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winter and later summer/early fall, Figure 1: Infectious Mononucleosis
respectively. These viruses are spread
by person-to-person contact with Incubation Prodrome Illness
respiratory secretions or contact with
contaminated objects. Symptoms of a Time Course (days) 30–45 3–5 5–21
viral URI include rhinorrhea, sneez-
ing, congestion, sore throat, non- Clinical Manifestation None headache fever
productive cough, and often malaise fatigue sore throat
and myalgias with little or no fever. anorexia tonsilar enlargement
malaise lymphadenopathy
The effects of URIs on the athlete myalgias splenomegaly
include the impact on mental and
physical performance and the valu- Laboratories Normal variable atypical
able training time lost. A number lymphocytosis
of athletes feel that exercise improves elevated liver
their resistance to these infections; function tests
however, there is some increasing heterophil +
evidence that the rigors of athletics
may place athletes at increased risk.3 be considered in certain groups such IM has several known complications
Most experts feel that training can as athletes who compete in winter including splenomegaly, splenic
be resumed safely a few days after sports or team sports, or elite athletes rupture, and airway obstruction.
resolution of symptoms in cases who cannot afford to miss a single Splenomegaly occurs in approximately
without any systemic involvement. workout or competition. Potential 50 percent of patients with IM but
In athletes with systemic symptoms, morbidities include transient soreness the prevalence of splenic rupture is
most recommend waiting 10 to at the injection site (25 to 50 percent) less than 0.2 percent.1 If splenic
14 days to return to normal training, or fever and myalgias (less than rupture does occur in an athlete, it
mostly because of the observed 1 percent).1 Absolute contraindica- typically occurs between day four
association between URI and viral tions to influenza immunization and day 21 of the illness.4 Guidelines
cardiomyopathy and other more include a patient with an egg allergy for the return to sport in athletes
severe viral infections. (because the vaccine is produced in with IM have varied.5,6,7 Burroughs
egg embryo cultures) or a current recommends avoidance of strenuous
Influenza febrile illness. The potential risks or contact activity for three to four
and benefits should be discussed and weeks followed by possible return
Influenza is an acute respiratory illness individual issues addressed prior to to high risk activity after assessment
caused by infection with influenza recommending the influenza vaccine of the spleen including the use of
viruses. The illness can affect the to athletes. radiographic evaluation as needed.5
upper and lower respiratory tracts It should be noted that there has been
and is often accompanied by systemic Infectious Mononucleosis no study establishing the timing of
signs and symptoms such as fever, absolute safe return to sports.
headache, myalgia, and weakness. Discovered in 1967 to be caused by
Outbreaks occur almost every winter the Epstein-Barr Virus (EBV), infec- Blood-borne Viral Pathogens
of varying severity. Influenza results tious mononucleosis (IM) is a disease
in significant morbidity in the general that commonly affects adolescents and Hepatitis B Virus (HBV)
population and in increased mortal- young adults. EBV is characterized HBV is transmitted through contact
ity in “high-risk” patients largely by an incubation period of 30 to 45 with body fluids. Clinical symptoms
because of pulmonary complications. days. This is followed by a prodro- include fever, malaise, myalgia, and
mal period of three to five days with jaundice. Laboratory studies used to
In the athlete, a case of influenza clinical symptoms such as malaise, diagnose HBV include Hepatitis B
is usually self-limiting but can result headache, fatigue, anorexia, and surface antigen, Hepatitis B core anti-
in loss of valuable practice or game myalgias. Symptoms in the five- to body, and Hepatitis B e-antigen. There
time. As a result, many have consid- fifteen-day period that follow include is one valid reported case of transmis-
ered immunizing athletes against sore throat with tonsillar enlargement, sion involving transmission of HBV
influenza. The potential benefits of cervical lymphadenopathy, soft palate between a high school wrestler and his
immunization are obvious and may petechiae, and splenomegaly. Clinical teammates.8 The risk of transmission
signs and laboratory abnormalities although not well studied is thought
are shown in Figure 1. to be higher in contact and collision

Although a self-limited illness,

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