The Impact of Infectious Diseases on Athletes: Diagnosis, Management, and Return-To-Play Guidelines

May SALEM; Mohammad MOHAMMED

Authors

May SALEM Dept. of Medical Laboratory Technologies - Gilgamesh University- Baghdad, IRAQ
Mohammad MOHAMMED Dept. of Medical Laboratory Technologies - Gilgamesh University- Baghdad, IRAQ

Vol. 2 No. 4 (2025): American Journal of Biomedicine and Pharmacy

Articles

April 7, 2025

Downloads

VIEW ARTICLE

Abstract
How to Cite
Metrics
References

Orthopedic injuries are commonly associated with sports; however, infectious diseases also contribute significantly to morbidity among athletes. While moderate-intensity exercise enhances immune function, extreme exercise durations and intensities may suppress immunity. Respiratory infections are the most prevalent, although athletes are also susceptible to skin, bloodborne, sexually transmitted, and cardiac infections. Infectious disease outbreaks remain a persistent concern in athletic populations. The management of infections in athletes aligns with general medical treatment protocols, yet considerations regarding return-to-play decisions and infection prevention strategies are particularly important in this demographic.

May SALEM, & Mohammad MOHAMMED. (2025). The Impact of Infectious Diseases on Athletes: Diagnosis, Management, and Return-To-Play Guidelines. American Journal of Biomedicine and Pharmacy, 2(4), 14–28. Retrieved from https://biojournals.us/index.php/AJBP/article/view/833

Download Citation

McGrew CA (2007). Acute infections. In: McKeag DB, Moeller JL, editors. ACSM's Primary Care Sports Medicine. Philadelphia (PA); 2007, p. 251-60.

Brukner P and Khan K (2006). Common sports related infections. In: Clinical Sports Medicine. New York (NY): McGraw Hill; 2006, p. 863-74.

Klossner D ( 2010). Appendix D, NCAA Banned Drugs. 2010-2011 NCAA Sports Medicine Handbook. Indianapolis (IN): National Collegiate Athletic Association.

Hosey RG, Rodenberg RE. Training room management of medical conditions: infectious diseases.Clin. Sport Med. 2005; 24:477-506.

Page CL, Diehl JJ (2007). Upper respiratory tract infections in athletes. Clin. Sports Med.; 26:345-59.

Luke A, D'Hemecourt P (2007). Prevention of infectious diseases in athletes. Clin. Sports Med.; 26:321-44.

Eichner R (1993). Infection, immunity and exercise: what to tell patients. Phys. Sports med.; 21:125.

King OS( 2009). Infectious disease and boxing. Clin. Sports Med.; 28:545-60.

Hosey RG, Rodenberg RE (2007). Infectious disease and the college athlete. Clin. Sports Med.; 26:451.

Putukian M, O'Connor FG, Stricker PR, et al. (2008). Mononucleosis and athletic participation: an evidence-based review. Clin. J. Sports Med.; 18(4):309-15.

C Ondolo, S Aversa, FM Passali, C Ciacco,C Gulotta, M Lauriello,and S Conticello.( 2009). Nasal and lung function in competitive swimmers. Acta Otorhinolaryngo Ital.; 29(3): 137–143.)

Young CC. (2007). Infectious disease and the extreme sport athlete. Clin. Sport Med.; 26:473-87.)

Kim AS. (2009). Clinical evidence handbook: sinusitis (acute), Am. Fam. Phys.; 79(4):320-1.).

Thijs M.H. Eijsvogels , Silvana Molossi MD,, Duck-chul Lee , Michael S. Emer, Paul D. Thompson MD. ( 2016). Exercise at the Extremes: The Amount of Exercise to Reduce Cardiovascular Events. Journal of the American College of Cardiology Volume 67, Issue 3, 26, Pages 316-329.

Storms WW. ( 2003). Review of exercise-induced asthma. Med Sci Sports Exerc.; 35(9):1464-70.

Anderson A, Daviskas E. (2000) The mechanism of exercise-induced asthma is... J Allergy Clin Immunol.;106(3):453-9.

Price J( 2001).Choices of therapy for exercise-induced asthma in children. Allergy; 66:12-7.

Ram F, Robinson SM, Black PN.( 2000).Effects of physical training in asthma: a systematic review. Br J Sports Med.;34: 162-7.

World Health Organization Coronavirus Disease (COVID-19). Available online: https://www.who.int/emergencies/diseases/novel-coronavirus-2019 (accessed on 6 May 2020).

