Key Points

• Upper respiratory infections are more common in heavily training athletes, and team physicians must consider both infection control measures and avoiding banned substances when treating high-level athletes.

• Infectious mononucleosis is associated with splenomegaly and a risk of splenic rupture. It requires that athletes avoid heavy exertion and contact sports until the spleen is of normal size, usually within 4 weeks.

Upper respiratory tract infection (URI) is a common complaint in primary care sports medicine. Regular, moderate exercise may decrease the risk for contracting a URI, but acute bouts of heavy exercise, such as running a marathon, and prolonged heavy training increase the risk for URI (Nie-man, 2003). Treatment of URI is symptomatic, but health care providers of competitive athletes must consider which substances are banned by the governing body overseeing their sport. Banned substances are subject to change, and physicians must be aware of current regulations. For example, the World Anti-Doping Agency (WADA), responsible for drug regulation for many international sports organizations, bans stimulants and many sympathomimetics. Ephed-rine is banned above a urine concentration threshold, and pseudoephedrine was banned until a rule change in 2005.

Most governing bodies, such as WADA (2009) and the National Collegiate Athletic Association (NCAA, 2009), have websites posting current banned substances (see Web Resources). These sites should be consulted before prescribing or recommending any medication for athletes subject to drug testing.

Physicians caring for teams must also consider infection control measures. URI, viral gastroenteritis, skin infection, and mononucleosis are of particular concern. Vectors that must be considered include common source spread (enteroviruses), person-to-person spread from sharing secretions (viral, fungal, bacterial skin infection), and airborne droplet spread (picornaviruses). Sharing of water dispensers, bottles, and towels should be eliminated. Handwashing must be encouraged and antibacterial soap or alcohol-based hand sanitizers provided. Shared equipment must be disinfected. Simple infection control measures are often not practiced in the setting of team sports, and educating athletes, coaches, and training staff is the responsibility of the team physician.

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