin infections occurred during the regular season (n = 76, 67.9%), were identified during practice (n = 100, 89.3%), and resulted in ≥24 hours' time loss (n = 83, 74.1%). The rate for viral skin infections was 1.72 times the rate for bacterial skin infections (95% CI = 1.09, 2.72) and 2.08 times the rate for fungal skin infections (95% CI = 1.28, 3.39). Fungal skin infections more often resulted in time loss <24 hours compared with all other skin infections (75.0% versus 12.5%; infection proportion ratio = 6.00; 95% CI = 3.30, 10.92).

CONCLUSIONS

  Our findings highlight the contagiousness of skin infections and suggest that skin infection rates may be attributable to high incidences among particular teams.

National Athletic Trainers' Association Position Statement: Management of Acute Skin Trauma

OBJECTIVE

  To present recommendations for the cleansing, debridement, dressing, and monitoring of acute skin trauma in patients.

BACKGROUND

  Acute skin trauma is common during participation in athletic and recreational activities. Clinical decisions and intervention protocols after injury vary among athletic trainers and are often based on ritualistic practices. An understanding of cleansing, debridement, and dressing techniques; clinical features of infection and adverse reactions; and monitoring of acute skin trauma is critical for certified athletic trainers and other allied health and medical professionals to create a local wound environment that promotes healing and lessens the risk of complications.

RECOMMENDATIONS

  These guidelines are intended to provide the certified athletic trainer and others participating in athletic health care with specific knowledge about and recommendations for the management of acute skin trauma.

Colonization With Methicillin-resistant Staphylococcus aureus and Risk for Infection Among Asymptomatic Athletes: A Systematic Review and Metaanalysis

BACKGROUND

Athletes are a vulnerable population for methicillin-resistant Staphylococcus aureus (MRSA) infection. Our aim was to determine MRSA colonization in asymptomatic athletes and estimate the risk for subsequent MRSA infection.

METHODS

We searched the PubMed and EMBASE (through 29 October 2015) for studies on MRSA colonization among asymptomatic athletes.

RESULTS

The pooled prevalence of MRSA colonization among athletes was 6% (95% confidence interval [CI], 1,13), and it was higher in the United States (8%; 95% CI, 2,17). USA300 was the most common strain detected (22%), and 62% and 36% of isolates were resistant to clindamycin and trimethoprim/sulfamethoxazole, respectively. The prevalence of MRSA colonization among collegiate athletes reached 13% (95% CI, 4,25). Sports with the highest prevalence among collegiate athletes were wrestling (22%; 95% CI, 0,85), football (8%; 95% CI, 3,15) and basketball (8%; 95% CI, 0,28). The risk for MRSA skin and soft tissue infection within 3 months after documented colonization among MRSA-colonized athletes was significantly higher than for noncolonized athletes (relative risk = 7.37, 95% CI, [2.47,21.94]). Decolonization treatment among colonized athletes decreased significantly the risk for infection (relative risk reduction = 0.33; 95% CI, .03,4.28).

CONCLUSIONS

The prevalence of MRSA colonization among asymptomatic athletes is comparable to that among individuals with chronic illness, it is higher among collegiate athletes and can be twice that for patients in intensive care units. Importantly, colonization is associated with a >7-fold increase in the incidence of subsequent MRSA infection. Infection control and decontamination protocols for this population need to be studied and implemented with urgency.

Sports-related dermatoses among road runners in Southern Brazil

BACKGROUND

Road running is a growing sport. OBJECTIVES: To determine the prevalence of sports-related dermatoses among road runners.

METHODS

Cross-sectional study of 76 road runners. Assessment was performed by means of a questionnaire, interview, and clinical examination. The chi-square and linear trend tests were used for analysis.

