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Incidence, Etiology, and Symptomatology of Upper Respiratory Illness in Elite Athletes

SPENCE, LUKE1; BROWN, WENDY J.1; PYNE, DAVID B.2; NISSEN, MICHAEL D.3-6; SLOOTS, THEO P.3-6; MCCORMACK, JOSEPH G.7; LOCKE, A. SIMON1,8,9; FRICKER, PETER A.2

Medicine & Science in Sports & Exercise: April 2007 - Volume 39 - Issue 4 - pp 577-586
doi: 10.1249/mss.0b013e31802e851a
CLINICAL SCIENCES: Clinical Investigations

Purpose: Upper respiratory illness (URI) is the most common medical condition affecting elite athletes. The aims of this study were to identify and evaluate the incidence, pathogenic etiology, and symptomatology of acute URI during a 5-month training and competition period.

Methods: Thirty-two elite and 31 recreationally competitive triathletes and cyclists, and 20 sedentary controls (age range 18.0-34.1 yr) participated in a prospective surveillance study. Nasopharyngeal and throat swabs were collected from subjects presenting with two or more defined upper respiratory symptoms. Swabs were analyzed using microscopy, culture, and PCR testing for typical and atypical respiratory pathogens. The Wisconsin Upper Respiratory Symptom Survey (WURSS-44) was used to assess symptomatology and functional impairment.

Results: Thirty-seven URI episodes were reported in 28 subjects. Incidence rate ratios for illness were higher in both the control subjects (1.93, 95% CI: 0.72-5.18) and elite athletes (4.50, 1.91-10.59) than in the recreationally competitive athletes. Infectious agents were identified in only 11 (two control, three recreationally competitive, and six elite) out of 37 illness episodes. Rhinovirus was the most common respiratory pathogen isolated. Symptom and functional impairment severity scores were higher in subjects with an infectious pathogen episode, particularly on illness days 3-4.

Conclusion: The results confirm a higher rate of URI among elite athletes than recreationally competitive athletes during this training and competition season. However, because pathogens were isolated in fewer than 30% of URI cases, further study is required to uncover the causes of unidentified but symptomatic URI in athletes. Despite the common perception that all URI are infections, physicians should consider both infectious and noninfectious causes when athletes present with symptoms.

1School of Human Movement Studies, The University of Queensland, Brisbane, AUSTRALIA; 2Sports Science and Sports Medicine, Australian Institute of Sport, Canberra, AUSTRALIA; 3Queensland Paediatric Infectious Diseases Laboratory, Sir Albert Sakzewski Virus Research Centre, Royal Children's Hospital, Brisbane, AUSTRALIA; 4Clinical and Medical Virology Centre, The University of Queensland, Brisbane, AUSTRALIA; 5Division of Microbiology, Queensland Health Pathology Service, Royal Brisbane Hospitals Campus, Brisbane, AUSTRALIA; 6Department of Paediatrics and Child Health, Royal Children's Hospitals, Brisbane, AUSTRALIA; 7Department of Medicine and Infectious Diseases, The University of Queensland and Mater Hospital Health Services, Brisbane, AUSTRALIA; 8Queensland Academy of Sport, Brisbane, AUSTRALIA; and 9Sunnybank Sports Medicine Clinic, Brisbane, AUSTRALIA

Address for correspondence: Luke Spence, Ph.D., School of Human Movement Studies, The University of Queensland, Brisbane 4072, Australia; E-mail: Lspence@hms.uq.edu.au.

Submitted for publication August 2006.

Accepted for publication November 2006.

©2007The American College of Sports Medicine