INFECTIONS AND RELATED DISORDERS IN SKELETAL MUSCLE, HEART MUSCLE, CONNECTIVE TISSUES, TENDONS AND LIGAMENTS IN ATHLETES

Abstract

Elite athletics requires maximum effort by the pursuer, exposing the tendons, ligaments and muscles, including the heart muscle, to intense and frequent mechanical and metabolic demands, which may increase the susceptibility to, and severity of, infections in these tissues. Furthermore, intense and frequent exercise with insufficient resting periods can compromise the immune system. Muscles and tendons are more vulnerable to overuse injuries in the recovery period following various infections. Although the etiology and pathogenesis of a substantial proportion of cases of tendinitis and tendinosis are still largely unknown, gram-positive cocci prevail as the most common etiologies in soft tissue infections. The recent identification of binding sites of staphylococci to intercellular tissue matrix components have opened up the possibility of selectively blocking such binding by prior vaccination. New molecular biological methods, enabling the identification of slow-growing bacteria that are difficult to culture, including Bartonella and Rickettsia, have created the possibility of studying the potential role also of such organisms in soft tissue conditions, including myocarditis. Acute myocarditis remains the most frequent form of myocarditis, commonly emerging in the course of an acute respiratory infection. Since myocarditis episodes are frequently subclinical and self-healing, athletes (and others) should generally be recommended rest during infections, especially during the early phase of the infection.