RESULTS

Most athletes were men (61%), aged 38±11 years, who ran mid- or long-distance courses (60.5%) for 45 to 60 minutes (79%), for a total of 25-64 km (42.1% ) or more than 65 km (18.4%) per week. The most prevalent injuries were blisters (50%), chafing (42.1%), calluses (34.2%), onychomadesis (31.5%), tinea pedis (18.4%), onychocryptosis (14.5%), and cheilitis simplex (14.5%). Among athletes running >64 km weekly, several conditions were significantly more frequent: calluses (p<0.04), jogger's nipple (p<0.004), cheilitis simplex (p<0.05), and tinea pedis (p<0.004). There was a significant association between the weekly running distance and the probability of skin lesions. Of the athletes in our sample, 57% trained before 10 a.m., 86% wore clothing and accessories for sun protection, 62% wore sunscreen, and 19.7% experienced sunburn. Traumatic and environmental dermatoses are common in practitioners of this outdoor sport, and are influenced by the weekly running distance.

CONCLUSION

In this group of athletes, rashes, blisters, sunburn, and nail disorders were recurrent complaints regardless of running distance. Calluses, athlete's foot, chapped lips, and jogger's nipple predominated in individuals who ran longer routes.

Skin infections in high school wrestlers: a nurse practitioner's guide to diagnosis, treatment, and return to participation

PURPOSE

To provide nurse practitioners (NPs) with a current guide for the diagnosis and treatment of high school wrestlers who present with common skin infections and to familiarize NPs with the National Federation of High School Associations Sports Medicine Advisory Committee return to participation guide and medical release form.

DATA SOURCES

Literature review of evidence-based research, journal articles, and reference texts related to skin lesions and high school wrestlers.

CONCLUSIONS

High school wrestlers with skin infections present in a variety of clinical settings. Improperly diagnosed and/or managed skin infections have the potential to get worse and continue to spread among teammates. Accurate diagnosis and treatment in combination with the use of a return to participation guide can improve outcomes and return the wrestler to participation sooner.

IMPLICATIONS FOR PRACTICE

NPs have a responsibility to accurately diagnose and treat skin lesions in a timely, safe, and efficient manner. In wrestling, athletes are exposed to unique opportunities to develop skin infections. With a working knowledge of the clinical presentation, diagnostic testing, and return to participation recommendations for common skin diseases, spread of skin infections to other wrestlers can be prevented and the athlete can return to play safely.

Cutaneous myiasis masquerading as methicillin-resistant Staphylococcus aureus

Numerous factors place athletes at increased risk for cutaneous infections, and as such, they are a common complaint in athletic training rooms. Methicillin-resistant Staphylococcus aureus (MRSA) is an increasingly common etiology, and given its severe sequelae, a high index of suspicion in this population is justified. We present 2 cases of college athletes who presented to the athletic training room with findings suspicious for MRSA infection. However, after further investigation, the true diagnosis of myiasis was reached. These cases highlight the importance of asking athletes about recent travel and considering a broad differential diagnosis when evaluating furuncular lesions.

Cutaneous infections in wrestlers

CONTEXT

Cutaneous infections are common in wrestlers. Although many are simply a nuisance in the everyday population, they can be problematic to wrestlers because such infections may result in disqualification from practice or competition. Prompt diagnosis and treatment are therefore important.

EVIDENCE ACQUISITION

Medline and PubMed databases, the Cochrane Database of Systematic Reviews, and UpToDate were searched through 2012 with the following keywords in various combinations: skin infections, cutaneous infections, wrestlers, athletes, methicillin-resistant Staphylococcus aureus, skin and soft tissue infections, tinea corporis, tinea capitis, herpes simplex, varicella zoster, molluscum contagiosum, verruca vulgaris, warts, scabies, and pediculosis. Relevant articles found in the primary search, and selected references from those articles were reviewed for pertinent clinical information.

RESULTS

The most commonly reported cutaneous infections in wrestlers are herpes simplex virus infections (herpes gladiatorum), bacterial skin and soft tissue infections, and dermatophyte infections (tinea gladiatorum). The clinical appearance of these infections can be different in wrestlers than in the community at large.

