title: Clinical investigation of athletes with persistent fatigue and/or recurrent infections.
abstract: OBJECTIVE
  To investigate whether underlying medical conditions contribute to the fatigue and high incidence of infections that can occur during repeated intense training.
  
  
  METHODS
  Forty one competitive athletes (22 male, 19 female) with persistent fatigue and/or recurrent infections associated with performance decrements had a thorough medical examination and a series of clinical investigations to identify potential medical causes.
  
  
  RESULTS
  Conditions with the potential to cause fatigue and/or recurrent infections were identified in 68% of the athletes. The most common were partial humoral immune deficiency (28%) and unresolved viral infections (27%). Non-fasting hypoglycaemia was common (28%). Other conditions included allergic disease (15%), new or poorly controlled asthma (13%), upper airway dysfunction (5%), sleep disorders (15%), iron depletion (3%), and one case of a thyroid disorder. A positive antinuclear antibody was detected in 21% of the athletes, without any clinical evidence of autoimmune disorders. Evidence of Epstein-Barr virus reactivation was detected in 22% of the athletes tested.
  
  
  CONCLUSIONS
  Athletes with recurrent infections, fatigue, and associated poor performance may benefit from a thorough investigation of potentially reversible underlying medical conditions, especially when these conditions cause disruption to training and competition. Unresolved viral infections are not routinely assessed in elite athletes, but it may be worth considering in those experiencing fatigue and performing poorly.
authors.affiliation: Hunter Area Pathology Service, John Hunter Hospital, New Lambton, NSW, Australia.
authors.forename: V L
authors.initials: VL
authors.lastname: Reid
authors.forename: M
authors.initials: M
authors.lastname: Gleeson
authors.forename: N
authors.initials: N
authors.lastname: Williams
authors.forename: R L
authors.initials: RL
authors.lastname: Clancy
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002908:Chronic Disease; D004198:Disease Susceptibility; D005221:Fatigue / Q000209:etiology* / Q000276:immunology; D005260:Female; D006801:Humans; D007136:Immunoglobulins / Q000097:blood; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012141:Respiratory Tract Infections / Q000209:etiology* / Q000276:immunology; D012307:Risk Factors; D013177:Sports / Q000502:physiology*; D014777:Virus Diseases / Q000150:complications / Q000175:diagnosis
chemical_list: D007136:Immunoglobulins