Scrum kidney: epidemic pyoderma caused by a nephritogenic Streptococcus pyogenes in a rugby team

Searching for Strep A in the clinical environment during a human challenge trial: a sub-study protocol

Streptococcus pyogenes (also known as group A Streptococcus , Strep A) is an obligate human pathogen with significant global morbidity and mortality. Transmission is believed to occur primarily between individuals via respiratory droplets, but knowledge about other potential sources of transmission via aerosols or the environment is limited. Such knowledge is required to design optimal interventions to control transmission, particularly in endemic settings. We aim to detail an experimental methodology to assess the transmission potential of Strep A in a clinical environment. We will examine potential sources of transmission in up to 20 participants recruited to the Controlled human infection for penicillin against Streptococcus pyogenes (CHIPS) Trial. Three approaches to understanding transmission will be used: the use of selective agar settle plates to capture possible droplet or airborne spread of Strep A; measurement of the possible distance of Strep A droplet spread during conversation; and environmental swabbing of personal and common high-touch items to detect the presence of Strep A on hard and soft surfaces. All methods are designed to allow for an assessment of transmission potential by symptomatic, asymptomatic and non-cases. Ethical approval has been obtained through Bellberry Human Research Ethics Committee (approval 2021-03-295). Trial registration number: ACTRN12621000751875. Any results elicited from these experiments will be of benefit to the scientific literature in improving our knowledge of opportunities to prevent Strep A transmission as a direct component of the primordial prevention of rheumatic fever. Findings will be reported at local, national and international conferences and in peer-reviewed journals.

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.

Fabric-skin models to assess infection transfer for impetigo contagiosa in a kindergarten scenario

Children in community bodies like kindergartens are predisposed to suffer from impetigo. To consider important measures for infection prevention, direct and indirect transmission routes of pathogens must be revealed. Therefore, we studied the role of skin and fabrics in the spread of the impetigo pathogen Staphylococcus aureus and the strain Streptococcus equi (surrogate to Streptococcus pyogenes) in order to assess infection transfer in realistic scenarios. The transmission of test strains was studied with standardized fabric-skin models using a technical artificial skin and fabrics of different fiber types commonly occurring in German kindergartens. In synthetic pus, both test strains persisted on artificial skin and fabrics for at least 4 h. Friction enhanced transfer, depending on the fiber type or fabric construction. In a skin-to-skin setup, the total transfer was higher than via fabrics and no decrease in the transmission rates from donor to recipients could be observed after successive direct skin contacts. Children in kindergartens may be at risk of transmission for impetigo pathogens, especially via direct skin contact, but also by the joint use of fabrics, like towels or handicraft materials. Fabric-skin models used in this study enable further insight into the transmission factors for skin infections on the basis of a practical approach.

Infectious disease outbreaks in competitive sports: a review of the literature

Recent outbreaks of infectious diseases in athletes in competitive sports have stimulated considerable interest. The environments in which these athletes compete, practice, receive therapy for injuries, and travel, both domestically and internationally, provide varied opportunities for the transmission of infectious organisms. The purpose of this medical literature review is to identify the agents most commonly reported in the medical literature as responsible for infectious disease outbreaks in specific sports and their modes of transmission and to guide targeted prevention efforts. A literature review of English-language articles in medical publications that reported outbreaks of infectious diseases in competitive athletes was conducted in PubMed MEDLINE from 1966 through May 2005. Outbreaks that were solely food borne were excluded. Fifty-nine reports of infectious disease outbreaks in competitive sports were identified in the published medical literature. Herpes simplex virus infections appear to be common among wrestlers and rugby players, with no single strain responsible for the outbreaks. Methicillin-resistant Staphylococcus aureus was responsible for several recent outbreaks of soft tissue and skin infections among collegiate and professional athletes. The most common mode of transmission in outbreaks was direct, person-to-person (primarily skin-to-skin) contact. Blood-borne exposure was implicated in 2 confirmed outbreaks of hepatitis. Airborne and vector transmissions were rarely reported. This review provides an overview of infectious disease outbreaks thought to be either serious enough or unusual enough to report. Appropriate surveillance of the frequency of infections will allow sports medicine staff to identify outbreaks quickly and take necessary measures to contain further transmission and prevent future outbreaks.

Community-acquired methicillin-resistant staphylococcus aureus: an emerging problem in the athletic population

Participants of contact sports are at risk for outbreaks of skin and soft tissue infection. Causes of reported outbreaks include Staphylococcus aureus, herpes simplex virus, Streptococcus pyogenes, and several fungi. Although once thought of solely as a nosocomial pathogen, methicillin-resistant Staphylococcus aureus has been identified as an emerging problem in the community, particularly in the athletic population. Despite a recent increase in reported outbreaks of community-acquired methicillin-resistant Staphylococcus aureus soft tissue infection in athletic teams, many sports medicine physicians are unfamiliar with the epidemiology of this pathogen. It is spread via person-to-person contact and is harbored within the anterior nares and on the skin of carriers. Outbreaks of community-acquired methicillin-resistant Staphylococcus aureus soft tissue infection are not treated by traditional beta-lactam antibiotics, and they can be difficult to eradicate. Such infections have been associated with significant morbidity, with up to 70% of involved team members requiring hospitalization and intravenous antibiotics. A thorough understanding of community-acquired methicillin-resistant Staphylococcus aureus is essential for the sports medicine physician to properly identify, treat, and control infectious outbreaks.

Infections associated with pediatric sport participation

Infections occur in childhood and adolescent athletes just as they do in all children and adolescents. Because of the sports environment, and in some instances the sport itself, athletes can be prone to infections that will alter their athletic performance or present risks to other athletes. Recognition of the infectious risks related to sports and the options for their treatment or, better yet, prevention, can help young athletes perform to their utmost potential.