CONCLUSION

For most cutaneous infections, diagnosis and management options in wrestlers are similar to those in the community at large. With atypical presentations, testing methods are recommended to confirm the diagnosis of herpes gladiatorum and tinea gladiatorum. There is evidence to support the use of prophylactic medications to prevent recurrence of herpes simplex virus and reduce the incidence of dermatophyte infections in wrestlers.

Prevalence of fungal skin infections in Iranian wrestlers

PURPOSE

Fungal infections are one of the most common skin infections. Athletes, especially in contact sports such as wrestlers are the group at risk of fungal skin infections (FSI). The aim of this study was to determine prevalence of FSI and some effective factors in wrestlers in Tehran, Iran.

METHODS

This study was a cross-sectional descriptive study which was conducted in 2009 and subjects were wrestlers of wrestling clubs of Tehran, Iran. In this study the prevalence of FSI and its related factors was collected based on clinical history, physical examination and laboratory tests. We also determined the rate of dermatophytic contamination of wrestling mats. The relationship between independent variables and incidence of fungal infection analyzed by Chi square test and regression analysis.

RESULTS

In this study, out of 454 wrestlers, 111 (24.5%) subjects had suspicious fungal skin lesions on physical examination. The Prevalence of FSI was 8.2% in all of the wrestlers (34.2% of the wrestlers with suspicious lesion). Malassezia furfur (50%) and trichophyton tonsurans (30%) were the most common causative agents. Epidermophyton floccosum (7.5%), Trichophyton rubrum (5%), Candida albicans (5%) and Trichophyton mentagrophytes (2.5%) were other isolated fungi. Eleven wrestling mats (44%) were contaminated with different fungal organisms.

CONCLUSION

The prevalence of fungal skin infection in Iranian wrestlers is relatively high. Appropriate preventive measures need to be prepared and implemented to reduce incidence of FSI in wrestlers.

Survey of high school athletic programs in Iowa regarding infections and infection prevention policies and practices

OBJECTIVE

To assess high school athletic programs' infection prevention policies and procedures and to estimate the frequency of skin and soft tissue infections (SSTIs) among Iowa's high school athletes.

METHODS

An on-line survey of high school athletic programs.

RESULTS

Nearly 60% of programs responded. Schools in higher classifications were more likely to have a certified athletic trainer (AT; P < 0.0001) and to report that they had a policy preventing athletes with SSTIs from participating in athletic events than were schools in lower classifications (P = 0.0002). Programs that had an AT reported that athletic training equipment (P = 0.01) and tables (P = 0.02) were cleaned more frequently than did programs without ATs. Programs were significantly more likely to provide training equipment than to provide soap or towels. About 57% of programs reported that at least one athlete acquired an SSTI during the prior school year, including methicillin- resistant Staphylococcus aureus (N = 14; 10.8%). Programs that had an AT (P = 0.02) were in higher classifications (P < 0.0001), educated athletes about SSTIs (P < 0.0001), or had policies regarding athletes with SSTIs (P = 0.01) were more likely than other programs to report having at least one athlete with an SSTI. The estimated SSTI rate per 1000 athletes ranged from 22.0 in 1A to 5.9 in 4A programs.

CONCLUSIONS

SSTIs are common among Iowa's high school athletes. Staff should review and update their infection prevention policies. Athletic programs need resources to support infection prevention efforts.

Evaluation of persistent antimicrobial effects of an antimicrobial formulation

CONTEXT

Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is becoming more prevalent in healthy athletic populations. Various preventive measures have been proposed, but few researchers have evaluated the protective effects of a prophylactic application of a commercially available product.

OBJECTIVE

To compare the persistent antimicrobial properties of a commercially available antimicrobial product containing 4% chlorhexidine gluconate (Hibiclens) with those of a mild, nonmedicated soap (Dr. Bronner's Magic Soap).

DESIGN

Cross-sectional study.

SETTING

Microbiology laboratory, contract research organization.

PATIENTS OR OTHER PARTICIPANTS

Twenty healthy human volunteers.