Centers for Disease Control and Prevention Coronavirus Disease 2019 (COVID-19). Available online: https://www.cdc.gov/coronavirus/2019-ncov/index.html (accessed on 6 May 2020).

World Health Organization Key Planning Recommendations for Mass Gatherings in the Context of the Current COVID-19 Outbreak Interim Guidance. Available online: https://www.who.int/csr/resources/publications/swineflu/h1n1_mass_gatherings/en/ (accessed on 6 May 2020).

Government of Canada Coronavirus Disease (COVID-19). Available online: https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19.html (accessed on 6 May 2020).

McCloskey, B.; Zumla, A.; Ippolito, G.; Blumberg, L.; Arbon, P.; Cicero, A.; Endericks, T.; Lim, P.L.; Borodina, M.(2020).Mass gathering events and reducing further global spread of COVID-19: A political and public health dilemma. Lancet, 395, 1096–1099

Parnell, D.; Widdop, P.; Bond, A.; Wilson, R.(2020).COVID-19, networks and sport. Manag. Sport Leis. 2020, 1–7.

Government of Canada COVID-19 (2020). Taking Care of Your Mental and Physical Health during the Pandemic. Available online: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/mental-health.html (accessed on 31 July 2020).

Government of Alberta Help Prevent the Spread of COVID 19. Available online: https://www.alberta.ca/prevent-the-spread.aspx (accessed on 23 July 2020).

Centers for Disease Control and Prevention How to Be Physically Active While Social Distancing DNPAO CDC. Available online: https://www.cdc.gov/physicalactivity/how-to-be-physically-active-while-social-distancing.html (accessed on 23 July 2020).

Hammami, A.; Harrabi, B.; Mohr, M.; Krustrup, P.(2020). Physical activity and coronavirus disease 2019 (COVID-19): Specific recommendations for home-based physical training. Manag. Sport Leis.; 1–6.

Laddu, D.R.; Lavie, C.J.; Phillips, S.A.; Arena, R. (2020). Physical activity for immunity protection: Inoculating populations with healthy living medicine in preparation for the next pandemic. Prog. Cardiovasc. Dis.; 4–6.

Orgilés, M.; Morales, A.; Delveccio, E.; Mazzeschi, C.; Espada, J.(2020). Immediate psychological effects of the COVID-19 quarantine in youth from Italy and Spain. Psy Ar Xiv

Rauschenberg, C.; Schick, A.; Goetzl, C.; Roehr, S.; Riedel-Heller, S.G.; Koppe, G.; Durstewitz, D.; Krumm, S.; Reininghaus, U. Social isolation, mental health and use of digital interventions in youth during the COVID-19 pandemic: A nationally representative survey. PsyArXiv 2020, 1–24.

Liang, L.; Ren, H.; Cao, R.; Hu, Y.; Qin, Z.; Li, C.; Mei, S.(2020). The Effect of COVID-19 on Youth Mental Health. Psychiatry Q .; 91(3): 841–852.

McGuine, T.A.; Biese, K.M.; Petrovska, L.; Hetzel, S.J.; Reardon, C.; Kliethermes, S.; Bell, D.R.; Brooks, A.; Watson, A.M.(2021). Mental Health, Physical Activity, and Quality of Life of US Adolescent Athletes During COVID-19–Related School Closures and Sport Cancellations: A Study of 13 000 Athletes. J. Athl. Train.; 56, 11–19.

Thakur, A. (2020). Mental Healht in High School Students at the Time of COVID-19: A Student’s Pespective. J. Am. Acad. Child Adolesc. Psychiatry , 59; 1309–1310

Arat, G.; Wong, P.W.C. (2017). The relationship between physical activity and mental health among adolescents in six middle-income countries: A cross-sectional study. Child Youth Serv., 38, 180–195.

Doré, I.; O’Loughlin, J.L.; Beauchamp, G.; Martineau, M.; Fournier, L.(2016). Volume and social context of physical activity in association with mental health, anxiety and depression among youth. Prev. Med., 91, 344–350

Lamblin, M.; Murawski, C.; Whittle, S.; Fornito, A.(2017).Social connectedness, mental health and the adolescent brain. Neurosci. Biobehav. Rev., 80, 57–68.

Ahn, S.; Fedewa, A.L(2011).. A meta-analysis of the relationship between children’s physical activity and mental health. J. Pediatr. Psychol ;36, 385–397.

Dale, L.P.; Vanderloo, L.; Moore, S.; Faulkner, G.(2019). Physical activity and depression, anxiety, and self-esteem in children and youth: An umbrella systematic review. Ment. Health Phys. Act., 16, 66–79.