Contagious diseases in competitive sport: what are the risks?

Great concern is often expressed over the possibility of contagion among athletes in competitive sports, particularly sports with much person-to-person contact. Human immunodeficiency virus (HIV) is only the most notorious of infectious agents; potentially, other viruses, bacteria, and even fungi may be involved. Because of the concern, however, special attention is paid to HIV and hepatitis B infections. For most of the infections considered, the athlete is more at risk during activities off the playing field than while competing. Inclusion of immunizations against measles and hepatitis B among prematriculation immunization requirements (PIRs) for colleges and universities would eliminate these two diseases from the list of dangers to college athletes and all students. Education, rather than regulations, should remain the cornerstone in considering the risks to athletes from contagious diseases.

A community pseudo-outbreak of invasive Staphylococcus aureus infection

Outbreaks of invasive infection caused by methicillin-susceptible and methicillin-resistant Staphylococcus aureus occur in hospitals, long term care institutions, and in patients discharged from these settings. In contrast, epidemic S. aureus infection has not been reported in well persons in the community. Here, we describe a group of healthy young adults who resided in the same neighborhood and participated together in school sports, and who developed serious S. aureus infections within 3 weeks of each other, suggesting a true community outbreak. Timely use of molecular epidemiological tools, however, demonstrated that their illnesses were caused by unrelated bacterial strains.

Infectious diseases in rugby players: incidence, treatment and prevention

Participation in rugby football can expose individuals to a variety of infectious diseases both on and off the field of play. The close physical contact and trauma inherent in playing rugby facilitates the transmission of viral, bacterial and fungal pathogens between players and may also lead to the acquisition of potentially lethal infections from the environment, such as tetanus. In the past few years there have been a number of reported outbreaks of infection amongst rugby players in the medical literature. The appearance of HIV infection has focused attention on the potential for transmission of this and other blood-borne viruses such as hepatitis B and C viruses from bleeding wounds sustained on the rugby field. As a result, various expert bodies have produced guidelines on the management of players with bleeding wounds. Opportunities are now available to rugby players to play outside their own countries, including the third world. This can bring them into contact with a wide range of travel-associated infections, some of which may be life threatening. In view of the above it is clear that rugby players and those who coach and manage rugby teams require information and education on the subject of infection and its prevention, as well as access to appropriate medical care and expertise. Many of the infections seen in rugby players are preventable, e.g. by promoting hygienic facilities and conduct in changing rooms and on the field of play, by exclusion of infected players from contact with others and, in some cases, by immunisation or chemoprophylaxis. Players who present with infections should be assessed, correctly diagnosed (using laboratory investigations where appropriate) and treated, and measures should be taken to prevent spread to team-mates and other contacts while respecting the confidentiality of the individual. Any outbreaks of infection should be reported to the appropriate authorities. There is evidence to suggest that strenuous physical exercise such as playing rugby can make individuals susceptible to certain types of infection and prolong time to recovery. More information is required on the true frequency and effects of infection in rugby players.

An outbreak of methicillin resistant Staphylococcus aureus infection in a rugby football team

Outbreaks of infection caused by methicillin resistant Staphylococcus aureus are common in hospitals and nursing homes, but until now none have been reported in the community. This is a report of an outbreak involving five members of a rugby football team.

Infection in athletes

Coaches and athletic team physicians have provided anecdotal information and case studies to support their beliefs that athletes may be unusually prone to illness during strenuous training or competition. Many athletes, in contrast, believe that physical activity improves their resistance to infectious disease. However, it is generally agreed that the stress of competition may make athletes temporarily more susceptible to infectious illness. A review of the literature shows that upper respiratory tract infections and skin infections are more prevalent in top level athletes than in the general population, particularly during periods of intensive training. Exercise induced changes occur in both the innate and adaptive components of the immune system; however, the relative importance of each component is unknown. Strenuous exertion and contact sports may compromise host defence both by reducing physical protection and by impairing immunosurveillance. Skin lacerations, vigorous sweating and maceration of the dermis impair the defence normally provided by the skin surface. In addition, adverse changes in soluble and cellular components of the immune system can increase susceptibility to infection. Persistence with strenuous training during an infectious illness can have deleterious effects; not only is athletic performance impaired, but the severity of the disease process can be augmented.

Sports injuries

Broad epidemiological information about sporting injuries is lacking, but several studies have examined the spectrum of injuries seen in referral clinics and in particular sporting activities. Attempts have been made to define some of the conditions which increase susceptibility to injury. Other studies have examined the frequency and causes of specific injuries. The increasing popularity of physical exercise and sports participation has almost certainly been followed by an increase of athletic injuries, especially overuse syndromes. The impact of this demand on hospital services has been mitigated in Britain by the growth of private clinics. Nevertheless, back pain and knee disorders caused by sport account for a substantial percentage of hospital rheumatology and orthopaedic referrals. The disabling consequences of some common disorders and the sequelae of serious injury are discussed in relation to society's attitude to body contact sports and the implications for health and social security resources. Evidence that children are especially vulnerable to sporting injuries is not compelling. Long-term adverse effects of childhood athleticism have not been confirmed. Sporting authorities have a duty to lesson the risks of serious injury but cannot do so effectively without allowing proper research. The growth of sports medicine and its professional organization provide opportunities for the instruction of sports-people and their officials. Hospital involvement is important for the academic impetus it may provide. With the exception of knees that have undergone meniscectomy, osteoarthritis is not a well-documented outcome of sporting activity. Evidence that several risk factors for coronary artery disease are reduced by exercise is a major health advantage. Increased bone mass is another benefit, although in females who develop hypogonadism in response to strenuous exercise, osteopenia may follow. The benefits of exercise appear to outweigh the hazards.