INTERVENTION(S)

The test and control products were randomly assigned and applied to both forearms of each participant. Each forearm was washed for 2 minutes with the test or control product, rinsed, and dried. At, 1, 2, and 4 hours after application, each forearm was exposed to MRSA for approximately 30 minutes.

MAIN OUTCOME MEASURE(S)

Differences in numbers of MRSA recovered from each forearm, test and control, at each post-application time point were compared.

RESULTS

Fewer MRSA (P < .0001) were recovered from the forearms treated with the test product (4% chlorhexidine gluconate) than from the forearms treated with the control product (nonmedicated soap).

CONCLUSIONS

The 4% chlorhexidine gluconate product demonstrated persistent bactericidal activity versus MRSA for up to 4 hours after application.

Topical review: skin infections in the foot and ankle patient

There are numerous cutaneous disorders that affect the foot, but of these conditions skin infections have the most significant impact on overall patient morbidity and clinical outcome. Skin infections in foot and ankle patients are common, with often devastating consequences if left unrecognized and untreated in both surgical and nonsurgical cases. There is a diverse array of infectious dermatoses that afflict the foot and ankle patient including tinea pedis, onychomycosis, paronychia, pitted keratolysis, verruca, folliculitis, and erysipelas. Prompt diagnosis, treatment, and surveillance of these common infectious conditions are critical in managing these dermatoses that can potentially progress to form deep abscesses and osteomyelitis. Infections can be managed with a combination of ventilated shoewear and synthetic substances to keep the feet dry, topical and oral antimicrobial agents, and patient education regarding preventative hygiene measures. The purpose of this review is to aid foot and ankle surgeons and other physicians in the diagnosis and treatment of infectious dermatoses affecting the foot.

Methicillin-resistant Staphylococcus aureus: an overview for manual therapists()

OBJECTIVE

Methicillin-resistant Staphylococcus aureus (MRSA) is associated with difficult-to-treat infections and high levels of morbidity. Manual practitioners work in environments where MRSA is a common acquired infection. The purpose of this review is to provide a practical overview of MRSA as it applies to the manual therapy professions (eg, physical and occupational therapy, athletic training, chiropractic, osteopathy, massage, sports medicine) and to discuss how to identify and prevent MRSA infections in manual therapy work environments.

METHODS

PubMed and CINAHL were searched from the beginning of their respective indexing years through June 2011 using the search terms MRSA, methicillin-resistant Staphylococcus aureus, and Staphylococcus aureus. Texts and authoritative Web sites were also reviewed. Pertinent articles from the authors' libraries were included if they were not already identified in the literature search. Articles were included if they were applicable to ambulatory health care environments in which manual therapists work or if the content of the article related to the clinical management of MRSA.

RESULTS

Following information extraction, 95 citations were included in this review, to include 76 peer-reviewed journal articles, 16 government Web sites, and 3 textbooks. Information was organized into 10 clinically relevant categories for presentation. Information was organized into the following clinically relevant categories: microbiology, development of MRSA, risk factors for infection, clinical presentation, diagnostic tests, screening tests, reporting, treatment, prevention for patients and athletes, and prevention for health care workers.

CONCLUSION

Methicillin-resistant S aureus is a health risk in the community and to patients and athletes treated by manual therapists. Manual practitioners can play an essential role in recognizing MRSA infections and helping to control its transmission in the health care environment and the community. Essential methods for protecting patients and health care workers include being aware of presenting signs, patient education, and using appropriate hand and clinic hygiene.

Infectious disease

Athletes are susceptible to the same infections as the general population. However, special considerations often need to be taken into account when dealing with an athlete who has contracted an infectious disease. Health care providers need to consider how even common illnesses can affect an athlete's performance, the communicability of the illness to team members, and precautions/contraindications related to athletic participation. Recent advances in the prevention, diagnosis, and/or management of frequently encountered illnesses, as well as certain conditions that warrant special attention in the athletic setting, are discussed in detail.