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Guillermo Varela to miss German Cup final with infected tattoo and furious Frankfurt end his loan. The Manchester United loanee’s infected arm artwork has spelled the premature end of his time at the Bundesliga club. Varela was instructed not to get the tattoo by Eintracht Frankfurt’s club doctor ahead of the club’s DFB-Pokal showdown against Borussia Dortmund on Saturday, but the 24-year-old decided to get it anyway., 24 May 2017

Athletes are subject to the same infections as the rest of the community; however, certain circumstances in sport may increase their susceptibility to infections. Athletes involved in team sports have close contact with teammates, which increases the likelihood of spread of infection. In addition, team members often share food and drink, particularly with the increased use of squeeze bottles during exercise.

In this chapter we:

  • review the relationships between exercise/activity and infections

  • discuss whether athletes should exercise or train when suffering an infection

  • discuss management of a range of specific infections in athletes according to the region of presentation—skin, respiratory, gastrointestinal and liver etc.

  • outline national infection prevention strategy guidelines.


There is considerable debate regarding the relationship between exercise and infection. It is important, first, to consider the relationship between exercise and the immune system and then examine whether there is an increased incidence of infection associated with intense exercise. Finally, we discuss when an athlete can train and play with an infection.

Exercise and the immune system

The immune system can be considered as two complementary parts.1 First is the innate immune system, which is non-specific regarding host defence. Its components include the skin, mucous membranes, phagocytes, natural killer (NK) cells, cytokines and complement factors. The latter two elements control and mediate immune function and help activate T- and B-lymphocytes, key parts of the acquired immune system. In contrast to the innate system, the acquired system protects the body against specific infectious agents during both initial and subsequent attacks.1

The body’s first line of defence consists of skin and mucous membranes, which can be impaired by temperature, wind, sun, humidity and trauma. Many upper respiratory pathogens are airborne and affected by airflow patterns, mechanical barriers and ciliary action in the respiratory tract.1

During exercise, the athlete switches from nasal to mouth breathing, and this can increase deposition of harmful particles in the lower respiratory tract. It also causes an increase in cooling and drying of the respiratory mucosa, which slows ciliary movement and increases mucous viscosity.2

Natural killer cells express spontaneous cytolytic activity against cells infected with viruses.1 NK cell counts increase 150–300% immediately after high-intensity exercise lasting less than 1 hour. Within 30 minutes of the end of such high-intensity exercise, however, NK cell ...

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