Acute infection: metabolic responses, effects on performance, interaction with exercise, and myocarditis.

Acute infections are associated with multiple host responses that are triggered by cytokines and correlated to fever, malaise and anorexia. The purpose of this systemic acute phase host reaction ("the acute phase response") is to mobilize nutrients for the increased needs of the activated immune system, as well as for energy production and tissue repair. Important effects include wasting of striated muscle, degradation of performance-related metabolic enzymes and, concomitantly, deteriorated central circulatory function. These effects result in decreased muscle and aerobic performance, the full recovery of which may require several weeks to months following week-long febrile infections. Also during early infection and fever, prior to the development of muscle wasting, performance is compromised by other mechanisms. Strenuous exercise may be hazardous during ongoing infection and fever and should always be avoided. In infection, muscle wasting seems to be less pronounced in the conditioned (trained) host than in the unconditioned host. Acute myocarditis most often has a viral etiology but bacteria and their toxins may also be the cause. Furthermore, slow-growing bacteria, previously difficult to diagnose, have emerged as potential "new" causes of subacute to chronic myocarditis. Since myocarditis may or may not be associated with fever, malaise, or catarrhal symptoms, athletes should be taught the symptoms suggestive of myocarditis. Whenever myocarditis is suspected exercise should be avoided.