Biddle, S.J.H.; Ciaccioni, S.; Thomas, G.; Vergeer, I.(2019). Physical activity and mental health in children and adolescents: An updated review of reviews and an analysis of causality. Psychol. Sport Exerc. , 42, 146–155.

Montgomery, S.C.; Donnelly, M.; Bhatnagar, P.; Carlin, A.; Kee, F.; Hunter, R.F. Peer (2020). Social network processes and adolescent health behaviors: A systematic review. Prev. Med., 130, 105900.

Bowen Li, Kwok Ng, Xiuhong Tong, Xiao Zhou, Jiangchuan Ye & Jane Jie Yu(2023). hysical activity and mental health in children and youth during COVID-19: a systematic review and meta-analysis Child and Adolescent Psychiatry and Mental Health volume 17, Article number: 92.

Zeyad Tareq Abdulrazzaq (2021). The effect of COVID-19 lockdown on Iraqi wrestlers. J Med Life. 2022 Aug;15(8):963–966.

Toshitaka Yajima and Kirk U. Knowlton(2009).Viral Myocarditis. From the Perspective of the Virus. Circulation.; 119:2615–2624

James McKinney, Kim A. Connelly,Paul Dorian, Anne Fournier, Jack M. Goodman, Nicholas Grubic,Saul Isserow, Nathaniel Moulson,François Philippon, Andrew Pipe, Paul Poirier,Taryn Taylor,Jane Thornton, Mike Wilkinson,and Amer M. Johri, COVID-19–(2021).Myocarditis and Return to Play: Reflections and Recommendations From a Canadian Working Group. Can J Cardiol.; 37(8): 1165–1174.

Robyn E. Bryde, MDa , Leslie T. Cooper Jr, MDa , DeLisa Fairweather , Damian N. Di Florio , Matthew W. Martinez,.(2023). Exercise After Acute Myocarditis When and How to Return to Sports. Cardiol Clin 41;107–115.

Helen Wright ,Malcolm ,Collins Martin Schwellnus .(2009).Gastrointestinal (GIT) symptoms in athletes: INTERNATIONAL SPORTMED JOURNAL 10(3):116-123.

Schwartz PA, Schwellnus MP,Koorts AS.(1995). The incidence and riskfactors of gastrointestinalsymptoms in six endurance sports. Sports Med; 20(1):17-24.

Helen Wright, Malcolm Collins, Martin P Schwellnus .(2009).Gastrointestinal (GIT) symptoms in athletes: A review of risk factors associated with the development of GIT symptoms during exercise.. International Sport Med Journal, Vol. 10 No. 3, pp. 116-123.

Carrie A. Jaworski and Valerie Rygiel, DO (2019). Acute Illness in the Athlete. Clin Sports Med. ; 38(4): 577–595.

Kordi R, Wallace WA.(2004). Blood borne infections in sport: risks of transmission, methods of prevention, and recommendations for hepatitis B vaccination, Br. J. Sports Med.; 38:678-84.

Seizaburo Kashiwagi, ; Jun Hayashi, ; Hideyuki Ikematsu, ; Shudo Nishigori, ; Kiichi Ishihara, ; Masaro Kaji, (1982)..An Outbreak of Hepatitis B in Members of a High School Sumo Wrestling Club. JAMA.;248(2):213-214

Kazuo Tobe, ; Kazuharu Matsuura, ; Toshio Ogura, ; et al .(2000).Horizontal Transmission of Hepatitis B Virus Among Players of an American Football Team. Arch Intern Med.;160(16):2541-2545.

Lung-Yi Mak,,Ian Beasley, and Patrick T. F. Kennedy.(2022).Chronic Viral Hepatitis in Elite Athletes: Approaches to Risk Assessment, Prevention and Management . J Athl Train.; 46(4): 445–450.

Ramin Kordi, ,* Keith Neal, Ali Akbar Pourfathollah, Mohammad Ali Mansournia, and W. Angus Wallace .(2004).Risk of Hepatitis B and C Infections in Tehranian Wrestlers. Br J Sports Med; 38:678–684.

R Kordi, W A Wallace (2004). Blood borne infections in sport: risks of transmission, methods of prevention, and recommendations for hepatitis B vaccination.Tattooing and body piercing are high-risk activities for transmission of blood borne infections. Br J Sports Med.;38(6):678-84.

Göran Friman and Lars Wesslén. (2000). Infections and exercise in high‐performance athletes .Immunol Cell Biol. 2000: 78(5): 510–522.

