Persistent fatigue and recurrent infections
Athletes with recurrent infections, persistent fatigue and associated poor performance should be investigated for potentially reversible underlying medical conditions, according to a new Australian study.
Chronic fatigue and infections are often put down to heavy training loads and excessive competition. But the researchers in this study identified treatable underlying medical conditions in more than two-thirds of the ‘run-down’ athletes they investigated.
Forty-one competitive athletes – 22 male, 19 female – complaining of persistent fatigue and/or recurrent infections had a thorough medical examination and a series of clinical investigations to identify the causes. More than a third of the athletes (15) were swimmers, seven were runners, six ironman competitors and three rugby league players, all competing at regional level or above. Thirty complained of fatigue and 22 of recurrent infections, mostly of the upper respiratory tract.
Evidence of at least one organic condition with the potential to cause fatigue and/or recurrent infections was identified in 28 (68%) of the subjects, with some showing evidence of more than one condition. There was no identifiable cause for fatigue/infections in the remaining 13 athletes (32%).
The most commonly identified conditions were as follows:
- Partial immune deficiency (11 cases). Of these, the most common finding was IgG3 deficiency, which is associated with susceptibility to viral upper respiratory tract infections (URTIs);
- Primary or unresolved viral infections (11 cases);
- Hypoglycaemia (10 cases). This was an unexpected finding as the athletes were non-fasting and generally well-informed about the need to replenish glucose stores after intense exercise. Hypoglycaemia is known to have detrimental effects on the immune system and has the potential to contribute to fatigue. The researchers point out that counselling athletes on the use of carbohydrates during recovery after exercise has the potential to correct this problem;
- Epstein-Barr virus reactivation (8 cases).
Other conditions identified included allergic disease (6), sleep disorder (6), poorly controlled or undiagnosed asthma (3) and newly-diagnosed exercise-induced asthma (3).
‘The most important outcome of this study was that all identified conditions were treatable,’ the researchers point out.
They conclude: ‘The results of this study indicate that medical conditions, in particular unresolved viral infections and parameters of immune suppression, may cause or contribute to fatigue and recurrent infections and subsequent poor performance in competitive athletes.
‘As the conditions are multifactorial, a thorough medical examination and appropriate investigations are paramount in the initial assessment of an athlete presenting with these persisting complaints.’
Br J Sports Med 2004;38:42-45
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