Santiago Tavares Paes, a , * João Carlos Bouzas Marins, b and Ana Eliza Andreazzi.(2015). Metabolic effects of exercise on childhood obesity: a current view. Rev Paul Pediatr.; 33(1): 122–129.

Plonka M, Toton-Morys A, Adamski P, Suder A, Bielanski W, Dobrzanska MJ. (2011). Association of the physical activity with leptin blood serum level, body mass indices and obesity in schoolgirls. J Phys and Pharm.; 62:647–656.

Laurie A. Bitting, Laurie A. Bitting Cynthia A. Trowbridge, Cynthia A. Trowbridge Lauren E. Costello, Lauren E. Costello .(1996). A Model for a Policy on HIV/AIDS and Athletics. J Athl Train.; 31(4): 356–357.

Maíta Poli de Araujo, Henrique Truffa Kleine , Tathiana Rebizzi Parmigiano , Natalia Tavares Gomes , Graziela Pascom Caparroz , Ismael Dale Cotrim Guerreiro da Silva , Manoel João Batista Castello Girão , Marair Gracio Ferreira Sartori.(2014). Prevalence of sexually transmitted diseases in female athletes in São Paulo, Brazil. einstein.;12(1):31-5

Daniel Lopez , Hollis H King, Janice A Knebl, Victor Kosmopoulos, Deraan Collins, Rita M Patterson.(2011). Effects of comprehensive osteopathic manipulative treatment on balance in elderly patients: a pilot study .J Am Osteopath Assoc ;111(6):373-9.

Matthew Pecci , Douglas Comeau, Veena Chawla . (2009). Skin conditions in the athlete Am J Sports Med. 2009 Feb;37(2):406-18.

Arezou Minooee , Jeff Wang , Geeta K Gupta .(2015).Sports: The Infectious Hazards .Skin Infections in Minnesota High School State Tournament Wrestlers: 1997-2006.Microbiol Spectr ;3(5). 26-56.

Julie Agel, Jack Ransone,,, FACSM,† Randall Dick, Robert Oppliger and Stephen W Marshall.(2007). Fungal Infections From Human and Animal Contact .J Athl Train.J Patient Cent Res Rev,:78-89.

Jacob R. Powell, LAT, Adrian J. Boltz, Hannah J. Robison, Sarah N. Morris, Christy L. Collins,and Avinash Chandran, (2021).Epidemiology of Injuries in National Collegiate Athletic Association Men's Wrestling: 2014–2015 Through 2018–2019,J Athl Train. 2021 Jul; 56(7): 727–733.

Lincoln P Likness .( 2011). Common dermatologic infections in athletes and return-to-play guidelines J Am Osteopath Assoc;111(6):373-9.

Steven M. Zinder, ATC,* Rodney S. W. Basler, Jack Foley, Chris Scarlata, and David B. Vasily, (2010) . National Athletic Trainers' Association Position Statement: Skin Diseases. J Athl Train.; 45(4): 411–428.

National Federation of State High School Associations, Sports Medicine Advisory Committee. Sports Related Skin Infections Position Statement and Guidelines. Indianapolis, IN: National Federation of State High School Associations; April 2010.http://www.nfhs.org/content.aspx?id=3325. Accessed May 15, 2011.

Pickup TL, Adams BB.(2007). Prevalence of tinea pedis in professional and college soccer players versus non-athletes. Clin. J. Sport Med. (2007) ;17(1):52-54.

Robins CM, Elewski BE. (2009).Tinea pedis. Medscape Reference Web site. Updated December 16, 2009. http://emedicine.medscape.com/article/1091684-overview. Accessed May 23, 2011.

William E. McDaniel (1977). Tinea Versicolor . Arch Dermatol. 1977;113(4):519-520.

Sharp JCM. (1994). ABC of sports medicine. Infections in sport. BMJ.;308 (6945): 1702-1796.

Pleacher MD, Dexter WW(2007). Cutaneous fungal and viral infections in athletes. Clin. Sports Med.;26(3):397-411.

Habif TP. (2004). Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 4th ed. St Louis, MO: Mosby

Anderson BJ. (2008). Managing herpes gladiatorum outbreaks in competitive wrestling: the 2007 Minnesota experience. Curr. Sports Med. Rep.;7(6):323-327.

J Mills, L Hauer, A Gottlieb, S Dromgoole, S Spruance(1987). Recurrent herpes labialis in skiers. Clinical observations and effect of sunscreen. Am J Sports Med. 1987 Jan-Feb;15(1):76-8.

Lawrence P. Lai, Jeffrey S. Shilt, John S. Georgy Herpes Zoster in a World Class Triathlete: ( 2015).A Case Report and Evaluation of Training Schedules in Relation to Immune Status. J-STAGE home/International Journal of Sport. 13 (2015)/. Volume 13 PP.111-115.

Andrew R. Peterson, MSPH Emma Nash and B.J. Anderson. (2018). Infectious Disease in Contact. Sports Health 11 (1) : 47-58

George G.A. Pujalte, Lorena M.C. Costa,Adrianna D. Clapp, R. John Presutti and Jason C. Sluzevich.(2023). More Than Skin Deep: Dermatologic Conditions in Athletes .Sports Health.15(1): 74–85.

Brian B Adams.(2001). Which skin infections are transmitted between athletes? West J Med.; 174(5): 352–353.

Brian B Adams .(2008). Skin infections in athletes. Dermatol Nurs . Feb;20(1):39-44.

Lautenbach E, Zaoutis T.(2009). Preventing MRSA infection in the community. LDI Issue Brief.;14(6):1-4.

Gupta K, MacIntyre A, Vanasse G, Dembry LM.(2007). Trends in prescribing β-lactam antibiotics for treatment of community-associated methicillin-resistant Staphylococcus aureus infections . J. Clin. Microbiol.;45(12):3930-3934.

Bowers AL, Huffman GR, Sennett BJ.( 2008). Methicillin-resistant Staphylococcus aureus infections in collegiate football players. Med. Sci. Sports Exerc.;40(8):1362-1367.

Safdar N, Bradley EA.(2008). The risk of infection after nasal colonization with Staphylococcus aureus [review]. Am J Med. 2008;121(4):310-315.

Simor AE, Phillips E, McGeer A, et al.(2007). Randomized controlled trial of chlorhexidine gluconate for washing, intranasal mupirocin, and rifampin and doxycycline versus no treatment for the eradication of methicillin resistant Staphylococcus aureus colonization .Clin. Infect. Dis.;44(2):178-185.

Bode LG, Kluytmans JA, Wertheim HF, et al.(2010). Preventing surgical-sight infections in nasal carriers of Staphylococcus aureus. N. Engl. J. Med.;362(1):9-17.

Loeb M, Main C, Walker-Dilks C, Eady A.(2003). Antimicrobial drugs for treating methicillin-resistant Staphylococcus aureus colonization. Cochrane Database Syst. Rev.;(4):CD003340 .

Rihn JA, Posfay-Barbe K, Harner CD, et al.(2005). Community-acquired methacillin-resistant Staphylococcus aureus outbreak in a local high school football team unsuccessful interventions. Pediatr. Infect. Dis. J.;24(9):841-843.

Cohen PR.(2008). The skin in the gym: a comprehensive review of the cutaneous manifestations of community-acquired methicillin-resistant Staphylococcus aureus infection in athletes. Clin. Dermatol.;26(1):16-26.

Huang-Shen Lin, Pei-Tzu Lin, Yu-Shiun Tsai, Shu-Hui Wang, and Ching-Chi Chi Cochrane .(2021).Database Syst Rev. 2021; 2021(2): CD013099.Interventions for bacterial folliculitis and boils (furuncles and carbuncles).

Steven M. Zinder, Rodney S. W. Basler, Jack Foley,Chris Scarlata, , and David B. Vasily.(2010). National Athletic Trainers' Association Position Statement: Skin Diseases. J Athl Train. 2010 Jul-Aug; 45(4): 411–428.

Emily Welch, Lucia Romani, and Margot J Whitfeld.(2021). Recent advances in understanding and treating scabies. Fac Rev.; 10: 28-40

Emma Nash, and B.J. Anderson.(2019). Infectious Disease in Contact Sports Sports Health.; 11(1): 47–58.

Deborah A. Cohen, Thomas L. McKenzie, Amber Sehgal, Stephanie Williamson, Daniela Golinelli, and Nicole Lurie.(2007). Contribution of Public Parks to Physical Activity.Am J Public Health.; 97(3): 509–514.

American Journal of Biomedicine and Pharmacy

The Impact of Infectious Diseases on Athletes: Diagnosis, Management, and Return-To-Play Guidelines

Authors

Downloads

Main menu

counter

template

IF

Information

American Journal of Biomedicine and Pharmacy

Username
Password
Remember me

American Journal of Biomedicine and Pharmacy

The Impact of Infectious Diseases on Athletes: Diagnosis, Management, and Return-To-Play Guidelines

Authors

Downloads

Main menu

login

counter

template

IF

Information